BackgroundRising rates of sexually transmitted infections (STIs) among adolescents and young adults are concerning. Emergency department (ED) visits offer a unique opportunity to increase STI testing. However, providers in the ED may not have the time or self-efficacy to screen patients, and patients may be unable to initiate discussion on their STI care needs. A patient decision aid may improve the effectiveness and efficiency of the ED encounter for STI testing.ObjectiveThis study aims to pilot STI Check in the Emergency Room (STIckER) app, a shared decision-making aid for urinary, oral, and rectal gonorrhea and chlamydia testing among adolescents and young adults, and assess STIckER’s efficacy and implementation outcomes in an adult and pediatric ED.MethodsWe are conducting a parallel-group, two-arm provider-randomized controlled pilot trial in the adult and pediatric EDs at an urban academic medical center. Fifty providers were randomized 1:1 to intervention (trained on STIckER) or control (standard of care). Adolescents and young adults aged 14‐24 years, English-speaking, and sexually active within the past 6 months are recruited during eligible shifts and assigned to the study arm of their provider. The standard of care comparator consists of usual provider-initiated STI discussions and testing without access to the decision aid; control participants receive a QR code directing them to a simple landing page encouraging them to ask their provider about STI testing. The planned enrollment target was 44 providers and 140 adolescent and young adult participants. Primary outcome is preliminary efficacy, defined as the proportion of adolescents and young adults receiving gonorrhea and chlamydia testing based on electronic medical record (EMR) review. Secondary outcomes include extragenital testing uptake, STI positivity rates, decisional conflict, and perceived level of shared decision-making. Implementation outcomes include feasibility, acceptability, appropriateness (using acceptability of intervention measure, intervention appropriateness measure, and feasibility of intervention measure), and provider self-efficacy. Data will be analyzed using descriptive statistics and regression models, with mixed-effects models applied if clustering by provider is detected. Exploratory analyses will examine differences by patient age, gender, and sexual identity, and provider characteristics.ResultsBetween September 2023 and July 2025, we completed recruitment of 44 providers and 139 adolescent and young adult participants across both adult and pediatric EDs. Enrollment targets were met, with high fidelity to intervention delivery and strong rates of survey completion by both patients and providers. Final data cleaning and analyses are underway, and primary results are expected to be available in late 2025.ConclusionsThis pilot trial will provide critical data on the feasibility, acceptability, and preliminary efficacy of a digital SDM tool to increase STI testing in the ED. Findings will inform the design of a future multisite trial and the potential for scaling STIckER to support equitable, patient-centered STI screening across diverse clinical settings.

BackgroundSuboptimal diet quality and physical inactivity are key risk factors for chronic disease and disability in Canada. However, the lack of high-quality population-level data hinders the development of evidence-based strategies to support improvements in diet quality, movement behaviors (physical inactivity, activity, and sleep), and health. The lack of data is also a barrier to developing capacity in diet and physical activity assessment and epidemiology in Canada.ObjectiveThis protocol describes the development of the largest known repository of dietary intake and movement behavior data in Canada by drawing upon an existing longitudinal cohort study, the Canadian Partnership for Tomorrow’s Health (CanPath). In the short-term, the data will be used to examine associations between system factors (eg, retail food environments) and dietary intake. In the longer-term, data will be available to pursue a range of research questions, including longitudinal associations between diet, movement behavior, and health outcomes.MethodsParticipants in CanPath (>330,000 adults) who can complete online questionnaires are eligible and will be asked to complete a baseline web-based questionnaire including questions on demographic characteristics and screeners capturing dietary intake and movement behaviors. Subsequently, participants will be invited to complete an online 24-hour dietary recall using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24-Canada-2018) and an online 24-hour activity recall using Activities Completed Over Time in 24 Hours (ACT24). Repeat recalls will be administered 1-2 weeks later. A subset of participants will be invited to complete 2 additional ASA24-Canada-2018 and Activities Completed Over Time in 24 Hours recalls 6 months later. One year after baseline, participants will be invited to complete past-year diet and movement behavior questionnaires. In Québec, dietary intake and movement behavior data are from 3000 CanPath participants enrolled in the NutriQuébec study. Participant addresses will be linked to geospatial data on the food, built, and social environment.ResultsData collection began in 2025. As of manuscript acceptance (November 4, 2025), 3171 participants had been recruited. Data processing and cleaning will be completed in 2027, and analyses will occur in 2028. It is anticipated that dietary intake and movement behavior data will be available for up to 100,000 adults.ConclusionsThis protocol outlines the collection of detailed data on dietary intake and movement behavior in a large cohort spanning all provinces in Canada. In addition to allowing examination of a range of research questions related to diet, movement behavior, and health, the combination of assessment tools will support methodological research, including expanding analytical strategies to mitigate the effects of error in dietary and movement behavior data. This effort will also build capacity in the collection, processing, and harmonization of dietary and movement behavior data among cohorts and provide a training ground for emerging researchers.International Registered Report Identifier (IRRID)PRR1-10.2196/71680

BackgroundIncreasing intergenerational coexistence in the job market may heighten the risk of intergenerational conflicts, which can negatively impact the inclusion and healthy participation of older workers. The foodservice sector is characterized by significant intergenerational coexistence, reinforced by the presence of student workers. According to the literature, practices promoting intergenerational cooperation can reduce the risk of conflict and contribute to a healthier work climate.ObjectiveThe main objective of this research project is to propose a prioritized list of intergenerational cooperation practices to promote the inclusion and healthy participation of older workers in the foodservice sector.MethodsThis project will be carried out in 2 stages. The first stage will use a descriptive interpretative design based on the photo-elicitation method to identify intergenerational cooperation practices from the perspective of older workers. The second stage will use the Technique for Research of Information by Animation of a Group of Experts method to obtain a group consensus among professionals, managers, and researchers to prioritize the identified practices.ResultsThe first stage of this project is underway. The study has been funded by the Quebec Network for Research on Aging since September 2024. Participant recruitment began at the end of January 2025, following ethics committee approval, and ended in May 2025. In total, 12 participants were recruited for stage 1. The data collected are currently being analyzed, and the results are scheduled to be submitted for publication in 2026.ConclusionsOn a theoretical level, this project will propose a list of practices promoting intergenerational cooperation at work in the foodservice sector, giving a voice to older workers to better understand their perspectives. This project will also offer a prioritization of those practices, based on the perspective of different actors (researchers, professionals, and managers of the foodservice sector). On a practical level, this knowledge will help the actors of the foodservice sector to integrate these practices into their organizations to promote the inclusion and healthy participation of older workers.International Registered Report Identifier (IRRID)DERR1-10.2196/79012

BackgroundYoung Black sexual minority men are disproportionately affected by HIV, especially in the Southern United States. To address this, we developed Brothers Building Brothers by Breaking Barriers (B6) intervention with a goal of enhancing social capital and engagement in care among young Black sexual minority men living with HIV. However, we encountered challenges to feasibility in recruiting and engaging for an in-person intervention.ObjectiveThe objectives of this study are to iteratively adapt the original B6 intervention for telehealth delivery (Phase 1), and pilot test the intervention through a waitlist-control trial to evaluate its feasibility, acceptability, and safety (Phase 2).MethodsIn Phase 1, we used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework to structure the iterative adaptation process of B6, working with a diverse study team and a Youth Advisory Board (YAB). After completing the preliminary adaptation process, we conducted initial Telehealth Brothers Building Brothers by Breaking Barriers (Tele-B6) pilot testing with a community partner organization. The result was a 5-week group-level intervention, delivered entirely remotely, consisting of a series of adapted activities to address bonding and bridging social capital, affirm intersectional identities, and engage in resilience-building processes. Following feedback integration from pilot-testing, we conducted Phase 2 with 60 young Black sexual minority men living with HIV recruited over the course of one year and who were randomized at the group level to either the immediate intervention or delayed (waitlist control) intervention group. Various data sources will be used to measure feasibility, acceptability, and safety, including surveys, postsession evaluation data, in-depth qualitative interviews, and review of medical records for HIV clinical outcomes.ResultsPhase 1, the adaptation process of B6, began in fall 2022 and was completed in spring 2023. Phase 2, the implementation of the waitlist control trial, began in spring 2023 and concluded in summer 2024. Final follow-up assessments were completed in fall 2024 and the results of the mixed methods evaluation are expected in winter 2025.ConclusionsThe adaptation process and telehealth delivery of B6 will add to the knowledge of strengths-based interventions designed to improve care engagement among young Black sexual minority men living with HIV.Trial RegistrationClinicalTrials.gov NCT05829759,https://clinicaltrials.gov/study/NCT05829759International Registered Report Identifier (IRRID)DERR1-10.2196/69961

BackgroundAdolescents and young adults with cancer require dedicated and tailored management that bridges adult and pediatric oncology services. At the National Cancer Centre Singapore, 40% of newly diagnosed adolescents and young adults report significant distress due to uncertainty about prognosis, treatment, and disruption of life milestones. A major unmet need is access to reliable, age-appropriate information. Prior studies demonstrate that digital technology can effectively deliver such support.ObjectiveThis study describes the protocol for evaluating AYABytes (Adolescent and Young Adult Building Youths, a Technology for Education and Sharing), a mobile app cocreated by patients and health care professionals to improve health-related quality of life for adolescent and young adult oncology patients. An iterative information-gathering process was conducted, including semistructured interviews with 2 clinicians, 3 cancer survivors, and 3 care partners to cocreate this mobile app. AYABytes is an interactive, phone-based intervention designed to engage adolescent and young adult oncology patients with personalized education, mood, and symptom self-management resources with an inbuilt algorithm that responds to patient-reported questionnaires.MethodsThe app will be evaluated in 2 phases—a pilot test and an implementation test. In the pilot test, the app will be launched to a test group of 20 adolescent and young adult oncology patients aged between 16 and 45 years, selected for representation among the age group and their malignancies. Patients will be allowed to use the app for 1 month. Feasibility and acceptability were assessed via a semistructured survey. In the implementation stage, 200 patients will be allowed to use the app over 6 months and will complete an EQ-5D-5L questionnaire at baseline and at the 1- and 6-month marks. Evaluation of the mobile app was performed via the mHealth App Usability Questionnaire at similar intervals.ResultsFunding for the development and trial of AYABytes was awarded in October 2020 through a National Cancer Centre Singapore research grant. Pilot testing was completed in May 2024. The implementation phase began in June 2024 and is currently ongoing.ConclusionsWe believe that AYABytes, a novel eHealth mobile app, will be both beneficial and easily used by adolescent and young adult oncology patients. Evaluating the app and its quantifiable impact on improving the quality of life of adolescent and young adult oncology patients will help enrich the evidence for mobile health interventions. It will also validate new digital approaches to help adolescent and young adult oncology patients reduce their distress and address unmet needs and concerns.International Registered Report Identifier (IRRID)DERR1-10.2196/69453

BackgroundTwo decades of research have highlighted persistent income-related health inequities in Canada across municipal, provincial, and national levels. While there is broad consensus among researchers, advocates, and health professionals that social determinants are the primary drivers of health, the empirical foundation supporting this remains relatively limited. A current renaissance in health system data access offers an opportunity to assess the multilevel impact of social factors on health inequalities, yet this potential remains underused.ObjectiveThis project aims to examine how social, economic, and political conditions shape health inequalities and investigate how structural and intermediate determinants explain disparities across national, provincial, city, neighborhood, and individual levels.MethodsWe will create the Canadian Social Determinants Urban Laboratory (CSDUL), a multilevel, longitudinal, virtual data environment that integrates 15 existing databases from Statistics Canada, the Canadian Institute for Health Information, the Canadian Urban Environmental Health Research Consortium, and DMTI Spatial. Guided by the World Health Organization social determinants of health framework, CSDUL will initially cover 2011 to 2015 due to data completeness and expand as additional years become available. CSDUL builds on Statistics Canada’s Canadian Population Health Survey and will link survey data to administrative and health records, including hospital discharges, ambulatory care, mortality, cancer registries, and longitudinal tax files. Area-level indicators will be added using historical postal codes and geospatial boundaries. Organized through a hub-and-node model, CSDUL includes a central hub and 5 research nodes. We will develop and validate area-based indicators to study social determinants at micro (individual), meso (neighborhood, city, and province), and macro (national) levels. A core deliverable is to assess the strengths and limitations of survey and administrative data for health research and derive variables accordingly. After developing CSDUL, we will replicate World Health Organization Regional Office for Europe income-related health inequality analysis for urban Canada and analyze the impact of social determinants on outcomes. We will apply a 2-fold Oaxaca-Blinder decomposition between the lowest and highest urban income quintiles. A major strength of CSDUL is its capacity to analyze how diverse determinants shape health across subgroups (eg, gender), identifying key drivers of health outcomes.ResultsThe indicators to be used in CSDUL are being developed and validated by the contributing nodes. In collaboration with node 3, we are constructing measures of social capital using DMTI Spatial Points of Interest data. A prototype version of CSDUL incorporating a limited set of indicators has been developed in Statistics Canada’s Research Data Centre. We anticipate receiving the finalized indicators from the nodes by August 2025 to September 2025 and aim to complete the decomposition analysis by December 2025.ConclusionsMultisectoral interventions are most effective when they are customized to meet the unique needs of specific subpopulations using robust and multilevel data sources such as CSDUL.International Registered Report Identifier (IRRID)DERR1-10.2196/71929

BackgroundThe COVID-19 pandemic challenged families, youth, and frontline workers, including childcare providers. Studying lived experiences before, during, and near the pandemic’s end from multiple perspectives provides a more holistic and deeper understanding of its effects and impacts.ObjectiveThis study investigated how parental, childcare provider, and youth stress, mental health, and role overload relate to individual coping and family functioning, as well as vaccine attitudes and uptake patterns among youth, parents, and childcare providers. Information learned from this investigation will inform policy and messaging for future public health crises.MethodsThis study is an explanatory sequential mixed methods study designed to capture the voices of parents of children younger than 18 years of age, childcare providers, and youth aged 12-17 years through surveys and interviews. This retrospective cross-sectional study began with a web-based survey that included demographic questions and validated scales to assess personal well-being, household and family dynamics, behavioral problems, and vaccination-related perceptions, attitudes, and behaviors. Open-ended responses about pandemic experiences for themselves and their families were included. A subsample of parents, youth, and childcare providers was selected for in-depth interviews about their pandemic-related experiences. Descriptive statistics were used to summarize demographic characteristics, and internal consistency was assessed for all survey measures using Cronbach α. Future studies will use inferential statistical techniques to analyze survey measures, thematic analysis for open-ended survey responses and interview data, and mixed methods data integration to synthesize quantitative and qualitative findings.ResultsData collection for the study began in August 2022 and finished in August 2023. Data analysis is currently in progress to address research questions, and study preparation and dissemination efforts are underway. A total of 506 adults and 93 youths answered a study survey, and 45 adults and 21 youths completed in-depth interviews. Among the 506 adults, 166 were childcare providers. The adult sample had a mean age of 42.8 (SD 9.15) years and was predominantly female (467/506, 92.3%), with 9.7% (49/506) identifying as Black, 4.7% (24/506) as Hispanic, and 81.2% (411/506) being parents of children aged 17 years or younger. The youth sample had a mean age of 14.5 (SD 1.63) years, and 55.9% (52/93) were female, 6.4% (6/93) were Black, and 17.2% (16/93) were Hispanic. Several dyads and triads participated. The sample included 42 parent-child dyads, 3 parent-parent dyads, 2 parent-parent-child triads, and 21 parent-child-child triads.ConclusionsThese data will be used to understand the diverse experiences of families, youth, and childcare providers during and after the COVID-19 pandemic. This includes successful and unsuccessful adaptations, responses to policies and mandates, and the unmet needs for health messaging, programs, policies, and services. This research aims to guide the development of effective policies and public health communication, fostering scalable and sustainable messaging resources.International Registered Report Identifier (IRRID)DERR1-10.2196/77521

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Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by social communication deficits and cognitive impairment. As pharmacological and behavioral treatments often show inconsistent efficacy, massage therapy-a low-risk complementary approach including tuina and acupressure-is used to improve cognitive symptoms, yet its systematic efficacy and safety remain unevaluated. This systematic review and meta-analysis aims to evaluate the efficacy and safety of massage therapy (categorized into traditional Chinese medicine-based and Western-based approaches) for improving specific cognitive domains (eg, executive function, attention, and memory) in individuals with ASD. Randomized controlled trials (RCTs) and cluster RCTs will be identified across 9 English and Chinese databases (including PubMed, Cochrane Library, and China National Knowledge Infrastructure) through September 2025. Two reviewers will independently perform study selection, data extraction, and risk-of-bias assessment using version 2 of the Cochrane risk-of-bias tool. A random-effects model will be primarily applied due to anticipated clinical diversity, with fixed-effects models reserved for sensitivity analyses of homogeneous data (I2=0%). Subgroup analyses will explore age, intervention context, and massage type. Evidence for primary outcomes-including checklist scores and specialized cognitive scales-will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Selection results will be summarized in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. This review will synthesize evidence on massage therapy's effects on cognitive outcomes measured using scales such as the Autism Behavior Checklist, Childhood Autism Rating Scale, and Autism Treatment Evaluation Checklist, as well as safety profiles. This study was funded in 2024. Following the September 2025 search, analysis will be completed by June 2026, with final results expected for submission in December 2026. This study will evaluate massage therapy's role in managing cognitive impairment in ASD. By synthesizing available evidence from RCTs, the findings will provide an evidence-based foundation for clinical decision-making and clarify whether manual therapies serve as safe, effective nonpharmacological adjuncts to existing ASD interventions.

BackgroundPatients undergoing maintenance hemodialysis (MHD) endure weakness due to prolonged dialysis treatment, such as the continuous decline of muscle strength in patients, which will have varying degrees of impact on human physiological, psychological, and social functions. Effective nonpharmacological interventions can improve their mental health and quality of life (QoL).ObjectiveThis study aimed to investigate the effects of sitting Baduanjin combined with acupoint massage on improving the frailty status of patients undergoing MHD and evaluate whether it can significantly improve their physical activity, alleviate depressive emotions, and comprehensively improve their QoL.MethodsThis is a randomized controlled study to be conducted in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, comprising 114 patients to be treated using MHD. Patients who meet the inclusion and exclusion criteria will be randomly divided into 3 groups: the control group will receive only conventional hemodialysis and care, the acupoint massage group will receive acupoint massage treatment in addition to the control group treatment, and the sitting combined with acupoint massage group will receive sitting Baduanjin combined with acupoint massage and the control group treatment. We aim to comprehensively evaluate the clinical efficacy by comparing the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Weight Loss) scale scores, grip strength, 10 times sit-to-stand test, Self-Rating Depression Scale scores, and QoL (Short Form Health Survey Questionnaire) scores before and after 8 weeks of treatment among the 3 groups. Statistical analysis will be conducted using the Statistical Package for the Social Sciences software (version 25.0; IBM Corporation).ResultsThe first participant was enrolled on August 8, 2024. As of August 2025, a total of 52 participants have been fully registered, and the intervention is currently in progress. We expect the completion of this trial to occur within the year 2025.ConclusionsThe results of this study can provide a scientific basis for the future treatment of patients with asthenia in hemodialysis.