This study examines how the 8-week Hoosier Sport program impacts cardiovascular disease (CVD) risks by promoting physical activity (PA) among rural, low-income children. Using a human-centered participatory co-design approach, the program aimed to increase PA levels (e.g., total PA, daily steps) in at-risk children. The present study explored the feasibility of the intervention as well as physiological and psychological changes across the intervention using a hybrid type 2 design (a model that evaluates both the effectiveness of an intervention and its implementation in real-world settings). Favorable feasibility indicators like attendance, acceptability, and compliance, with a 23.3% recruitment rate and 94.3% retention rate, were observed. Moreover, participants attended over 80% of sessions across the 8 weeks. Accelerometers (AX3) tracked daily steps and total PA for 7 days before and after the intervention, revealing increased PA levels throughout. At post-intervention, notable improvements were observed in psychological factors such as autonomy, social competence, and global self-worth. This study highlights the importance of tailored PA interventions in schools, emphasizing their potential to improve PA levels among rural, low-income children.

Purpose: This investigation aimed to explore relationships among health behaviors, psychological factors, and body image in rural adolescents. Design: A cross-sectional survey was conducted. Setting: The study took place in a rural school in the Midwest region of the United States. Subjects: Participants (n = 45) were rural adolescents (6th-9th grade). Measures: Physical activity was assessed using the CAPL-2 and IPAQ, social media usage and addiction were evaluated through daily screen time and the BSMAS, body image was measured using the BSQ and BAS-2, anxiety levels were assessed with the GAD-7, and interoceptive abilities were measured by the MAIA-Y. These measures are validated for use in adolescent populations. Analysis: Linear regression models examined relationships between physical activity, social media usage, anxiety, body image, and interoceptive abilities. Effect sizes for significant predictors were determined using Cohen’s d. Results: Novel relationships were identified among rural adolescents, including a positive association between body appreciation and physical literacy (d = 0.322, P = 0.002), a negative association between body appreciation and social media addiction (d = 0.866, P < 0.001), and a positive association between social media addiction and anxiety levels (d = 0.341, P < 0.001). Conclusion: Social media impacts the well-being of rural adolescents. Promoting physical literacy and social media literacy may mitigate negative effects and should be prioritized in future interventions.

Background: Physical inactivity in the U.S. poses a significant risk of developing chronic health factors associated with cardiovascular disease. Children from rural communities are especially vulnerable to inactivity. The Hoosier Sport program aims to address this by working to increase physical activity in 6th and 7th grade students in a rural Indiana middle school. Hoosier Sport uses sport participation coupled with health education delivered by college-service learning students to establish healthy behaviors that children can sustain throughout their life. The purpose of this prospective longitudinal study was to evaluate the implementation of Hoosier Sport in a rural middle school, using a multi-component evaluation approach. Methods: This prospective program evaluation study utilized The Consolidated Framework for Implementation Research (CFIR) to assess feasibility outcomes such as recruitment, retention, fidelity, attendance, acceptability, and cost. CFIR was incorporated through surveys completed by Hoosier Sport team members to identify facilitators and barriers. Fidelity was measured using SOSPAN and SOFIT tools. SOSPAN (System for Observation of Staff Promotion of Activity and Nutrition) monitored staff interactions with children during physical education classes. SOFIT (System of Observing Fitness Instruction Time) evaluated the duration and type of activities in each lesson context. For our descriptive analysis, we calculated means and standard deviation for continuous variables and percentages for categorical variables. Results: All feasibility measures met or exceeded the a priori threshold, indicating high success. Fidelity was high among college student implementers and child participants. SOSPAN showed that staff did not use physical activity as punishment, engaged in physical activity 62.5% of the time, provided verbal encouragement 87.5% of the time, and used elimination games only 2.5% of the time. SOFIT revealed significant promotion of moderate-to-vigorous physical activity, with 94% during the 4-week strength training intervention and 95% during the 4-week basketball intervention. The barrier buster tool identified general agreement with most statements, indicating promising system-level acceptability. Conclusion: The study results demonstrate successful feasibility, high fidelity, and promising system-level acceptability. These findings underscore the importance of continued refinement and repeated evaluation of the program in alignment with the ORBIT model. The use of college student implementers presents a sustainable model that benefits all participants involved.

Sport-based youth development programs, delivered through campus–community partnerships, can create impactful experiences for college students, meet university objectives, and improve the health of children in under-resourced rural communities. This study aimed to pilot test intervention mapping (IM), a systematic approach to intervention development and implementation, to refine the Hoosier Sport intervention, which is a local public health initiative that utilizes the Obesity-Related Behavioral Intervention Trials (ORBITs) model to improve physical activity in middle school children. The IM process, which included a diverse IM planning and advisory group of university representatives and local schools, was guided by self-determination theory (SDT) and social cognitive theory (SCT) and followed four steps: Logic Model of the Problem, Logic Model of Change, Program Design, and Program Production. Using SDT and SCT, we identified our personal determinants as autonomy, competence, and relatedness, while our environmental determinants were role-modeling and sports equipment access. We then created change methods and practical applications for refining and implementing our intervention and gathered pilot test data to assess the feasibility of the intervention. The IM process provided a more robust and evidence-based approach to intervention design and production, while involving stakeholders to foster meaningful collaboration and increase program success. By using IM in program development, public health interventions that promote youth development through sport will likely be more easily scaled up.

Background/Objectives: Physical inactivity and sedentary lifestyles remain leading behavioral risk factors for chronic disease across generations. Mothers with young children face unique barriers to exercise, including time constraints, fatigue, and limited access to supportive environments. Lion Hearts was developed to address these barriers through a family-centered, community-based approach that integrates physical activity, strength training, and health education. This protocol describes the systematic application of the Intervention Mapping (IM) framework to develop Lion Hearts, a multigenerational CrossFit-based program for mothers and children. Methods: Following the first four steps of the IM framework—needs assessment, matrices, intervention design, and program creation—behavioral determinants were identified through literature review, national data, and community input. The resulting 12-week program integrates twice-weekly family CrossFit sessions, monthly cardiovascular health workshops, and weekly home-based challenges delivered through local affiliates using a train-the-trainer model. Results: IM produced a theoretically grounded and evidence-based intervention targeting individual (self-efficacy, outcome expectations), interpersonal (modeling, relatedness), and environmental (access, social support) determinants. The process resulted in detailed logic models, behavior change matrices, and implementation materials, including family handbooks and coach guides. Conclusions:Lion Hearts represents a scalable, multigenerational approach to CVD prevention that leverages existing community fitness infrastructure. By embedding prevention within family systems and CrossFit affiliates, the program offers a sustainable, replicable model to enhance physical activity, strengthen family health behaviors, and reduce intergenerational CVD risk.

Cardiovascular disease remains the leading cause of death in the United States, with rural communities experiencing elevated risk. Youth in rural settings are particularly vulnerable, reporting worse health outcomes than their urban peers. The growing influence of social media has added complexity to adolescent health behaviors, particularly among youth experiencing challenges with physical and mental well-being. This qualitative study presents findings from a co-design initiative conducted with rural middle school students to examine adolescents’ views on body image, social media use, and engagement in physical activity, and to inform the development of the Hoosier Sport Re-Social intervention. Fourteen middle school students (grades 7–8) from a rural community participated in a structured co-design process spanning five sessions over nine weeks. A deductive thematic analysis was employed using Basic Psychological Needs Theory (BPNT) and Social Comparison Theory (SOCO) as guiding frameworks.