Background: Adverse childhood experiences such as violence, substance use, and family disruption disproportionately affect youth in urban communities, increasing the risk of emotional and behavioral challenges. Social-emotional learning (SEL) and trauma-informed programming are effective strategies for mitigating these effects, fostering resilience, and promoting mental well-being. Game-based learning is a promising, engaging method for delivering SEL content. STRYV365 developed Brain Agents, a trauma-informed, game-based SEL intervention aimed at improving emotional regulation, coping strategies, and interpersonal skills among students in grades 5 through 9. Objective: This study explored students’ experiences with and perceptions of Brain Agents, evaluating its effectiveness in fostering SEL skills and resilience across 4 diverse urban schools in Milwaukee, Wisconsin. Methods: A cluster-randomized, incomplete block factorial crossover design was implemented from 2022-2024. Of 1626 eligible students, 329 (20%) had caregiver consent and student assent. Among these, 180 students in grades 5‐9 played Brain Agents at school over 4‐5 weeks, for an average of 10 sessions and 23 minutes per session. SEL-related outcomes were assessed using surveys, focus groups, and interviews. Qualitative data were analyzed using Dedoose software, with thematic coding conducted by multiple coders to ensure reliability. Results: Student demographics included 189/321 (58.9%) Black, 112/321 (34.9%) White, and 221/321 (68.8%) from economically disadvantaged backgrounds. Baseline surveys of 277 children revealed that 202 (72.9%) of students had experienced the death of someone close, 147 (53.1%) had a close contact incarcerated, and 39 (14.1%) reported feeling nervous or anxious daily. Strengths included 230 (83.0%) students reporting life satisfaction and 183 (66.1%) able to calm down when upset. Game performance data from 328 students indicated varying levels of achievement, with a median of 3 (IQR 1.5-4) missions completed, 4 (IQR 2-6) stars earned, 8 positive energies collected, and 2 (IQR 1-2.5) crew members rescued. Grades 7‐8 had the highest engagement, while grade 9 students had the lowest participation. Qualitative analysis from 62 participants identified 8 core themes: qualities of most pride, neighborhood relationships, challenges in life, emotions associated with loss of control, coping strategies, future goals, experiences with Brain Agents, and suggestions to improve the game. Students most frequently cited anger as a cause of emotional dysregulation and named coping strategies such as self-calming, asking for help, and perseverance. Feedback on Brain Agents highlighted improved focus, emotional control, and critical thinking, with younger students more positively engaged. Suggested improvements included better graphics, more customization, and cooperative play. Conclusions: Brain Agents was positively received by students, particularly those in earlier grades, and demonstrated potential as an effective trauma-informed SEL tool. The findings support the role of game-based interventions in enhancing resilience and emotional intelligence among youth exposed to adversity. Broader implementation may extend benefits to diverse student populations and settings.

Background: Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. Objective: We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. Methods: The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. Results: Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: “interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective.” Conclusions: We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities.

Background: Rates of prediabetes and type 2 diabetes are alarmingly high among racial/ethnic minority youth. The current study examines the virtual adaptation of an in-person peer-led youth diabetes prevention program. Methods: The initial phase involved the study team adapting workshop sessions from an in-person to a virtual format (Zoom). We conducted a 2-h feasibility pilot in December 2020 and implemented the full 12 session pilot program from June to September 2021 with 14 prediabetic adolescents recruited from our hospital-based general pediatric clinic. Weekly sessions were led by trained peer educators and focused on promoting healthy eating and physical activity using behavioral techniques (e.g., goal setting, brainstorming, and problem solving). Results: The virtual adaptation of our program was shown to be feasible and acceptable among our pilot participants. We were able to deliver the same workshop content and behavioral skills development as the in-person workshop using a variety of Zoom features. Conclusions: Our peer-led youth diabetes prevention program was successfully adapted and implemented in a virtual format and was well accepted by at-risk youth. Future research is needed to examine the impact of virtual youth lifestyle interventions on behavioral and clinical outcomes such as weight and diabetes risk.

Objectives: Once the COVID-19 pandemic arrived in New York City (NYC), stay-at-home orders led to more time spent indoors, potentially increasing exposure to secondhand marijuana and tobacco smoke via incursions from common areas or neighbors. The objective of this study was to characterize housing-based disparities in marijuana and tobacco incursions in NYC housing during the pandemic. Design: We surveyed a random sample of families from May to July 2020 and collected sociodemographic data, housing characteristics, and the presence, frequency, and pandemic-related change in incursions. Setting: Five pediatric practices affiliated with a large NYC health care system. Participants: In total, 230 caregivers of children attending the practices. Main Outcome Measures: Prevalence and change in tobacco and marijuana smoke incursions. Results: Tobacco and marijuana smoke incursions were reported by 22.9% and 30.7%, respectively. Twenty-two percent of families received financial housing support (public housing, Section-8). Compared with families in private housing, families with financial housing support had 3.8 times the odds of tobacco incursions (95% CI, 1.4-10.1) and 3.7 times the odds of worsening incursions during pandemic (95% CI, 1.1-12.5). Families with financially supported housing had 6.9 times the odds of marijuana incursions (95% CI, 2.4-19.5) and 5 times the odds of worsening incursions during pandemic (95% CI, 1.9-12.8). Children in financially supported housing spent more time inside the home during pandemic (median 24 hours vs 21.6 hours, P = .02) and were more likely to have asthma (37% vs 12.9%, P = .001) than children in private housing. Conclusions: Incursions were higher among families with financially supported housing. Better enforcement of existing regulations (eg, Smoke-Free Public Housing Rule) and implementation of additional policies to limit secondhand tobacco and marijuana exposure in children are needed. Such actions should prioritize equitable access to cessation and mental health services and consider structural systems leading to poverty and health disparities.

There have been few youth-led diabetes prevention programs. Our objective was to conduct focus groups to explore peer influences on adolescent lifestyle behaviors and strategies for implementing a youth peer education model for diabetes prevention. We conducted six focus groups with 52 youth (ages 13–22; 62% male, 38% female; 64% Hispanic, 36% non-Hispanic Black) from East Harlem, NYC. We used a Thematic Analysis approach to identify major themes, compared findings, and resolved differences through discussion and consensus. Three dominant themes arose: (1) Adolescents generally encounter more unhealthy peer influences on diet and more healthy peer influences on physical activity; (2) Adolescents endorse youth-led diabetes prevention strategies and describe ideal qualities for peer leaders and methods to support and evaluate leaders; (3) Adolescents prefer text messaging to monitor behaviors, track goals, and receive personalized guidance. Using study findings, our Community Action Board developed a peer-led diabetes prevention program for prediabetic adolescents.