Background: Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective: We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths’ mental health needs and document how they informed IMAGINE design. Methods: We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results: Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions: Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group.

In 2021, nearly 66 of every 1,000 adolescent girls ages 15–19 in the Dominican Republic gave birth. Adolescent mothers face health disparities including increased risk for rapid repeat pregnancy and lower breastfeeding rates. Mobile health (mHealth) is a growing approach for reaching adolescents. FAMA (Fortaleciendo la Autodeterminación de Madres Adolescentes) was a 12-week moderated digital education support group with adolescent mothers in the Dominican Republic, associated with improvements in health knowledge and contraceptive uptake. This study explores the FAMA intervention’s mechanism of action through a mixed-methods secondary data analysis using WhatsApp messages and post-intervention interviews to characterize experiences of social support and patterns of intervention engagement. We assessed associations between multiple measures of engagement and intervention outcomes. Linear or Poisson regression was used to evaluate association with health knowledge, and social support. or contraceptive uptake, respectively, selected based on type and distribution of each outcome variable. Models adjusted for key confounders. Findings indicate FAMA was largely used to exchange companionship and informational support. We found a significant positive association between engagement as measured by acknowledging intervention messages and improved health knowledge (adjusted coefficient: 2.84, CI: 0.83-4.84, p= 0.01). In contrast, we found a negative association between engagement as measured by social support exchange and improved health knowledge (adjusted coefficient: -5.78, CI: -10.42- -1.00, p= 0.02), suggesting that interactions focused on support may not reinforce informational content as directly as other forms of engagement. Our findings suggest that engagement with FAMA was associated with increases in knowledge and a close reading of message content is most beneficial for knowledge gain. This analysis enhances understanding of user engagement with group mHealth interventions and contributes new approaches to measure engagement, accounting for different engagement styles participants may have. Future digital interventions may leverage our findings to design interventions that encourage beneficial engagement types.

Youth experiencing homelessness and housing instability (YEH) face disproportionate health risks and structural barriers to health equity, which were intensified during the COVID-19 pandemic. We conducted a community-based participatory research study with 21 adolescents (ages 13–17) and transitional-aged youth (ages 18–26) experiencing homelessness or housing instability in San Diego, California, USA. Between February and July 2023, we conducted six “arts-based engagement sessions” (5 in English, 1 in Spanish) that blended expressive arts and focus group approaches to examine how YEH accessed, evaluated, and applied health information, and how trust and material and structural resource constraints shaped engagement with COVID-19 information and prevention guidance. We analyzed data via applied thematic analysis. Participants described how COVID-19 restrictions and economic disruption amplified pre-existing housing precarity, worsening material conditions and mental health. Participants selectively trusted COVID-19 information based on who provided it, how credible it felt, and whether it aligned with their lived experiences. Community-based providers and, for some, churches and cultural or ancestral knowledge were key information sources. Trust in government and public health messaging was conditional and shaped by perceptions of credibility, coherence, and political motivation. Participants described information overload and rapidly changing guidance as overwhelming and often incompatible with their material realities, leading to disengagement, reliance on intuition, or deprioritization of prevention behaviors. Effective communication during future health emergencies must center trusted relational messengers, align guidance with lived realities, and address the structural conditions that shape whether health information can be meaningfully acted upon.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Youth experiencing homelessness and housing instability exhibit disparities in tobacco use and co-use of tobacco and cannabis products compared to their stably housed peers. Interventions to address these disparities have had limited success to date. This may be related to a lack of fit between intervention approaches and the unique needs and preferences of this marginalized population. Leveraging strategies to facilitate authentic engagement of youth in intervention research, including collaborating with youth in the cocreation of intervention goals and strategies, presents an opportunity to overcome challenges of previous research to mitigate tobacco-related disparities among youth experiencing homelessness and housing instability. Objective: This protocol aims to engage youth collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. It outlines strategies to recruit and partner with youth to cocreate a strengths-based, expressive arts intervention to reduce harms associated with tobacco use and tobacco/cannabis co-use and evaluate our youth engagement strategies. Methods: The community and academic partners leading this intervention study developed a structure that allows for two levels of youth collaboration. This structure, developed through consultation with a youth action board, facilitates youth (aged between 14 and 26 years) involvement in intervention design, implementation, and pilot testing. At the higher collaboration level, youth will join the intervention research team as “co-researchers,” engaging weekly with study-related tasks and contributing equitably to the research processes (eg, selecting intervention strategies and supporting data analysis) in alignment with their personal and professional goals. At the lower collaboration level, youth will engage with the research team as “advisors,” providing targeted feedback at key points during intervention development. Brief surveys, field notes, ethnographic memos, focus group discussions, and semistructured interviews will be used to evaluate our process and impact among the engaged youth. Results: To date, we have engaged 7 co-researchers who have participated in several capacity-building and professional development activities, including research ethics training and tobacco prevention advocacy training. Co-researchers have contributed to intervention development brainstorming sessions, evaluated available interventions to address youth tobacco use, and developed materials to expand the group of co-researchers and advisors. Preliminary data suggest sufficient youth engagement (study goal of engaging 10 co-researchers in a 2-year study period) and that engagement processes are highly acceptable to youth collaborators. Lessons learned to date have helped us to improve and refine our engagement processes (eg, technological barriers). Conclusions: This protocol describes a holistic approach to equitably and authentically engaging youth as collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. The approach may serve as a useful model that can be adapted for other youth-focused intervention research.

Background: Youth experiencing homelessness and housing instability exhibit disparities in tobacco use and co-use of tobacco and cannabis products compared to their stably housed peers. Interventions to address these disparities have had limited success to date. This may be related to a lack of fit between intervention approaches and the unique needs and preferences of this marginalized population. Leveraging strategies to facilitate authentic engagement of youth in intervention research, including collaborating with youth in the cocreation of intervention goals and strategies, presents an opportunity to overcome challenges of previous research to mitigate tobacco-related disparities among youth experiencing homelessness and housing instability. Objective: This protocol aims to engage youth collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. It outlines strategies to recruit and partner with youth to cocreate a strengths-based, expressive arts intervention to reduce harms associated with tobacco use and tobacco/cannabis co-use and evaluate our youth engagement strategies. Methods: The community and academic partners leading this intervention study developed a structure that allows for two levels of youth collaboration. This structure, developed through consultation with a youth action board, facilitates youth (aged between 14 and 26 years) involvement in intervention design, implementation, and pilot testing. At the higher collaboration level, youth will join the intervention research team as “co-researchers,” engaging weekly with study-related tasks and contributing equitably to the research processes (eg, selecting intervention strategies and supporting data analysis) in alignment with their personal and professional goals. At the lower collaboration level, youth will engage with the research team as “advisors,” providing targeted feedback at key points during intervention development. Brief surveys, field notes, ethnographic memos, focus group discussions, and semistructured interviews will be used to evaluate our process and impact among the engaged youth. Results: To date, we have engaged 7 co-researchers who have participated in several capacity-building and professional development activities, including research ethics training and tobacco prevention advocacy training. Co-researchers have contributed to intervention development brainstorming sessions, evaluated available interventions to address youth tobacco use, and developed materials to expand the group of co-researchers and advisors. Preliminary data suggest sufficient youth engagement (study goal of engaging 10 co-researchers in a 2-year study period) and that engagement processes are highly acceptable to youth collaborators. Lessons learned to date have helped us to improve and refine our engagement processes (eg, technological barriers). Conclusions: This protocol describes a holistic approach to equitably and authentically engaging youth as collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. The approach may serve as a useful model that can be adapted for other youth-focused intervention research. International Registered Report Identifier (IRRID): DERR1-10.2196/69441

BACKGROUND Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. OBJECTIVE We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths’ mental health needs and document how they informed IMAGINE design. METHODS We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. RESULTS Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. CONCLUSIONS Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group. CLINICALTRIAL