Objectives: This paper presents the results of a study developed to inform the design of a multigenerational digital lifestyle intervention for overweight/obese women cancer survivors and their families. We followed the first six phases of the Integrate, Design, Assess, and Share (IDEAS) framework.Methods: Grandmothers with breast, endometrial, or ovarian cancers (n = 46;66.1 ± 0.9 years old; 34% Hispanic, 33% non-Hispanic black, 33% non-Hispanic white) self-reported their lifestyle behaviors, family structure, mobile device use, and interest in a family-based lifestyle intervention. A randomly selected subset of 21 participants subsequently completed qualitative interviews to understand their family relationships, weight-related challenges, and feedback on intervention prototypes.Results: Participants reported low fruit intake (0.9 ± 0.1 servings/day), moderate vegetable intake (3.0 ± 0.2 servings/day), and high levels of moderate physical activity (990 ± 234 MET-minutes/week). The majority owned a smartphone (93%) and expressed interest in family-based programs (80%) that focused on weight management (91%). Qualitative data were collapsed into seven intervention considerations, including: capitalizing on existing familial support, involving local family who need lifestyle change, tapping into survivors' internal strengths, validating prior weight loss, overcoming barriers to sustained lifestyle change, providing information on cancer risk, and motivating families through reinforcing activities.Conclusions: Following the IDEAS framework, our next steps are to develop a fullyfunctioning prototype and conduct a randomized pilot trial to test the feasibility and effects of a digital intervention that empowers racially/ethnically diverse overweight/obese women cancer survivors to improve their physical activity and dietary intake and to lose weight by encouraging healthy lifestyle behaviors in their children and grandchildren. K E Y W O R D Scancer, digital health, family-based, lifestyle behaviors, obesity, oncology, multigenerational, nutrition, physical activity, prevention

Background: Previous literature has shown a negative relationship between parental stress and youth moderate to vigorous physical activity (MVPA). This study examined (1) the relationship between parental stress and adolescent MVPA, (2) the moderating role of family communication on this relationship, and (3) gender differences in these effects among overweight and obese Hispanic adolescents. Methods: Hispanic adolescents (N = 280, 52% female, 13.0 [0.8] y old, 44% obese, 12% severely obese) and their parents (88% female, 44.9 [6.5] y old) completed baseline measures for an efficacy trial. Adolescents self-reported MVPA in minutes per week for work, transportation, and recreation using a validated measure. Multiple regression analyses with interaction terms and multigroup methods were conducted. Results: There was a negative effect of parental stress on adolescent MVPA (β = −0.15, t = −2.018, P ≤ .05). This effect was moderated by family communication (β = 0.20, t = 2.471, P = .01), such that the association between parental stress and youth MVPA was stronger for adolescents with low levels of family communication. Furthermore, a multiple group model showed that the interaction was significant for boys (β = 0.27, t = 2.185, P = .03), but not for girls. Conclusions: Findings provide support that addressing parental stress and family communication may help facilitate MVPA among Hispanic boys, the most at-risk group for pediatric obesity.

Physical inactivity is a major public health issue among older adults and children. This study presents preliminary results that will inform the development of a technology-based physical activity intervention for grandparents and grandchildren (ages 6–12 years old). The authors used an iterative user-centered design framework to gather quantitative data from grandparents (n = 35) and subsequently invited a subset of 12 of them to engage in qualitative interviews. Participants were 63.1 ± 9.8 years old, 80% female, 64% U.S.-born, 43% Hispanic, 66% single, and 40% <$15K income. The majority of grandparents reported mobile device proficiency, very close relationships with their grandchildren, and interest in participating in an intergenerational intervention. Four key themes related to family closeness, dynamics, routines, and technology informed intervention development. Next steps involved a pilot trial using Fitbits and a fully functioning technology-based prototype. Grandparents are uniquely positioned within their families to serve as agents of change in health-promoting interventions.

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Background:Women with metastatic breast cancer face unique challenges as they cope with life-limiting prognoses and arduous treatments. However, the vast majority of research has focused on optimizing quality of life in women with early-stage, nonmetastatic breast cancer and little is known about supportive care needs among women living with metastatic cancer. As part of a larger project that sought to inform the development of a psychosocial intervention, the aim of this study was to characterize supportive care needs among women with metastatic breast cancer and elucidate challenges unique to living with a life-limiting prognosis.Methods:Four, 2-hour focus groups with 22 women were audio-recorded, transcribed verbatim, and analyzed in Dedoose using a general inductive approach to code categories and extract themes.Results:A total of 16 codes emerged from 201 participant comments regarding supportive care needs. Codes were collapsed into four supportive care need domains: (1) psychosocial, (2) physical and functional, (3) health system and information, and (4) sexuality and fertility needs. The most prevalent needs were breast cancer–related symptom burden (17.4%), lack of social support (14.9%), uncertainty (10.0%), stress management (9.0%), patient-centered care (7.5%), and sexual functioning (7.5%). More than half of needs (56.2%) were in the psychosocial domain, and more than two-thirds of needs (76.8%) were in the psychosocial and physical and functional domains. Supportive care needs unique to living with metastatic breast cancer included the cumulative effects of continuously undergoing cancer treatment on symptom burden, worry from scan-to-scan regarding response to cancer treatments, diagnosis-related stigma and social isolation, end-of-life concerns, and misconceptions regarding metastatic breast cancer.Conclusions:Findings suggest that women with metastatic breast cancer have unique supportive care needs compared with women with early-stage breast cancer that are specific to living with a life-limiting prognosis and are not typically captured in existing self-report measures of supportive care needs. The results also highlight the importance of addressing psychosocial concerns and breast cancer–related symptoms. Women with metastatic breast cancer may benefit from early access to evidence-based interventions and resources that specifically address their supportive care needs and optimize quality of life and well-being.