The use of social media in nutrition interventions for adolescents and young adults-A systematic review

Undergraduates' knowledge, attitudes, and behaviours associated with fad diets

PURPOSE

We aimed to determine undergraduate students' use and knowledge of fad diets as well as examine how appealing students found these diets given the goal of rapid weight loss and/or improved health. Twenty-three students from a Midwestern university (mean age = 19.2, mean BMI = 27.35, 69.6% female) were recruited through new student orientations for this qualitative study. Approximately 52% of participants identified as White, 30% as Black, 13% as Asian, and 4% as multi-racial.

METHODS

Knowledge and opinions about fad diets were collected via focus groups and individual interviews. Coding of transcripts was conducted by hand using the constant comparative method and data were analysed based on grounded theory.

RESULTS

Two primary themes emerged: very negative views of fad diets and the importance of healthy eating. Although few participants had tried fad diets, they thought these diets: 1) did not lead to sustained weight loss, 2) were associated with disappointment and health issues, and 3) were money-making schemes delivered heavily through social media. Participants also valued healthy eating.

CONCLUSION

Experimental studies are needed to examine how healthy eating among university students can be supported through credible sources, accurate information, and established connections via innovative social media platforms.

Hungry for nutrition information: Undergraduate students' engagement with nutrition social media nutrition content

Background: Social media is a fast-changing, normalized way through which youth access health and nutrition information. Yet, social media content that lacks expertise or altruistic motives can negatively impact this vulnerable population through mis- or disinformation. Aim: The aims of this study were to 1) assess how adolescents and young adults engage with nutrition information across social media platforms and account types, and 2) describe their preferences for nutrition social media content. Methods: We conducted an exploratory mixed methods study with 57 undergraduate students enrolled in an introductory public health nutrition course. First, we calculated descriptive statistics on close-ended survey data on social media use and sociodemographic variables. Then, we performed thematic analysis on open-ended survey data regarding social media use, preferences, and experiences. Results: The median age of participants was 20 years old; 70% of participants identified as female and 11% identified as male. We found that TikTok and Instagram were highly preferred by participants for weight loss, wellness, diet promotion, and sports and fitness topics. In general, participants reported wanting personalized content that conveys positive nutrition messages that are supported by credible expertise. Conclusion: These findings suggest that the nutrition community can engage adolescents and young adults by presenting information as image- and video-based content on social media. Social media content related to weight loss, wellness, diet promotion, and sports and fitness topics should establish credibility using visible markers and embrace body positive messaging for maximum uptake.

Understanding obesity among young adults in India: A focus group study

INTRODUCTION

The study aims to understand the knowledge and awareness about risk factors and consequences of obesity, barriers and motivators to weight loss, and potential solutions for weight management among young adults (YAs) in India.

METHOD

Six focus group discussions were conducted with an inductive approach among obese YAs (18-30 years) recruited through snowball and purposive sampling. The principle of maximum diversity was used to build a pool of varied and extensive information regarding obesity in YAs. The discussions were audio-recorded and transcribed verbatim using NVivo 1.0 by QSR International to generate codes, subthemes, and themes from the discussions.

RESULT

Among the thirty recruited YAs (mean age 24.7 ± 2.84 years), nearly half were from a high-income group (56.6 %) and had postgraduate education (53.3 %). Key themes included the need for increased awareness about obesity risk factors and consequences across different societal levels. Physical appearance was the primary motivator for weight loss, followed by physical endurance and social support. Major barriers included lack of energy, time, motivation, lifestyle changes, easy access to unhealthy foods, work commitments, and workplace culture. A holistic approach involving dietary changes, physical activity, and educational and policy reforms was suggested as potential solutions.

CONCLUSION

The challenges faced by YAs in developing countries regarding different aspects of the development and management of obesity are unique and different from the other population groups. Individualized weight management modules may be useful for managing obesity in this group.

Nigerian adolescents' exposure to fast food marketing via Instagram

OBJECTIVES

To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement.

DESIGN

A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received.

RESULTS

The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, 'teen language' and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content.

CONCLUSION

Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents' exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements.

Familiarity with the internet and health apps, and specific topic needs are amongst the factors that influence how online health information is used for health decisions amongst adolescents

BACKGROUND

Many adolescents believe that online health information is reliable, particularly when they are familiar with the source of information.

OBJECTIVE

To analyse the degree of influence of online health information on high school students' health decisions and examine whether socio-demographic characteristics, digital literacy, use of different websites and interest in specific health topics are associated with a stronger influence of online health information on adolescents' health-related decisions.

METHODS

Participants were students from four public high schools in Belgrade, Serbia. Socio-demographic and behavioural questionnaire as well as the e-health literacy scale (eHEALS) were used to collect data.

RESULTS

The study sample comprised 702 students. A total of 79.6% of students reported that online health information influenced their health decisions to a certain extent (from 'a little' to 'a lot'). Being a boy, using the internet since younger age, better self-perceived e-health literacy, using health apps, Google, health forums, websites of health institutions, social media and YouTube, being interested in diet/nutrition, sexually transmitted infections and cigarettes were the characteristics associated with a stronger influence of online health information on students' health decisions.

CONCLUSION

This study provides clues about how online health-related information can be used to adjust and enhance health promotion amongst adolescents.

Behavioural determinants of healthy and environmentally friendly diets in French university students

Although encouraging the shift toward sustainable diets in young adults is a major challenge to preserve population and planet health, the precursors of sustainable diets in this population remain unknown. This study aimed to identify the behavioural determinants of healthier and more environmentally friendly diets among university students. A sample of 582 French university students reported their food consumption using an online 125-item food frequency questionnaire. The nutritional quality (adherence to French recommendations, sPNNS-GS2) and the greenhouse gas emissions (GHGE) of students' diets were calculated for an isocaloric diet. Behavioural determinants were measured based on a literature review and classified into the Capability, Opportunity, Motivation Behaviour (COM-B) framework. Linear models, adjusted for socioeconomic characteristics, were run to identify the most prominent behavioural predictors of nutritional quality and GHGE of students' diets. Higher cooking skills (β = 0.38, p = 0.01) and health motives (β = 0.91, p < 0.001) were associated with higher nutritional quality. Greater environmental knowledge was linked to lower GHGE (β = -0.07, p = 0.002), while health and weight control motives were associated with higher GHGE (β = 0.26, p = 0.02 and β = 0.39, p < 0.001). Enhancing cooking skills and environmental knowledge could enable healthy and environmentally friendly diets, but health-based motives can act as a lever and as a barrier.

Using Digital Storytelling and Social Media to Combat COVID-19 Vaccine Hesitancy: A Public Service Social Marketing Campaign

Disparities in vaccine confidence and uptake among racial and ethnic minorities have resulted in a disproportionate burden of COVID-19 in these populations. Social media campaigns have shown promise in public health promotion and behavioral interventions. In January 2022, an academic-community partnership launched #Vax4Community, a 6-month social media campaign centered around the use of digital storytelling videos. The campaign purpose was to decrease vaccine hesitancy, combat vaccine misinformation and disinformation, and increase vaccine confidence within three distinct target communities: the justice-involved population, South Asian residents, and public housing youth in the metropolitan area of New York City (NYC). Our approach included the production and dissemination of digital storytelling videos featuring personal vaccine experiences from target populations. We evaluated key performance indicators (KPIs) of the campaign, including post impressions, reach and engagement across social media platforms, and shares from partner organizations. Overall, we received 1,910,662 post impressions, 699,722 unique users reached, and 2,880 post engagements across Instagram, Facebook, LinkedIn, and Twitter, and 147 shares from 48 partner organizations. Social media campaigns require strategic design in branding, messaging and outreach channels and could serve as an important tool to disseminate emotionally relatable content and trusted information to prime target populations to respond more optimally to public health interventions. The purpose of this paper is to describe the process of creating and disseminating these digital stories and the KPIs of the social media campaign.

Anorexia and Bulimia Nervosa in Spanish Middle-Aged Adults: Links to Sociodemographic Factors, Diet, and Lifestyle

AIM

This study examines the prevalence of eating disorders, particularly anorexia and bulimia nervosa, among middle-aged Spaniards, noting their rising incidence in men as well as women. It explores how these disorders relate to sociodemographic factors and lifestyle habits.

METHODS

A cross-sectional survey was conducted from August 2020 to November 2021 via online platforms. Participants were Spanish nationals aged 31-50 years residing in Spain.

RESULTS

Out of 9913 respondents, 96.66% reported no diagnosed eating disorders, while 3.34% reported one or more (0.36% anorexia nervosa; 0.53% bulimia nervosa; 1.97% other eating disorders; 0.48% multiple disorders). Concerns about body image and lack of control over food intake were reported by 50% and 28%, respectively, suggesting potential undiagnosed disorders. Significant BMI differences were noted between healthy individuals and those with anorexia or bulimia.

CONCLUSIONS

Anorexia and bulimia affect both adolescents and middle-aged individuals, challenging existing stereotypes. The high prevalence of undiagnosed eating disorder behaviors highlights the need for early detection. To address these issues in Spain, targeted awareness programs are essential to reduce stigma and improve service access through clinical, social, and political collaboration.

Youth participation in substance use prevention: A national profile, 2011-2019

PURPOSE

Prevention efforts are critical to avoid the negative consequences of substance use in adolescents. This study aimed to examine national trends and sociodemographic differences in adolescents' participation in school-based substance use prevention (SUP) education, community-based SUP programs, as well as family conversations about substance use.

METHODS

Publicly available data for adolescents aged 12-17 from the annual cross-sectional surveys of the National Survey on Drug Use and Health 2011-2019 were analyzed.

RESULTS

Across the survey years, up to 74.9%, 12.2%, and 58.1% of adolescents reported having participated in school-based SUP education, community-based SUP programs, and family conversations about the danger of substance use in the past-year, respectively. From 2011 to 2019, statistically significant decreases were observed in adolescents' participation in school-based SUP education (OR = 0.97, 95% CI: 0.96, 0.98, p < 0.001) and community-based SUP programs (OR = 0.98, 95% CI: 0.97, 0.99, p < 0.001). Meanwhile, no significant changes were observed in adolescents' participation in family conversations about the dangers of substance use. Overall, lower levels of participation in school-based and community-based SUP programs were found in adolescents aged 16-17. Adolescents living in rural areas showed lower levels of participation in school-based SUP programs and family conversations about SUP. Racial/ethnic minority adolescents overall were less likely to participate in conversations with parents about SUP than Whites.

CONCLUSIONS

Further development and implementation of developmentally appropriate, gender-specific, culturally sensitive, and contextually informed SUP programs at school, community, and family levels are needed.

Delivery platforms for reaching adolescents with nutrition interventions in low- and middle-income countries

Adolescents in low- and middle-income countries (LMICs) are a vulnerable population given increased nutritional needs as puberty approaches. School-based nutrition programs exist in some settings, but the comprehensive provision of nutrition services requires knowledge of the mechanisms to reach out-of-school adolescents. A comprehensive scoping review was performed using formal and informal search strategies to landscape all potential delivery platforms with nutrition services to reach adolescents. Peer-reviewed studies, institutional strategies, program evaluations, and programmatic reports in LMICs were reviewed, including gray literature. A total of 87 out of 270 identified publications and reports describing nutrition programs for adolescents were identified. Although nutrition programs targeted at adolescents were sparse, various innovative and inclusive delivery platforms were included, such as school feeding programs, school-based anemia control, and nutrition-friendly school initiatives; health facility-based, youth-friendly health and nutrition services; social safety nets targeted at adolescents; community-based approaches targeting youth development and peer education within youth centers and faith-based settings; and technology-based platforms, including digital health services and mass media communication sensitization and mobilization efforts. Existing delivery mechanisms and platforms in health and other sectors that target adolescents offer great potential to extend nutrition interventions to this vulnerable yet hard-to-reach population.

A Social Media Content Analysis of Dental Health Information Involving the Use of Miswak (Salvadora persica) Chewing Stick on YouTube™

Background The widespread availability of Internet access and the rising popularity of social media platforms have facilitated the dissemination of health-related information, including dental health practices. However, assessing the quality and effectiveness of such information remains a challenge, particularly concerning traditional practices such as Miswak (Salvadora persica) usage. This study aims to assess the description, use, and effectiveness of the Miswak (Salvadora persica) chewing stick posted as video clips on YouTube™ and provide considerations for future interventions. Methodology YouTube videos were searched using the terms "Miswak," "Siwak," "Salvadora persica," and "Chewing stick." Each video's descriptive features, i.e., title, links, country of origin, upload date, running time, views, comments, likes, and dislikes, were recorded. Content quality was assessed using the DISCERN tool, which rates the reliability, dependability, and trustworthiness of online sources across 16 items. Scores were aggregated for analysis. The statistical analysis examined video features and associations between the speaker, video type, source, and quality, with significance set at a p-value <0.05 using SPSS Statistics Version 20 (IBM Corp., Armonk, NY, USA). Results A total of 45 videos were included in the study, with the majority (62%) created by the "other professionals" category. Almost three-quarters (73.3%) of the videos were educational. The quality of the video clips was correlated with the speaker source and category of "other," revealing that high-quality information was considered such when the source was other than a dentist. Further, we found that a video's source did not elicit differences in the opinion of the video's quality. Conclusions This social media analysis provides considerations and implications for future research on the potential use of YouTube as a platform for Miswak educational interventions.

Differences in the Values and Related Factors of Eating a Balanced Meal among the Younger Generation in Japan

This study examined young Japanese adults' values regarding the consumption of balanced meals consisting of staples, main dishes, and side dishes and how these values relate to demographics, socioeconomic status, nutrition knowledge, attitudes, skills, behaviors, and diet-related quality of life. Data were obtained from the "Survey on Dietary Habits of the Younger Generation" (2000 responses, ages 18-39), of which 1888 valid responses were analyzed. The principal component analysis identified three value patterns: PC1-valuable yet burdensome; PC2-environment-reliant, weak initiative; and PC3-low value due to hassle. Both PC1 and PC3 were associated with prioritizing prices in food choices and knowledge of a balanced meal. However, PC1 participants valued balanced meals and possessed meal preparation skills, whereas PC3 participants valued balanced meals less and had negative attitudes toward eating them. PC1 was positively associated with the frequency of eating balanced meals while PC3 was negatively associated. PC2 individuals had positive attitudes toward eating balanced meals but were less concerned about nutritional balance when choosing foods themselves. This study highlights the importance of adopting an approach that aligns with the value patterns of the target population.

The use of sentiment and emotion analysis and data science to assess the language of nutrition-, food- and cooking-related content on social media: a systematic scoping review

Social media data are rapidly evolving and accessible, which presents opportunities for research. Data science techniques, such as sentiment or emotion analysis which analyse textual emotion, provide an opportunity to gather insight from social media. This paper describes a systematic scoping review of interdisciplinary evidence to explore how sentiment or emotion analysis methods alongside other data science methods have been used to examine nutrition, food and cooking social media content. A PRISMA search strategy was used to search nine electronic databases in November 2020 and January 2022. Of 7325 studies identified, thirty-six studies were selected from seventeen countries, and content was analysed thematically and summarised in an evidence table. Studies were published between 2014 and 2022 and used data from seven different social media platforms (Twitter, YouTube, Instagram, Reddit, Pinterest, Sina Weibo and mixed platforms). Five themes of research were identified: dietary patterns, cooking and recipes, diet and health, public health and nutrition and food in general. Papers developed a sentiment or emotion analysis tool or used available open-source tools. Accuracy to predict sentiment ranged from 33·33% (open-source engine) to 98·53% (engine developed for the study). The average proportion of sentiment was 38·8% positive, 46·6% neutral and 28·0% negative. Additional data science techniques used included topic modelling and network analysis. Future research requires optimising data extraction processes from social media platforms, the use of interdisciplinary teams to develop suitable and accurate methods for the subject and the use of complementary methods to gather deeper insights into these complex data.

What adolescents see on Instagram: Content analysis of #intermittentfasting, #keto, and #lowcarb

AIM

To describe popular diet content visible on #intermittentfasting, #keto, and #lowcarb on adolescent social media accounts.

METHODS

An adolescent Instagram profile captured 200 'top' images from three popular diet hashtags (#intermittentfasting, #keto, and #lowcarb) across two timepoints. Images were coded using a pre-determined ontology as food (core or discretionary; common foods/food groups), people (group, individual, before/after), or informative. Descriptive statistics were used to summarise these categories across hashtags.

RESULTS

At the time of first data collection, there were 3.8 million #intermittentfasting, 19 million #keto, and 22 million #lowcarb posts on Instagram. At the second timepoint there were 4.3 million #intermittentfasting, 21.5 million #keto, and 24.3 million #lowcarb posts. Images tagged #intermittentfasting were categorised as 44% food, 39% people, 10% information; #keto were 64% food, 28% people, 5% information; and #lowcarb were 69% food, 14% people, 16% information. Food images mostly depicted animal proteins (58.6% of #intermittentfasting; 62.9% of #keto; and 40.1% of #lowcarb). Images of people were individual (44%) or before/after (39%); mostly female (77%), of white (53%) ethnicity. Across all posts, 12.5% were linked to a commercial product/program, and 2.3% provided nutrition information.

CONCLUSION

Diet-related images visible when adolescents search #intermittentfasting, #keto, and #lowcarb on Instagram promote animal-based foods with or without vegetables. These diet hashtags on Instagram do not provide nutrition information and are not helpful for young people searching for diet information online.

An Exploratory Content Analysis of the Use of Health Communication Strategies and Presence of Objectification in Fitness Influencer Social Media Posts

Health and fitness content intended to inspire people to live healthy lives (e.g. "fitspiration") has been linked to negative body image among girls and young women. Fitness influencers purport wanting to motivate healthy behaviors. This study seeks to examine the presence of strategies known to positively influence health behaviors (e.g. attitudes, self-efficacy) as well as of content known to have a negative influence (e.g. objectification) among fitness influencers. We conducted a content analysis (N = 441) of a random sample of one year of posts from four Instagram fitness influencers popular with girls and young women in the United States. The main analysis consisted of codes related to objectification, health promotion strategies, health-related content, and social engagement (i.e., likes). We found that fitness influencers included content that conveyed constructs previously found to positively influence health behaviors (e.g., attitudes and self-efficacy), but objectification was frequently present, in more than half of the posts. Additionally, we found that the presence of objectification in posts was negatively associated with likes, a form of social endorsement. We suggest health communicators aim to work in tandem with fitness influencers to include content that may motivate positive health behaviors and improve media literacy and that influencers aim to reduce the amount of objectifying content included in their posts. Our findings shed light on content being conveyed and possible insights into the negative effects associated with viewing such content.

Perceptions of Breastfeeding Among Adolescents and Young Adults

Purpose: We aimed to understand adolescents' and young adults' perceptions and the extent of their knowledge about breastfeeding. Methods: Participants (adolescents and young adults in the United States, 14-24 years of age) were texted five open-ended questions about their perceptions of various aspects of breastfeeding including their initial reaction to breastfeeding, the impact on the infant and parent, how it compares with formula, and whether they were breastfed. The responses were analyzed for themes using an inductive content analysis approach. Responses were compared using χ2 tests to assess if knowledge and education about breastfeeding differed according to gender identity and age. Results: Among 1,283 participants, 829 responded (response rate = 64.4%). The average age was 18.8 (standard deviation [SD] = 2.9), with 53% female and 10% Black. Most adolescents and young adults understand there are health benefits of breastfeeding for the breastfeeding dyad (n = 589; 78.8%), yet also indicate an awareness of negative aspects (n = 256; 36.1%). Participants who identified as female or gender-variant and those who were older were more likely to refer to the emotional and bonding connections breastfeeding creates (p = 0.0011 and p = 0.0002). Males were more likely to have less knowledge about breastfeeding effects on the breastfeeding person but have more negative attitudes toward formula (p = 0.0298 and p = 0.0543). Younger respondents tended to indicate that formula was better than breast milk (p = 0.0534). Conclusion: We found a mix of positive and negative perceptions of breastfeeding among adolescents and young adults. Understanding how youth view breastfeeding can inform targeted education for this population that includes all genders and can begin before pregnancy.

The impact of social media interventions on eating behaviours and diet in adolescents and young adults: a mixed methods systematic review protocol

INTRODUCTION

Adolescents and young adults are susceptible population when it comes to healthy eating and dietary behaviours. The increasing use of social media by this age group presents a unique opportunity to promote healthy eating habits. Social media has become a popular platform for promoting health interventions, particularly among young people. However, there is a lack of consensus on the effectiveness of social media interventions in this population. This mixed-method systematic review aims to synthesise the available evidence on the impact of social media interventions on healthy eating behaviours among young people, their qualitative views and user experiences, and the intervention characteristics, behaviour change theories and techniques used to promote healthy eating.

METHODS AND ANALYSIS

We will conduct a comprehensive search of seven electronic databases, including ASSIA, Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus and Web of Science. The search strategy will use a combination of Medical Subject Headings terms and keywords covering three domains: social media, eating behaviours and young people. The search will be limited to peer-reviewed published papers in any language, published from 2000. Three independent reviewers will screen studies based on predetermined eligibility criteria. Data will be extracted and analysed using a convergent segregated mixed-method approach. We will use random-effect meta-analysis or Synthesis Without Meta-analysis for quantitative data and thematic synthesis for qualitative data. Finally, narrative synthesis using concurrent triangulation will be used to bring together the results of the mixed-method data analysis to provide a comprehensive and integrated understanding of the impact and other features of social media interventions. This systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

ETHICS AND DISSEMINATION

Ethical approval is not required since this systematic review will not collect original data. The outcomes of this review will be shared through peer-reviewed publications and conference presentations and will contribute to the PhD thesis of the primary author.

PROSPERO REGISTRATION NUMBER

CRD42023414476.

Exposure to Instagram junk food content negatively impacts mood and cravings in young adults: A randomized controlled trial

Exposure to different types of images on social media is known to affect physical and mental wellbeing including changes in perception of body image (BI) and dietary behavior. The present study aimed to assess the effects of junk food-related Instagram content exposure on body image, overall mood, and cravings in young adults. A randomized crossover experimental design was used. After filling out a baseline survey, participants (n = 63, aged 18-24) browsed either a control Instagram account feed or an account rich in junk food images during 15 min. They then filled a short survey evaluating their state BI, mood, and cravings (T1). After a 1-week washout period (T2), participants browsed the other account type followed by the same short survey as in T1. Results showed that exposure to junk food content was associated with increased feelings of hunger, stress, sadness, and exhaustion, in addition to higher salty, savory, and fatty food cravings. Moreover, participants showed higher desire for junk food and lower desire for healthy food items from a virtual food tray after junk food content exposure. There was no impact of content type on state BI dissatisfaction. In conclusion, exposure to junk-food related content on social media negatively affects mood and cravings, subsequently influencing food choices. The present findings shed light on the need for interventions aimed at providing cognitive and emotional competencies for enhancing media literacy and promoting mindful social media use.

Media Literacy Practices to Prevent Obesity and Eating Disorders in Youth

PURPOSE OF REVIEW

Obesity and eating disorders share common issues related to media use and effects, especially in the USA. Current research increasingly demonstrates that media literacy can address this problem. This narrative review highlights current media literacy-based research for obesity and eating disorder prevention among youth.

RECENT FINDINGS

Current research using media literacy techniques to prevent obesity indicates that these interventions improve nutrition outcomes, improve family communication about food, improve critical thinking about food advertisements, reduce sugar and fat intake, and reduce screen use for parents and youth. In addition, eating disorder research reveals that media literacy techniques lead to higher scores of body satisfaction and self-esteem, with lower scores of perfectionism, thinness, and ideal masculinity. There is a need for media literacy-based interventions to focus on family communication to prevent obesity and eating disorders. Furthermore, there should be more focus on identified levels of prevention and specific clinical outcomes.

A systematic review of interventions targeting physical activity and/or healthy eating behaviours in adolescents: practice and training

Despite the many health benefits of physical activity (PA) and healthy eating (HE) most adolescents do not meet current guidelines which poses future health risks. This review aimed to (1) identify whether adolescent PA and HE interventions show promise at promoting behaviour change and maintenance, (2) identify which behaviour change techniques (BCTs) are associated with promising interventions, and (3) explore the optimal approaches to training deliverers of adolescent PA/HE interventions. Nine databases were searched for randomised controlled, or quasi-experimental, trials targeting 10-19 year olds, with a primary aim to increase PA/HE, measured at baseline and at least six months post-intervention, in addition to papers reporting training of deliverers of adolescent PA/HE interventions. Included were seven PA studies, three HE studies and four studies targeting both, with two training papers. For PA studies, two were promising post-intervention with two promising BCTs, and five were promising for maintenance with two promising BCTs. For HE studies, three were promising at post-intervention and four at maintenance, both with four promising BCTs. There is preliminary evidence that interventions support adolescents to improve their PA and HE behaviours over a period of at least six months.

[Consequences of digital media on the health of children and adolescents with a focus on the consumption of unhealthy foods]

Children and adolescents' media time has increased since 2019. Prolonged time spent with media and media multitasking is increasingly being discussed as a health determinant. This narrative review highlights the importance of media time on the development of obesity and metabolic disorders in children and adolescents and discusses in more detail the associations with consumption of unhealthy foods and increased exposure to media food marketing.The prolonged durations that children and adolescents spend with social and digital media in their leisure time are positively related to sensory taste preferences for sweet, fatty, and salty foods as well as to higher snack food and energy intakes. Moreover, prolonged media time is also associated with a long-term increased risk of metabolic syndrome and its single components. The potential of social media for promoting physical activity and healthy eating lies especially in simplifying the inclusion of otherwise hard-to-reach groups. Further, social media may facilitate social support from peers and thus positively influence the well-being of young users.Particularly against the background of the not yet fully developed cognitive abilities of children and adolescents, the article refers to options for action to protect young media users. Exposure to certain social media content appears to negatively relate to children and adolescents' food choices and eating behaviors, supporting the call to regulate advertising directed at young consumers for foods and beverages that do not meet WHO criteria for child-friendly foods in these media.

Barriers to home food preparation and healthy eating among university students in Catalonia

Despite college being a critical life stage for developing enduring healthy dietary behaviours, Spanish university students show poor adherence to a healthy diet. Since research has shown an association between home cooking and healthy eating, the aim of this study was to analyse the main barriers that influence home food preparation and healthy eating among students at three Catalan universities. Focus groups, the photovoice technique and a validated questionnaire were used. Six focus groups (10 female; 14 male; aged 18-22) were conducted. NVivo9, was used to analyse the transcripts using an inductive thematic analysis. In two focus groups, the photovoice technique was used to further explore their perceptions about a healthy diet and their barriers for home cooking and healthy eating. The validated questionnaire was sent out to obtain data on students' diet quality, food environment and cooking self-efficacy for the focus group's design. We found that lack of motivation was the main barrier to healthy eating and home cooking, which was further influenced by the lack of cooking self-efficacy. Young adults lacked the knowledge and skills to prepare quick, affordable, and nutritious meals. Hence, even lack of time was cited as a primary barrier, time constraints seemed to be related to personal priorities. Students did not feel motivated to eat healthy and adopt time-deepening behaviours that influence food-choices. Thus, further research is required to develop context-specific culinary interventions that enhance students' cooking self-efficacy and identify strategies for encouraging students to adopt healthier eating habits.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

The individual-level effects of social media campaigns related to healthy eating, physical activity, and healthy weight: A narrative review

Objective

Social media are promising channels for health communication promoting positive weight-related behaviors, but no prior studies have synthesized evidence on the independent effects of social media campaigns focused on promoting healthy eating, physical activity (PA), and healthy weight. This study aimed to fill that gap and inform future social media-based obesity-prevention research and practice by reviewing findings from studies testing the effects of such campaigns on individual-level cognitive, behavioral, and anthropometric outcomes.

Method

The Web of Science and PubMed databases were searched for peer-reviewed articles published between 2012 and 2023 that explored the independent effects of social media campaigns related to healthy eating, PA, or weight management. Study characteristics and outcomes were extracted and summarized.

Results

Eleven studies were included in this review describing campaigns targeting healthy eating-related outcomes (e.g., fruit and vegetable consumption, meal preparation, nutrition label reading), PA, or weight management. Most campaigns (n = 7) were developed by universities or research centers. Priority audiences included parents, adult females, adolescents, college students, and adult government employees. The majority (n = 8) of the campaigns used single platforms, with the most common being Facebook, Instagram, blogs, and YouTube. Campaigns had mixed effects on cognitive outcomes (e.g., intention, attitude, knowledge), behavioral outcomes (e.g., food choices, PA), and anthropometric outcomes (e.g., weight, waist circumference).

Conclusion

Social media campaigns focused on promoting healthy eating, PA, and healthy weight had mixed effects on individual-level cognitive, behavioral, and anthropometric outcomes. Various limitations of the included studies make it difficult to ascertain which factors influence campaign effectiveness. Advancing knowledge in this area is important, particularly given social media's widespread use and potential for broad reach. New research with features such as rigorous study designs, larger and more diverse samples, and strong theoretical foundations may provide important insights into what types of interventions are effective or not and under what conditions.

Patterns of digital health access and use among US adults: A latent class analysis

Background Digital technologies allow users to engage in health-related behaviors associated with positive outcomes. We aimed to identify classes of US adults with distinct digital technologies access and health use patterns and characterize class composition. Data came from Health Information National Trends Survey Wave 5 Cycles 1-4, a nationally representative cross-sectional survey of US adults ( N  = 13,993). We used latent class analysis to identify digital technologies access and health use patterns based on 32 behaviors and access to requisite technologies and platforms that include the internet, internet-enabled devices, health monitors, and electronic health records (EHRs). We ran a multinomial logistic regression to identify sociodemographic and health correlates of class membership ( n  = 10,734). Results Ten classes captured patterns of digital technology access and health use among US adults. This included a digitally isolated, a mobile-dependent, and a super user class, which made up 8.9%, 7.8%, and 13.6% of US adults, respectively, and captured access patterns from only basic cellphones and health monitors to near complete access to web-, mobile-, and EHR-based platforms. Half of US adults belonged to classes that lacked access to EHRs and relied on alternative web-based tools typical of patient portals. The proportion of class members who used digital technologies for health purposes varied from small to large. Older and less educated adults had lower odds of belonging to classes characterized by access or engagement in health behaviors. Hispanic and Asian adults had higher odds of belonging to the mobile-dependent class. Individuals without a regular healthcare provider and those who had not visited a provider in the past year were more likely to belong to classes with limited digital technologies access or health use. Discussion Only one third of US adults belonged to classes that had near complete access to digital technologies and whose members engaged in almost all health behaviors examined. Sex, age, and education were associated with membership in classes that lacked access to 1 + digital technologies or exhibited none to limited health uses of such technologies. Results can guide efforts to improve access and health use of digital technologies to maximize associated health benefits and minimize disparities.

A systematic review of educational nutrition interventions based on behavioral theories in school adolescents

The purpose of this study was to summarize the evidence from studies conducted on adolescents, evaluating educational nutrition interventions for the modification of food consumption through controlled trials based on behavior change theories or models and implemented in school settings. A systematic search was carried out through PubMed and ERIC databases between November and December 2020, and updated in February 2023; English-language keywords were used, and no publication date limits were applied. Two authors independently performed the search, data extraction, data synthesis and risk of bias assessment. Twelve studies meeting the inclusion criteria were included. The interventions were based on different theories; the most used was the Social Cognitive Theory. Eleven of the twelve studies showed favorable modifications in the consumption of at least two of the food groups. Most studies were at low risk of bias, and only one was classified as high risk. It is concluded that educational nutrition interventions based on behavior change theories/models and implemented in the school setting influence positive changes in adolescents eating behavior.

Associations Between Patient-Reported Outcome Measures of Physical and Psychological Functioning and Willingness to Share Social Media Data for Research Among Adolescents With a Chronic Rheumatic Disease: Cross-Sectional Survey

Background

Social media data may augment understanding of the disease and treatment experiences and quality of life of youth with chronic medical conditions. Little is known about the willingness to share social media data for health research among youth with chronic medical conditions and the differences in health status between sharing and nonsharing youth with chronic medical conditions.

Objective

We aimed to evaluate the associations between patient-reported measures of disease symptoms and functioning and the willingness to share social media data.

Methods

Between February 2018 and August 2019, during routine clinic visits, survey data about social media use and the willingness to share social media data (dependent variable) were collected from adolescents in a national rheumatic disease registry. Survey data were analyzed with patient-reported measures of disease symptoms and functioning and a clinical measure of disease activity, which were collected through a parent study. We used descriptive statistics and multivariate logistic regression to compare patient-reported outcomes between youth with chronic medical conditions who opted to share social media data and those who did not opt to share such data.

Results

Among 112 youths, (age: mean 16.1, SD 1.6 y; female: n=72, 64.3%), 83 (74.1%) agreed to share social media data. Female participants were more likely to share (P=.04). In all, 49 (43.8%) and 28 (25%) participants viewed and posted about rheumatic disease, respectively. Compared to nonsharers, sharers reported lower mobility (T-score: mean 49.0, SD 9.4 vs mean 53.9, SD 8.9; P=.02) and more pain interference (T-score: mean 45.7, SD 8.8 vs mean 40.4, SD 8.0; P=.005), fatigue (T-score: mean 49.1, SD 11.0 vs mean 39.7, SD 9.7; P<.001), depression (T-score: mean 48.1, SD 8.9 vs mean 42.2, SD 8.4; P=.003), and anxiety (T-score: mean 45.2, SD 9.3 vs mean 38.5, SD 7.0; P<.001). In regression analyses adjusted for age, sex, study site, and Physician Global Assessment score, each 1-unit increase in symptoms was associated with greater odds of willingness to share social media data, for measures of pain interference (Adjusted Odds Ratio [AOR] 1.07, 95% CI 1.001-1.14), fatigue (AOR 1.08, 95% CI 1.03-1.13), depression (AOR 1.07, 95% CI 1.01-1.13), and anxiety (AOR 1.10, 95% CI 1.03-1.18).

Conclusions

High percentages of youth with rheumatic diseases used and were willing to share their social media data for research. Sharers reported worse symptoms and functioning compared to those of nonsharers. Social media may offer a potent information source and engagement pathway for youth with rheumatic diseases, but differences between sharing and nonsharing youth merit consideration when designing studies and evaluating social media-derived findings.

Social Media Interventions for Patients and Public: Opportunities and Challenges for the Urology Community

Interactive interventions represent a new application of social media in urology that involves multidirectional communication within a group. Such interventions have the potential to influence health behaviours in patients and the public and result in a significant impact on urological diseases.

Postsecondary Students' Knowledge of and Adherence to the 2019 Canada's Food Guide: A Cross-sectional Pilot Survey

Purpose: We conducted a pilot survey among young adults attending a suburban Canadian university to understand: (1) knowledge of the 2019 Canada's Food Guide (CFG); (2) self-reported food choices and eating habits; (3) perceived influence of the CFG on food choices and eating habits; and (4) suggestions to improve engagement with CFG.Methods: Students were recruited, through posts on social media platforms, to complete an online questionnaire between 7 March and 6 April 2020.Results: One-hundred and twenty-one (70% women) students responded. One-third (33%) of women and 8% of men reported consuming the recommended proportion of vegetables and fruits (i.e., 40%-60% of the plate) at their most recent meal (P = 0.001). Men were more likely to report overconsuming protein foods than women (58% vs 32%, P = 0.005). The perceived influence of the CFG on food choices and eating habits was low, with a mean score 2.2 ± 1.4 out of 7, with 7 indicating "highly influential." Over 92% of participants believed awareness of the CFG could be improved through social media platforms.Conclusions: Although half of the participants correctly answered all 8 questions that assessed knowledge of the CFG, there is an opportunity for dietitians and related health professionals to improve engagement with CFG.

Gamification as a health education strategy of adolescents at school: Protocol for a systematic review and meta-analysis

The objective of the study is to present a systematic review and meta-analysis protocol for evaluating the effects of health education gamification-based interventions, on health parameters (food consumption, sleep quality and physical activity) of adolescent students. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022373833). The search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA, and ADOLEC. Intervention studies (clinical trials - randomized or non-randomized) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomized controlled trials, non- randomized controlled trials and quasi-experimental trials. Two independent researchers will conduct all assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed using RevMan 5.4.1 software. We will conduct the study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline. The review will summarize the current evidence on gamification health education changes in parameters related to the health of adolescents. Gamification has been used to verify the increase in adherence to healthy habits or the development of health-related skills, but there are still few results for the adolescent population. We expect that the systematic review could indicate strategies with gamification interventions and also determine how these strategies can improve health parameters of adolescent students, and they will be available as a reference for these interventions.

Social media use and health risk behaviours in young people: systematic review and meta-analysis

OBJECTIVES

To examine the association between social media use and health risk behaviours in adolescents (defined as those 10-19 years).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXic, PsyArXiv, medRxiv, and Google Scholar (1 January 1997 to 6 June 2022).

METHODS

Health risk behaviours were defined as use of alcohol, drugs, tobacco, electronic nicotine delivery systems, unhealthy dietary behaviour, inadequate physical activity, gambling, and anti-social, sexual risk, and multiple risk behaviours. Included studies reported a social media variable (ie, time spent, frequency of use, exposure to health risk behaviour content, or other social media activities) and one or more relevant outcomes. Screening and risk of bias assessments were completed independently by two reviewers. Synthesis without meta-analysis based on effect direction and random-effects meta-analyses was used. Effect modification was explored using meta-regression and stratification. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).

RESULTS

Of 17 077 studies screened, 126 were included (73 included in meta-analyses). The final sample included 1 431 534 adolescents (mean age 15.0 years). Synthesis without meta-analysis indicated harmful associations between social media and all health risk behaviours in most included studies, except inadequate physical activity where beneficial associations were reported in 63.6% of studies. Frequent (v infrequent) social media use was associated with increased alcohol consumption (odds ratio 1.48 (95% confidence interval 1.35 to 1.62); n=383 068), drug use (1.28 (1.05 to 1.56); n=117 646), tobacco use (1.85, 1.49 to 2.30; n=424 326), sexual risk behaviours (1.77 (1.48 to 2.12); n=47 280), anti-social behaviour (1.73 (1.44 to 2.06); n=54 993), multiple risk behaviours (1.75 (1.30 to 2.35); n=43 571), and gambling (2.84 (2.04 to 3.97); n=26 537). Exposure to content showcasing health risk behaviours on social media (v no exposure) was associated with increased odds of use of electronic nicotine delivery systems (1.73 (1.34 to 2.23); n=721 322), unhealthy dietary behaviours (2.48 (2.08 to 2.97); n=9892), and alcohol consumption (2.43 (1.25 to 4.71); n=14 731). For alcohol consumption, stronger associations were identified for exposure to user generated content (3.21 (2.37 to 4.33)) versus marketer generated content (2.12 (1.06 to 4.24)). For time spent on social media, use for at least 2 h per day (v <2 h) increased odds of alcohol consumption (2.12 (1.53 to 2.95); n=12 390). GRADE certainty was moderate for unhealthy dietary behaviour, low for alcohol use, and very low for other investigated outcomes.

CONCLUSIONS

Social media use is associated with adverse health risk behaviours in young people, but further high quality research is needed to establish causality, understand effects on health inequalities, and determine which aspects of social media are most harmful.

STUDY REGISTRATION

PROSPERO, CRD42020179766.

Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review

BACKGROUND

Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media-based nutrition education interventions to inform the implementation of future social media-based nutrition education interventions.

OBJECTIVE

A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media-based nutrition education interventions for adolescents was conducted.

METHODS

We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media-based nutrition education interventions was extracted.

RESULTS

A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied.

CONCLUSIONS

Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media-based nutrition interventions and the need for user-centered design of the interventions.

Digital interventions to moderate physical inactivity and/or nutrition in young people: a Cancer Prevention Europe overview of systematic reviews

Background

Strategies to increase physical activity (PA) and improve nutrition would contribute to substantial health benefits in the population, including reducing the risk of several types of cancers. The increasing accessibility of digital technologies mean that these tools could potentially facilitate the improvement of health behaviours among young people.

Objective

We conducted a review of systematic reviews to assess the available evidence on digital interventions aimed at increasing physical activity and good nutrition in sub-populations of young people (school-aged children, college/university students, young adults only (over 18 years) and both adolescent and young adults (<25 years)).

Methods

Searches for systematic reviews were conducted across relevant databases including KSR Evidence (www.ksrevidence.com), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE; CRD). Records were independently screened by title and abstract by two reviewers and those deemed eligible were obtained for full text screening. Risk of bias (RoB) was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. We employed a narrative analysis and developed evidence gap maps.

Results

Twenty-four reviews were included with at least one for each sub-population and employing a range of digital interventions. The quality of evidence was limited with only one of the 24 of reviews overall judged as low RoB. Definitions of "digital intervention" greatly varied across systematic reviews with some reported interventions fitting into more than one category (i.e., an internet intervention could also be a mobile phone or computer intervention), however definitions as reported in the relevant reviews were used. No reviews reported cancer incidence or related outcomes. Available evidence was limited both by sub-population and type of intervention, but evidence was most pronounced in school-aged children. In school-aged children eHealth interventions, defined as school-based programmes delivered by the internet, computers, tablets, mobile technology, or tele-health methods, improved outcomes. Accelerometer-measured (Standardised Mean Difference [SMD] 0.33, 95% Confidence Interval [CI]: 0.05 to 0.61) and self-reported (SMD: 0.14, 95% CI: 0.05 to 0.23) PA increased, as did fruit and vegetable intake (SMD: 0.11, 95% CI: 0.03 to 0.19) (review rated as low RoB, minimal to considerable heterogeneity across results). No difference was reported for consumption of fat post-intervention (SMD: -0.06, 95% CI: -0.15 to 0.03) or sugar sweetened beverages(SSB) and snack consumption combined post-intervention (SMD: -0.02, 95% CI:-0.10 to 0.06),or at the follow up (studies reported 2 weeks to 36 months follow-up) after the intervention (SMD:-0.06, 95% CI: -0.15 to 0.03) (review rated low ROB, minimal to substantial heterogeneity across results). Smartphone based interventions utilising Short Messaging Service (SMS), app or combined approaches also improved PA measured using objective and subjective methods (SMD: 0.44, 95% CI: 0.11 to 0.77) when compared to controls, with increases in total PA [weighted mean difference (WMD) 32.35 min per day, 95% CI: 10.36 to 54.33] and in daily steps (WMD: 1,185, 95% CI: 303 to 2,068) (review rated as high RoB, moderate to substantial heterogeneity across results). For all results, interpretation has limitations in terms of RoB and presence of unexplained heterogeneity.

Conclusions

This review of reviews has identified limited evidence that suggests some potential for digital interventions to increase PA and, to lesser extent, improve nutrition in school-aged children. However, effects can be small and based on less robust evidence. The body of evidence is characterised by a considerable level of heterogeneity, unclear/overlapping populations and intervention definitions, and a low methodological quality of systematic reviews. The heterogeneity across studies is further complicated when the age (older vs. more recent), interactivity (feedback/survey vs. no/less feedback/surveys), and accessibility (type of device) of the digital intervention is considered. This underscores the difficulty in synthesising evidence in a field with rapidly evolving technology and the resulting challenges in recommending the use of digital technology in public health. There is an urgent need for further research using contemporary technology and appropriate methods.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Efficacy of technology-based personalised feedback on diet quality in young Australian adults: results for the advice, ideas and motivation for my eating (Aim4Me) randomised controlled trial

OBJECTIVE

Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction.

DESIGN

Randomised controlled trial.

SETTING

Web-based intervention for young adults living in Australia.

PARTICIPANTS

18-24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire.

RESULTS

Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme.

CONCLUSION

Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods.

Factors Influencing Adolescents’ Use of Social Media for Nutrition Intervention

Adolescents are the largest population using social media in daily life, and their use is influenced by a wide range of factors. Hence, it is applied in nutrition intervention, which improved their health. However, some intervention lacks participation and engagement. This study identifies factors influencing adolescents’ social media use for nutrition interventions. An in-depth interview was conducted virtually for 30 to 60 minutes focusing on nutrition-related matters with 15 adolescents. Almost all of them were interested to participate in nutrition interventions on social media. User characteristics, environmental factors, and social media features were identified as the factors impacting them.

How digital health technologies promote healthy life in the Post-COVID-19 Era: evidences from national survey on Chinese adolescents and youngsters

The rapid development of intelligent technologies coupled with the stay-at-home trends in the Post-COVID-19 Era has significantly changed youth's health behavior as well as reshaped their lifestyles. Digital health technologies (DHTs) have been more and more used for health management among youngsters. However, little was known about the use of DHTs among youths and its consequences on their health, especially in developing countries like China. Inspired by behavior intervention technology (BIT) model, this study examined the underlying mechanisms of use and social interactions of DHTs on Chinese adolescents' and youngsters' healthy lifestyles and mental health, using a representatively national survey among high school and freshman students in China (N = 2,297). It found that use of DHTs had a significantly positive effect on Chinese youths' healthy lifestyles and mental health, with behavioral regulation as a mediator. However, social interactions of DHTs were negatively associated with their mental health. The findings contribute to a better guidance on health promotion, as well as the enhanced design of DHTs' products.

Exploring Social Media Preferences for Healthy Weight Management Interventions Among Adolescents of Color: Mixed Methods Study

BACKGROUND

Social media holds promise as an intervention platform to engage youths in healthy weight management and target racial inequities in obesity.

OBJECTIVE

This mixed methods study aimed to examine social media habits, preferences, and obesity-related behaviors (eg, diet and physical activity) among adolescents of color and understand preferences for healthy weight management interventions delivered via social media.

METHODS

This mixed methods study is comprised of a cross-sectional web-based survey and a series of digital focus groups. Study participants (English-speaking youths of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous web-based survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45- to 60-minute web-based group discussions assessing social media habits, preferred social media platforms, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach.

RESULTS

A total of 101 adolescents completed the survey and 20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (eg, content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet.

CONCLUSIONS

Findings from this study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media-based interventions to engage adolescents of color in healthy weight management content.

Social media analytics and their applications to evaluate an activity in online health interventions using CRITIC and TOPSIS techniques

The usage of social media is increasing by leaps and bounds in our day-to-day lives. It affects daily routines and brings a lot of change in different departments like health and education systems during the COVID-19 pandemic. Healthcare research and practice have been significantly impacted by the astounding growth of social media. Social media are changing health information management in several ways, from offering appropriate ways to enhance healthcare professional contact and share health-related knowledge and experience to facilitating the development of innovative medical research and wisdom. Social media analytics (SMAs) are efficient and effective interaction instruments that can be useful for both patients and clinicians in health interventions. Moreover, a significant portion of those involved in clinical practices (such as clinicians, professional colleges, and departments of health) are unaware of the importance of social media, its potential applications in their daily lives, as well as the possible consequences and how these will be handled. In the presented study, we proposed MCDM-based approaches known as "Criteria Importance Through Inter Correlation" (CRITIC) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) in order to identify the effective alternative among several options and make a better decision. After extracting features from the literature review, we choose six significant and relevant features and assign weights to them using CRITIC techniques while utilizing the TOPSIS technique to rank the alternatives based on their performance values. After the implementation of both methods and evaluation procedure, it is determined that the alternative with the highest score is placed at the top and called the "best alternative," while the alternative with the lowest score is placed at the bottom and called the worst alternative. Finally, we suggest a variety of research initiatives and new research areas where the aforementioned procedures become extremely useful in evaluating SMAs and their uses in online health interventions.

Hashtag fitspiration: credibility screening and content analysis of Instagram fitness accounts

BACKGROUND

Fitspiration is a social media phenomenon purported to inspire viewers to lead healthier lifestyles but can result in negative psychological outcomes such as body dissatisfaction. This study aimed to develop a tool to audit Instagram fitspiration accounts and screen for content that could have potentially negative psychological effects.

METHODS

This study developed and implemented an audit tool to (1) identify credible fitspiration accounts (i.e., accounts that do not portray potentially harmful or unhealthy content) and (2) describe the content of identified accounts. The most recent 15 posts of 100 leading Instagram fitspiration accounts were audited. Accounts were deemed non-credible and were excluded if they contained fewer than four fitness-related posts or portrayed nudity or inappropriate clothing, sexualisation or objectification, extreme body types, "thinspiration", or negative messages.

RESULTS

Many accounts contained fewer than four fitness-related posts (n = 41), sexualisation or objectification (n = 26), nudity or inappropriate clothing (n = 22), and/or extreme body types (n = 15). Three accounts failed on all four criteria, while 13, 10 and 33 failed on three, two, or one criterion, respectively. Therefore, only 41% of accounts were considered credible. Inter-rater reliability (percentage agreement and Brennan and Prediger's coefficient κ_q) was high (Stage 1: 92% agreement [95% CI 87, 97], κ_q 0.84 [95% CI 0.73, 0.95]; Stage 2: 93% agreement [95% CI 83, 100], κ_q 0.85 [95% CI 0.67, 1.00]). Account holders of credible fitspiration accounts were predominantly female (59%), aged 25-34 (54%), Caucasian (62%), and from the United States (79%). Half held a qualification related to physical activity or physical health (e.g., personal trainer, physiotherapy; 54%). Most included accounts included an exercise video (93%) and example workout (76%).

CONCLUSION

While many popular Instagram fitspiration accounts offered credible content such as example workouts, many accounts contained sexualisation, objectification or promotion of unhealthy or unrealistic body shapes. The audit tool could be used by Instagram users to ensure the accounts they follow do not portray potentially harmful or unhealthy content. Future research could use the audit tool to identify credible fitspiration accounts and examine whether exposure to these accounts positively influences physical activity.

Impact of Health, Environmental, and Animal Welfare Messages Discouraging Red Meat Consumption: An Online Randomized Experiment

BACKGROUND

Reducing red meat consumption is a key strategy for curbing diet-related chronic diseases and mitigating environmental harms from livestock farming. Messaging interventions aiming to reduce red meat consumption have focused on communicating the animal welfare, health, or environmental harms of red meat. Despite the popularity of these 3 approaches, it remains unknown which is most effective, as limited studies have compared them side by side.

OBJECTIVE

Our aim was to evaluate responses to red-meat-reduction messages describing animal welfare, health, or environmental harms.

DESIGN

This was an online randomized experiment.

PARTICIPANTS

In August 2021, a convenience sample of US adults was recruited via an online panel to complete a survey (n = 2,773 nonvegetarians and vegans were included in primary analyses).

INTERVENTION

Participants were randomly assigned to view 1 of the 4 following messages: control (neutral, non-red meat message), animal welfare, health, or environmental red-meat-reduction messages.

MAIN OUTCOME MEASURES

After viewing their assigned message, participants ordered hypothetical meals from 2 restaurants (1 full service and 1 quick service) and rated message reactions, perceptions, and intentions.

STATISTICAL ANALYSES PERFORMED

Logistic and linear regressions were performed.

RESULTS

Compared with the control message, exposure to the health and environmental red-meat-reduction messages reduced red meat selection from the full-service restaurant by 6.0 and 8.8 percentage points, respectively (P = .02 and P < .001, respectively), while the animal welfare message did not (reduction of 3.3 percentage points, P = .20). None of the red-meat-reduction messages affected red meat selection from the quick-service restaurant. All 3 red-meat-reduction messages elicited beneficial effects on key predictors of behavior change, including emotions and thinking about harms.

CONCLUSIONS

Red-meat-reduction messages, especially those describing health or environmental harms, hold promise for reducing red meat selection in some types of restaurants. Additional interventions may be needed to discourage red meat selection across a wider variety of restaurants, for example, by making salient which menu items contain red meat.

Gut health, the microbiome and dietary choices: An exploration of consumer perspectives

AIMS

To explore consumer perceptions regarding dietary behaviours related to the gut microbiome, to assist in effective translation of research to practice.

METHODS

Online focus groups were conducted (adults with no formal medical or nutrition training). Semi-structured open-ended questioning explored perspectives related to gut health and dietary behaviours. A qualitative descriptive analysis approach was undertaken in duplicate.

RESULTS

Fourteen focus groups were conducted (n = 38, 15 males, 23 females). Four overarching themes regarding consumer perceptions were identified. These were (a) gut health equates with wellbeing, (b) there are divergent perceptions of how diet influences gut health, (c) interest in scientific evidence does not necessarily influence dietary behaviour and (d) gastrointestinal symptoms influence dietary behaviour.

CONCLUSIONS

Consumers are interested in gut health and understand that diet may be important. Given that current literature regarding diet and gut health does not differ from dietary guidelines, consumer interest may provide a timely slant to promote longstanding guidelines. Consumer education to limit scepticism around government messaging, including utilisation of social media by nutrition professionals, may be key to improving adherence to guidelines.

Exploring Korean adolescent stress on social media: a semantic network analysis

Background

Considering that adolescents spend considerable time on the Internet and social media and experience high levels of stress, it is difficult to find a study that investigates adolescent stress through a big data-based network analysis of social media. Hence, this study was designed to provide basic data to establish desirable stress coping strategies for adolescents based on a big data-based network analysis of social media for Korean adolescent stress. The purpose of this study was to (1) identify social media words that express stress in adolescents and (2) investigate the associations between those words and their types.

Methods

To analyse adolescent stress, we used social media data collected from online news and blog websites and performed semantic network analysis to understand the relationships among keywords extracted in the collected data.

Results

The top five words used by Korean adolescents were counselling, school, suicide, depression, and activity in online news, and diet, exercise, eat, health, and obesity in blogs. As the top keywords of the blog are mainly related to diet and obesity, it reflects adolescents' high degree of interest in their bodies; the body is also a primary source of adolescent stress. In addition, blogs contained more content about the causes and symptoms of stress than online news, which focused more on stress resolution and coping. This highlights the trend that social blogging is a new channel for sharing personal information.

Conclusions

The results of this study are valuable as they were derived through a social big data analysis of data obtained from online news and blogs, providing a wide range of implications related to adolescent stress. Hence this study can contribute basic data for the stress management of adolescents and their mental health management in the future.

Comparing the effect of social media-based drama, music and art therapies on reduction in post-traumatic symptoms among Nigerian refugees of Russia's invasion of Ukraine

PURPOSE

The objective of this study was to ascertain the effectiveness of social media-based music, art and drama therapies in treating PTSD symptoms among Nigerian evacuees from the Russia-Ukraine war.

DESIGN AND METHODS

This study was a quasi-experiment involving a sample of 330 participants that were randomly assigned to control and treatment groups. The treatment group was further classified into three groups according to the different contents of the therapies they received.

RESULTS

The study result showed that social media-based therapies effectively reduced PTSD symptoms for participants in the treatment group, unlike those who did not receive the intervention. Comparatively, drama therapy was more effective than art and music therapies. The reason drama therapy was more effective could be because it engaged the minds and body of the participants more than the other therapies.

CONCLUSION

Although art, music and drama therapies are effective treatment options for reducing symptoms of PTSD among victims of war, drama therapy is the most effective among them all.

PRACTICAL IMPLICATIONS

The result of this study has practical implications for health promotion from the perspective of nursing services by showing that social media-based therapies could serve as viable and cost-effectivealternativese to face-to-face group therapy.

Development of eHealth-Based Behavior Change Support for Young Adults Using the Nine Principles Framework

Implementing behavior strategies into nutrition research requires consideration. The Nine Principles framework was used to develop an eHealth behavior change support (BCS) program to enhance young adults' adherence to (1) eating healthily and (2) recording dietary intake when participating in a randomized control trial. The Theory of Planned Behavior and qualitative focus group data informed a 10-week pilot of the BCS delivered on Facebook and texts. The BCS appeared to support optimal dietary recording and maintained dietary behaviors, suggesting using a framework underpinned by theory and user-centered design may be a promising avenue to enhance adherence in randomized control trials.

Use of Social Media by Adolescents for Nutrition Intervention: Factors to consider

Adolescents are the largest population using social media in daily life, and their use is influenced by a wide range of factors. Hence, it is applied in nutrition intervention, which improved their health. However, some intervention lacks participation and engagement. This study identifies factors influencing adolescents’ social media use for nutrition interventions. An in-depth interview was conducted virtually for 30 to 60 minutes focusing on nutrition-related matters with 15 adolescents. Almost all of them were interested to participate in nutrition interventions on social media. User characteristics, environmental factors, and social media features were identified as the factors impacting them.

Association Between Health Information‒Seeking Behavior on YouTube and Physical Activity Among U.S. Adults: Results From Health Information Trends Survey 2020

Introduction

Although physical activity has many health benefits, 45.8% of U.S. adults did not meet the WHO recommendation in 2018. Delivering health-related content, particularly physical activity, through YouTube may help to overcome some barriers, such as lack of access to resources. This study aimed to examine the association between watching health-related information on YouTube and increased levels of physical activity among U.S. adults.

Methods

Using the U.S. national cross-sectional survey-Health Information National Trends Survey 2020 (n=3,865), we conducted a multivariable logistic regression on obtaining 150 minutes of at least moderate-intensity physical activity per week (WHO guidelines) by watching health-related information on YouTube, controlling for demographics (age, sex, race/ethnicity), socioeconomics (income, education level, insurance coverage, employment), current use of cigarettes and e-cigarettes, use of electronic wearable devices (e.g., Fitbit), self-reported health status, BMI, and the presence of chronic conditions (e.g., diabetes, heart disease, cancer) and depression or anxiety disorders.

Results

Overall, 40.8% (weighted) of respondents reported using YouTube to watch health-related videos, and 39.2% reported meeting the WHO-recommended physical activity level. After controlling for covariates, adults who reported watching health-related videos on YouTube in the past 12 months (versus not watching) were 1.33 times more likely to do 150 minutes or more of moderate physical activity a week (AOR=1.33; 95% CI=1.01, 1.76).

Conclusions

This study suggests that adults who view health-related YouTube videos may be more likely to meet the WHO-recommended level of physical activity. This finding could inform future behavioral interventions using online video platforms to promote physical activity.

Social networks: A quality tool for health dissemination?

BACKGROUND

Social networks are integrated in our lives and, amongst other functions, they are a means of dissemination. There are numerous social network accounts dedicated to health that could be used as an educational resource. The aim of this study was to evaluate the quality of accounts dedicated to health in different social networks, assessing their content and didactic and technological effectiveness and accessibility.

MATERIALS AND METHODS

Observational cross-sectional descriptive study in which an analysis of social networks related to health was carried out from April to June 2021 in Spain. Twenty-eight accounts were analysed using a mixed qualitative-quantitative methodology. Content analysis of the speeches disseminated through the selected accounts was performed. In addition, the quality of the accounts was assessed with the Instrumento de Evaluación de Recursos Educativos Digitales (#IE_RED) (Digital Educational Resources Evaluation Instrument [#IE_RED]).

RESULTS

Four categories were identified according to the content: student-focused profiles, specific professionals' profiles, current health issues and profiles promoting a healthy lifestyle. In addition, the quality of the accounts obtained a score that indicates they meet the requirements to be validated as a good educational digital resource but could be improved. Instagram social network accounts and those managed by nurses scored significantly higher.

CONCLUSIONS

The analysed accounts were revealed as a quality tool for health dissemination, with varied content and applicable to teaching. Their use could be applied both to the training of health professionals and to the promotion of the population's health.

The BabyTok Project: Examining the Feasibility and Acceptability of a Light-Touch Social Media Project for Infant-Toddler Teachers

High-quality early care and education is a known protective factor for infants and toddlers who experience early childhood poverty, especially for early communication outcomes. However, the quality of care is variable in the United States, and efforts to increase the quality of interactions is impeded by cost and high rates of turnover in the field. In this paper, we explore a low-cost, light touch social media intervention that uses the TikTok platform to increase infant-toddler teachers' (ITTs) knowledge of early communication and social interactions while validating the important role that ITTs play in the lives of young children. We use a mixed method, pre-post design to explore the feasibility and acceptability of the BabyTok project from the vantage point of the ITT participants. Teachers offered positive feedback about the content, delivery of the intervention through TikTok and the impact on their feelings about their role in helping young children learn.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10643-022-01426-y.