Kate Guastaferro’s research while affiliated with New York University and other places

Background Using the multiphase optimization strategy (MOST) framework, we aimed to identify an optimized mHealth-delivered intervention for reducing recreational sedentary screen time (rSST) by at least 60 min/day among adults. Methods Eligible participants were 23–64 years old and self-reported elevated rSST (> 3 h/day). Following a 7-day baseline, participants received a core mHealth application (self-monitoring and 50% reduction target and educational materials) and were randomly assigned to three additional components set to on/off in a full-factorial (2³) experiment: LOCKOUT: rSST electronically restricted; TEXT: rSST reduction prompts; and EARN: rSST through physical activity. rSST was assessed at baseline and 16 weeks via an integrated measure that included objectively assessed sedentary time (activPAL accelerometer) and screen time (TV Wifi plugs and tablet usage). We used a linear mixed effect model to evaluate the change in rSST for the three intervention components and their interactions. Results A total of 82% of the randomized participants (N = 110) were female, with a mean ± SD age of 41 ± 11.7 y and a BMI of 29.7 ± 7.8 kg/m2, and their mean (95% CI) rSST was 184.7 (172.8, 196.5) min/day at baseline. The expected difference (baseline vs. 16 weeks) in rSST was greatest for the intervention versions with the core plus EARN on with an average reduction of -118.1 (-163.0, -73.1) min/day and for core plus LOCKOUT, TEXT, & EARN on (-125.7 [-172.0, -79.3] min/day). Conclusions We identified several promising intervention versions that exceeded our optimization objective. This study provides important evidence on efficacious multicomponent interventions that should be moved forward to the evaluation phase of the MOST framework to test the effect of rSST reductions on health outcomes. Trial registration (clinicaltrials.gov NCT04464993)

Importance Child sexual abuse (CSA) impacts 15% of girls and 8% of boys worldwide, incurring high public costs and devastating consequences for survivors. US incidence rates have stagnated over the past 15 to 20 years, signaling a dire need for innovation in primary prevention. In 2024, the US Preventive Services Task Force reported that there is insufficient evidence for the effectiveness of child abuse preventive strategies, and none have shown decreases in incidence rates at the population level. Objective To test whether a coordinated, community-wide preventive intervention could significantly reduce population-level incidence rates of CSA. Design, Setting, and Participants This population cohort study used synthetic control methods with a counterfactual condition and CSA incidence data from a statewide child welfare information system. Participants included a population-based sample in the state of Pennsylvania. Intervention From 2018 through 2020, the state of Pennsylvania launched a 3-pronged CSA prevention intervention in 5 counties that included: (1) exposing 5% of the adult population (approximately 72 000) to online and in-person trainings with an accompanying countywide media campaign, (2) delivering a psychoeducation program to 100% of second-grade students (approximately 17 000), and (3) providing parent training to 100% of parents served by the child welfare system (approximately 300). Intervention counties were a priori matched to 1 of 5 control counties based on population size and preintervention CSA rates. Main Outcomes and Measures Aggregate rates of both substantiated and unsubstantiated CSA reports were examined across intervention and control counties for 5 preintervention years and 3 postintervention years. Results Within 1 year of intervention launch, CSA reports were significantly reduced in intervention counties, as compared with control counties for both substantiated (average treatment of the treated [ATT] = −17.22; 95% CI, −34.15 to −4.20) and unsubstantiated reports (ATT = −36.04; 95% CI, −74.40 to −3.88). Conclusions In this evaluation of a place-based, coordinated, countywide intervention, reports of both substantiated and unsubstantiated CSA were shown to be significantly reduced at the population level.

Background Using the multiphase optimization strategy (MOST) framework, we aimed to identify a feasible, acceptable and optimized set of mHealth-delivered behavioral strategies for reducing recreational sedentary screen time (rSST) by at least 60 min/day. Methods Eligible participants were 23–64 years old and had high rSST (> 3 h/day). We used a full factorial (23) design in which participants received a “core” mHealth application and were randomized to combinations of three components (on vs. off): LOCKOUT: rSST electronically restricted; TEXT: rSST reduction prompts; and EARN: rSST through physical activity. rSST was assessed at baseline and at 8 and 16 weeks of age via an integrated measure of sedentary time and screen time. We used a linear mixed effect model to test the change in rSST for the three intervention components and their interactions. Results A total of 82% of the randomized participants (N = 110) were female, with a mean ± SD age of 41 ± 11.7 y and a BMI of 29.7 ± 7.8 kg/m2, and their mean (95% CI) rSST was 184.7 (172.8, 196.5) min/day at baseline. The expected difference (baseline vs 16 weeks) in rSST was greatest for the intervention versions with a core, LOCKOUT, TEXT, & EARN (−125.7 [−172.0, −79.3] min/day) at the “on” level. The participants were satisfied with the study and found the app helpful in reducing rSST (> 94%). Technical issues resulted in 20% being somewhat dissatisfied with the app. Conclusions We identified several promising intervention versions that exceeded our optimization objective. The intervention version that included core, LOCKOUT, TEXT, & EARN components “on” was efficacious, feasible and acceptable and should be used to test the effect of rSST reductions on health outcomes. Trial registration (clinicaltrials.gov NCT04464993)

Background Adaptation is widely recognized as important when interventions are to be delivered in new settings or with new populations. However, there are gaps in the literature on how adaptations are carried out and documented. IMARA is a 12-h evidence-based sexual health intervention for Black teens and their mothers, designed for delivery over two days. We present our systematic process of adapting IMARA for Latinas to produce the Floreciendo (“Blooming”) program for Latina teens (14–18 years old) and their female caregivers (e.g., mothers, sisters). Methods Using a community-based participatory research (CBPR) approach, we carried out a qualitative study that included 7 focus groups: 4 with staff from community partner organizations (n = 29), 2 with Latina teens (14–18 years) (n = 11), and 1 with female caregivers (n = 5). We also conducted seven key informant interviews with experts in sexual health and Latina health. We used Escoffery’s recommended steps to guide our adaptation process. Data were thematically coded and adaptations documented using the FRAME for reporting modifications to evidence-based interventions. Results Informed by the data, we grouped IMARA content into four sessions for Floreciendo, each with unique curricular content and designed to be delivered in two hours (eight hours total): (1) Foundations in Sexual Risk Prevention; (2) Condoms and Contraception; (3) Family Strengthening; and (4) Gender and Relationships. We documented adaptations made for each session. For example, participants emphasized unplanned pregnancy as an important issue facing Latina teens. In response, we added an activity providing hands-on experience with contraceptive methods. Participants also highlighted how gender norms and family expectations in Latine culture shape Latina teens’ sexual and reproductive health practices. We therefore developed activities and opportunities for discussion addressing these cultural influences. We removed IMARA activities considered of lower priority (e.g., portrayal of women in the media). Conclusion This study addresses gaps in the literature by reporting in detail the adaptations we made to an evidence-based intervention using qualitative methods. The four curriculum sessions we generated through our adaptation process will form the basis of the intervention components we will test in future work using the multiphase optimization strategy (MOST) framework.

Background Child sexual abuse (CSA) is a significant public health concern, and there is a lack of universal, evidence-based primary prevention interventions that extend beyond a focus solely on children. Parents remain a consistently underutilized target for primary prevention efforts aimed at mitigating CSA despite their unique relationship and close proximity to their children. CSA risk is not confined to any specific demographic, and its effects on affected children are well-documented, significantly impacting numerous dimensions of their wellbeing. Thus, there is a clear and urgent need to address this gap in prevention strategies. Methods This study will use a quasi-experimental design (target N = 412) to examine potential gains in CSA-related awareness and intentions to use protective behaviors among parents who participate in a universal parent-focused CSA prevention workshop, Smarter Parents. Safer Kids., compared to those who do not. Participants in both the control (n = 206) and experimental group (n = 206) will complete 3 survey assessments: Survey 0 (baseline), Survey 1 (1-month), and Survey 2 (3-month follow-up). The experimental group will participate in a Smarter Parents. Safer Kids. workshop between the Surveys 0 and 1. We will use data collected from the baseline to measure potential mediators of CSA-related awareness and intention to use protective and preventive behaviors. In adjacent efforts to enhance the curriculum’s reach with future dissemination and implementation, we will also explore the impact of recruitment materials and strategies on parental engagement. Conclusion Results of this study will advance efforts to implement parent-focused CSA prevention with a universal audience.

Background Practical examples of studies integrating implementation science and the multiphase optimization strategy (MOST) framework are lacking. Floreciendo is a sexual and reproductive health program for Latina teens and their female caregivers, adapted from the IMARA evidence-based program. Purpose We prepared for delivering Floreciendo by developing an implementation plan to support the program’s adoption and sustainment. Methods Drawing on a community-based participatory research approach, we used qualitative methods to explore program logistics, implementation determinants and strategies, adoption, and sustainability. We positioned our study activities within the preparation phases of both the MOST and the EPIS frameworks. We conducted and rapidly analyzed seven focus group discussions—one with Latina teens (n = 9), one with female caregivers (n = 6), four with organizational staff (n = 32), and one with IMARA staff (n = 6)—and seven key informant interviews. Results Participants described community organizations as the preferred location for workshops in offering a “safe space.” They recommended workshop delivery on two days over separate weekends. Teens and caregivers requested relatable, bilingual Latina facilitators. Implementation barriers were raised (e.g. work conflicts) with strategies to address them (e.g. provide stipends). Organizational adoption was perceived as likely since the workshop addresses clients’ needs and fits with organizational values. Recommendations for sustainment included identifying funding opportunities specific to each organization. Conclusions Findings directly informed our immediate plans to optimize Floreciendo using the MOST framework and principles and our long-term goals for adoption and sustainability. Implementation science can strengthen studies using the MOST framework.

As occupational therapy research advances and the body of evidence supporting effective interventions continues to grow, there is a need to expedite the transfer of research findings into practice, and the use of intervention development frameworks becomes increasingly essential. In this column, we introduce the Multiphase Optimization Strategy (MOST), an engineering-inspired framework for the development, optimization, and evaluation of multicomponent interventions. MOST allows for the systematic development and evaluation of optimized interventions that prioritize effectiveness within constraints like affordability, scalability, and efficiency. Using MOST while developing an intervention may reduce the delay between intervention development and real-world implementation. Moreover, adopting MOST will bolster the use of rigorous research designs in occupational therapy studies and foster shared terminology with other disciplines that have successfully applied this framework across a range of health priorities and conditions. Thus, we advocate integrating MOST into occupational therapy intervention development research.

Purpose: Breastfeeding initiation and longer duration are known to reduce risk of breast and ovarian cancer. While racial disparities in breast cancer diagnosis and mortality rates exist in the United States, disparate rates of breastfeeding initiation and duration continue to widen. The positive effects of these community lactation support through peer education programs among Black mothers have been demonstrated, but these programs are limited by the lack of reach to vulnerable families. Integration of lactation education and support within parenting programs targeting complementary maternal behaviors, such as psychosocial stress does not exist. This proof-of-concept study uses novel Systematic Braiding methodology to develop an integrated maternal behavior parenting curriculum. Methods: In line with the systematic braiding technique, key stakeholders of two evidence based programs, Intergen (a culturally competent breastfeeding peer-educator program) and SafeCare® (a widely disseminated evidence-based parenting program), were consulted to identify core program components, shared and unique theoretical constructs, and programmatic targets including: population of interest, behaviors, delivery mode, program content, dose and length, assessment, fidelity monitoring. Results: 10 program developers and content experts identified shared and unique theoretical constructs and programmatic targets including: population of interest – at-risk minority parents, behaviors (parenting, breastfeeding, and cancer prevention), delivery mode (in person and self-guided), program content, dose and length, assessment, and fidelity monitoring. Areas of integration were captured to inform the braiding of the new curriculum based in social cognitive theory and the theory of planned behavior including modules on cancer education, prevention through breastfeeding, and screening were captured to inform the braiding of the new curriculum. Future directions will assess the acceptability and feasibility of the braided curriculum via user-centered feedback across informants from each of four key informant groups: 1) target recipients of the curriculum including Black women, <36 weeks gestation; 2) potential program providers; 3) community health care professionals; and 4) state-level legislative representatives. Interim findings will be presented. Discussion: There is limited exploration on using widely disseminated parenting programs to increase breastfeeding uptake among African American mothers. This study takes first steps towards developing a robust intervention to increase the reach of breastfeeding education to expecting African American mothers through a widely disseminated parenting model. Improving knowledge of cancer prevention through breastfeeding along with behavior (initiation and duration) among this at-risk population may positively impact breast and ovarian cancer risk. Citation Format: Marlo Vernon, Ashwini Tiwari, Elinita Pollard, Biplab Datta, Zach Hoffman, Kate Guastaferro, Shannon Self-Brown. Addressing health disparities around breastfeeding: Development of a braided curriculum [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B070.