Feasibility and Preliminary Outcomes of a School-Based Intervention to Promote Body Image in Rural Adolescents: The Hoosier Sport Re-Social Pilot Study

Feasibility and Preliminary Outcomes of a School-Based Intervention to Promote Body Image in Rural Adolescents: The Hoosier Sport Re-Social Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility and Preliminary Outcomes of a School-Based Intervention to Promote Body Image in Rural Adolescents: The Hoosier Sport Re-Social Pilot Study Janette M. Watkins, Janelle Goss, Autumn Schigur, Megan Kwaiser, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7365890/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Adolescents in rural communities face unique barriers to physical and mental well-being, including limited recreational resources and high exposure to social media, which can negatively affect body image. Hoosier Sport Re-Social is a school-based program designed to improve body image, enhance social media literacy, and increase physical activity among rural middle school students. This pilot study evaluated the program’s feasibility and explored preliminary behavioral and psychosocial outcomes. Methods A 4-week intervention was delivered during health and physical education classes to students in grades 6–8 at a rural Midwestern middle school. The program integrated sport skill development, body confidence lessons, and social media literacy activities. Feasibility was assessed through the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure, along with attendance and retention rates. Outcomes included daily physical activity (accelerometry), social media usage (phone-recorded screen time), social media literacy, body satisfaction, body appreciation, and basic psychological needs satisfaction. Paired-sample t-tests examined pre- to post-intervention changes, and linear mixed-effects models explored behavioral predictors of body image change, adjusting for age and gender. Results Thirty-two students (53% female; mean age 12.7 years) participated. Median feasibility scores exceeded the a priori success threshold for both adolescents and implementers. Attendance averaged 93% for participants and 99% for implementers. From pre- to post-intervention, daily physical activity increased (p = .002) and social media use decreased (p = .008). Body dissatisfaction decreased (p = .002; large effect size), and body appreciation increased (p = .011; moderate-to-large effect size), with greater improvements observed in participants who increased physical activity (interaction p = .022). Social media literacy scores significantly improved (p < .001), while social media addiction and basic psychological needs satisfaction showed no significant change. Conclusions The Hoosier Sport Re-Social program was feasible, well-received, and associated with positive changes in physical activity, social media use, and body image among rural adolescents. Findings support further evaluation with larger, more diverse samples and longer follow-up to assess sustainability and scalability. Trial registration: Retrospectively registered at ClinicalTrials.gov (NCT06556719; registration date: February 3, 2025). health promotion body positivity social media literacy physical activity Figures Figure 1 Figure 2 Introduction Adolescents in rural communities encounter challenges that uniquely impact their physical and mental health, such as limited access to healthcare, recreational facilities, and social support systems, creating disparities in health outcomes compared to their urban counterparts [ 1 ]. These challenges are increasingly compounded by growing reliance on social media platforms, which have transformed the way adolescents connect, communicate, and perceive themselves [ 2 ]. While social media offers potential benefits such as fostering connections and promoting self-expression, it also poses significant risks to mental health, particularly through its impact on body image and self-esteem [ 3 ]. For adolescent girls, in particular, the pervasive nature of curated and idealized images on social media has been linked to the development of negative body image [ 4 ]. This phenomenon is concerning as poor body image is associated with a range of adverse outcomes, including reduced self-worth, higher levels of anxiety, and disordered eating behaviors [ 4 , 5 ]. Additionally, negative body image has profound implications for health behaviors, notably contributing to disengagement from physical activity (PA) and organized sports [ 6 ]. Sports participation is a critical factor in promoting physical health and psychological resilience, offering potential benefits such as improved cardiovascular fitness, reduced stress, and enhanced social connections [ 7 ]. However, body image concerns, such as feeling self-conscious about their bodies, often discourage adolescent girls from participating in sports [ 8 ], particularly in rural areas where opportunities for structured PA may already be limited [ 9 ]. Indeed, research shows that 45% of females will quit sports by the age of 14, due to poor body image [ 10 ]. Disengagement from PA not only hinders physical health, but also exacerbates mental health challenges, including heightened anxiety. PA plays a critical role in promoting mental well-being by reducing symptoms of anxiety and depression, enhancing self-esteem, and fostering resilience in adolescents [ 11 ]. Studies have demonstrated that regular PA triggers the release of endorphins and other neurochemicals that improve mood, while also reducing physiological stress markers such as cortisol levels [ 12 ]. Furthermore, engaging in sports or recreational activities can provide adolescents with a sense of accomplishment and social connection, both of which are protective factors against mental health difficulties [ 7 ]. Conversely, reduced participation in PA can lead to a vicious cycle of declining physical health and worsening mental well-being. Adolescents who disengage from PA are at greater risk of developing chronic health conditions such as obesity and cardiovascular disease, which can negatively impact self-esteem and further contribute to mental health challenges [ 13 ]. Additionally, sedentary behavior has been linked to increased screen time, particularly on social media, which can amplify body image concerns and feelings of social isolation [ 3 ]. This cycle is especially pronounced in rural areas, where adolescents often face structural barriers to participation in PA, including limited access to recreational facilities, organized sports, and transportation [ 14 , 15 ]. Hoosier Sport Re-Social is a school-based intervention for rural adolescents (grades 6–8) designed to reduce high social media use and increase physical activity (PA). Using a multilevel approach, it promotes body positivity, social media literacy (the ability to access, analyze, evaluate, create, and act using all forms of communication) [ 16 , 17 ], and sport skill development through PE and health classes, along with take-home activities. At the individual level, it enhances knowledge, motivation, and self-efficacy for PA and media literacy, supporting positive body image. Interpersonally, it fosters peer support, family engagement, and healthy social norms to reduce high social media use (defined as 3 + hours daily) [ 18 ] and encourage sport participation. At the community level, it integrates evidence-based curricula to promote inclusive, body-positive environments. By teaching media literacy and body appreciation, it helps adolescents resist harmful online comparisons and validation-seeking behaviors [ 4 , 19 ]. Additionally, Self-Determination Theory (SDT) [ 20 ] was used to create the framework of the Hoosier Sport Re-Social. SDT examines human motivation by identifying conditions that foster optimal engagement and those that inhibit or undermine self-motivation, social functioning, and personal well-being. Both unstructured and structured PA have been effective in satisfying basic psychological needs among adolescents [ 21 ]. Moreover, satisfying basic psychological needs has been linked to increased participation in PA among adolescents [ 22 ]. This alignment not only enhances their overall well-being but also contributes to positive developmental outcomes during the critical developmental period of adolescence [ 23 ]. Indeed, adolescents who are able to satisfy their psychological needs through PA may be more likely to participate in that behavior. Therefore, SDT was a key part of the proposed intervention framework (see Fig. 1 ). This pilot study evaluated the feasibility and preliminary outcomes of Hoosier Sport Re-Social , a school-based intervention designed to improve body image, enhance social media literacy, and increase PA among rural adolescents. Feasibility was assessed through participant engagement, adherence, and feedback. We hypothesized that the intervention would improve body satisfaction, reduce high social media use, and increase PA, with potential variations in outcomes by sex and age. We first assessed baseline satisfaction of basic psychological needs and examined its associations with social media and physical literacy, time spent on social media or in PA, and related baseline knowledge. Additionally, we explored changes in mental health outcomes over time and separately examined changes in cognitive outcomes. Findings from this pilot will inform the intervention’s scalability and future adaptations for rural communities. Methods Design and Procedure Parental consent was obtained remotely via an informed consent document distributed through Qualtrics survey software [ 24 ]. Adolescents provided in-person assent and completed surveys using Qualtrics to ensure understanding, improve compliance, and address any questions. The study was approved by the institutional review board at Indiana University (#21473). The full youth survey is available upon request. The intervention was implemented over four weeks, totaling approximately 12 sessions—one 45-minute health class session and two 45-minute PE classes each week—resulting in roughly 540 minutes of structured programming. The structured curriculum combined lessons on body confidence, social media literacy, and sport skill development to address the intervention's objectives of improving body image, reducing the negative influence of social media, and increasing PA among rural youth. Data collection occurred at week 0 and week 5 (one week pre- and post-intervention). Figure 2 shows the timeline for all procedures. The intervention utilized the Body Confidence curriculum developed by Nike and Dove [ 25 ], which focuses on fostering body positivity, enhancing self-esteem, and challenging unrealistic societal beauty standards through interactive discussions and reflection-based activities. This curriculum was delivered in a classroom setting and adapted to be developmentally appropriate for middle school youth, including modules on media literacy, peer pressure, and positive self-talk. Along with the PA curriculum, the intervention integrated the Youth Toolkit from the Center of Humane Technology [ 26 ] to address social media literacy. This component taught students to recognize persuasive design, set healthy boundaries with screen time, and reflect on how online content influences their mental health and body image. For the PA component, the intervention incorporated sport skill development activities from Hoosier Sport [ 27 , 28 ], which promote inclusive, non-competitive participation across various sports (e.g., soccer, floor hockey) and emphasize physical literacy and enjoyment of movement. Full lesson plans and survey tools are available upon request. Setting and Sample The sample for this pilot study was comprised of female and male adolescents from a rural community. Specifically, 6th-8th grade students from a Midwestern middle school were recruited to participate in the study. A total of 32 participants were included, comprising 53.12% females ( n = 17) and 46.87% males ( n = 15), with ages ranging from 11 to 14 ( m = 12.69, SD = 0.95) years. Participant characteristics can be found in Table 1 . Table 1 Participant Characteristics Characteristic Value Age (Mean ± SD) 12.7 ± 1.1 # from 6th Grade 14 (43.80%) # from 7th Grade 4 (12.50%) # from 8th Grade 14 (43.80%) Boys 13 (40.62%) Girls 19 (59.37%) White, non-Hispanic 23 (71.90%) Black or African American 3 (9.40%) Hispanic or Latino 6 (18.80%) Measures Feasibility was assessed using adolescent-adapted versions of the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) [ 29 ]. Each measure has demonstrated adequate psychometric properties in adult populations, including content validity, reliability, structural validity, structural invariance, known-groups validity, and responsiveness to change [ 29 ]. Retention and attendance were measured to assess the intervention's feasibility, using a 75–80% benchmark for successful participation. Although norms are not fully established, this range is based on literature and reflects a balance between rigorous expectations and realistic outcomes [ 30 ]. Measures of PA included daily PA and physical literacy. These were assessed using a combination of validated tools to capture multiple dimensions of movement behaviors. Physical literacy was assessed using the Canadian Assessment of Physical Literacy Second Edition (CAPL-2) [ 31 ], a 22-item tool measuring physical literacy across four domains: physical competence, motivation and confidence, knowledge and understanding, and engagement in activities. It demonstrated high reliability (α: 0.71–0.97) in youth under 15, with higher scores indicating greater physical literacy [ 32 ]. Additionally, PA levels were captured using Axivity AX3 accelerometers (Axivity, Newcastle upon Tyne, UK). The AX3 is a highly accurate triaxial devices in youth (97.3%) [ 33 , 34 ], tracked daily steps and activity levels over seven days, with participants wearing them on their non-dominant wrist to ensure accuracy and compliance. Measures of social media included screen time, addiction, and literacy. Social media usage was evaluated through smartphone-recorded screen time. The Social Media Information Literacy (SMIL) survey, which has shown high reliability in youth (α: 0.97) [ 35 ], was used to measure social media literacy. The SMIL consists of six domains: navigation, curation, appraisal, understanding, creation, and interaction. The SMIL was administered as a separate survey as an in-class activity during health. The Bergen Social Media Addiction Scale (BSMAS) [ 36 ] measured social media addiction levels across platforms, demonstrating strong reliability in young adults (α: 0.86), with higher scores reflecting greater addiction [ 37 ]. Body image measures included body satisfaction and body appreciation. Body image was assessed using the Body Satisfaction Questionnaire (BSQ), a 34-item tool with high reliability in young adults (α: 0.93), where higher scores indicated greater dissatisfaction [ 38 ]. Body appreciation was measured using the 13-item Body Appreciation Scale 2 (BAS-2), which evaluated acceptance, respect, and functionality, showing strong reliability in adult populations (α > 0.80) [ 39 ]. Higher scores indicated greater body appreciation. Using both measures allowed for a more comprehensive understanding of body image by capturing both negative perceptions (dissatisfaction) and positive attitudes (appreciation) toward the body, offering a fuller picture of participants’ body-related experiences. Psychosocial factors included psychological needs, which were assessed using the 24-item Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS), which includes six subscales—three for need satisfaction (Autonomy, Competence, Relatedness) and three for need frustration [ 40 , 41 ]. Participants rated items on a 1–5 Likert scale, with higher scores indicating greater satisfaction or frustration. The BPNSFS has demonstrated strong internal consistency (α = 0.70–0.90) across diverse populations [ 42 ]. Data Analysis Descriptive statistics, including means and standard deviations, were calculated for the FIM, AIM, and IAM. Median scores were assessed against the a priori success threshold of 16 out of 20 to evaluate intervention feasibility. Attendance and retention rates were recorded as additional feasibility indicators and reported as percentages. To examine changes in measures, paired-sample t-tests were conducted to compare pre- and post-intervention scores. Additionally, linear mixed-effects models were used to conduct repeated-measures analyses of covariance (ANCOVAs), evaluating the main and interaction effects of Time (pre vs. post) and changes in physical activity and social media use on body image outcomes, while adjusting for age and gender. Change scores (i.e., post minus pre values) were used as behavioral predictors to assess their influence on outcome trajectories over time. These models included a random intercept for participant ID to account for within-subject correlation across time points. Type III sums of squares and Satterthwaite’s method were used to estimate fixed effects and associated degrees of freedom. Correlation analyses were used to explore baseline relationships between satisfaction of basic psychological needs (autonomy, competence, relatedness), health behaviors (social media time and PA levels), and knowledge (social media literacy and physical literacy). These baseline analyses were conducted to understand initial associations among key constructs prior to intervention exposure, helping to inform potential targets for behavior change. Additionally, social media addiction (BSMAS ranking) was explored with social media literacy (SMIL score), and exercise motivation (CAPL sub-scale) with physical literacy (CAPL score). These analyses aimed to assess whether knowledge and literacy in each domain were meaningfully related to relevant behavioral outcomes. Pearson correlations were computed to assess associations, with significance set at p < 0.05. The Holm correction was applied to adjust for multiple comparisons. Results Feasibility Indicators Feasibility indicators reported by the adolescent participants surpassed the success threshold (median = 16), as did indicators reported by implementers. All feasibility indicators can be seen in Table 2 . Attendance of the students was 92.97% across health classes, and 92.71% for all PE classes. The primary reason for absents were sick days (accounting for 83.67% of absents), and state testing (16.33%). Attendance for implementers was 99.87% across both health and PE classes. Table 2 Feasibility Scores Adolescent Scores Variable Mean Median SD FIM 17.00 17 2.78 AIM 17.44 18 2.56 IAM 17.25 18 2.66 Implementer Scores FIM 19.00 19 1.08 AIM 18.44 19 1.32 IAM 18.25 18 1.22 Pre- to Post-Intervention Changes A series of paired-samples t-tests were conducted to evaluate the impact of the intervention on PA, social media usage, on cognitive, mental health, and body image outcomes. A summary of the statistical results, including t-values, p-values, mean differences, and confidence intervals, is presented in Table 3 . Results indicated a statistically significant increase in total PA from pre- to post-intervention using the accelerometer (AX3) data, as well as a significant decrease in social media usage over the same period using data pulled directly from participants’ phone settings to obtain objective measures of screen time. Social media addiction scores did not statistically differ. For psychological measures, no significant changes were observed in self-reported autonomy, competence, relatedness, or satisfaction from the BPNSFS. Moreover, BSQ scores significantly decreased, suggesting reduced body dissatisfaction; also, BAS scores significantly increased, indicating an improvement in body appreciation following the intervention. Table 3 T-Tests Summary Measure Pre Post t-value p-value 95% CI Physical Activity-Related Outcomes AX3 PA (mins/day) 135.96 146.39 16.656 0.002* [3.947, 16.912] Physical Literacy (CAPL-2) 5.28 5.47 1.071 0.292 [-1.413, 4.538] Social Media-Related Outcomes Social Media Usage (hrs./week) (Phone Settings) 59.9 55.51 -2.794 0.008* [-7.605, -1.182] BSMAS 14.03 11.38 -1.608 0.117 [-6.024, 0.711] SMIL 8.94 16.50 4.038 < 0.001** [3.743, 11.382] Psychosocial-Related Outcomes Autonomy (BPNSFS) 24.13 25.00 0.89 0.380 [-1.131, 2.881] Competence (BPNSFS) 23.50 23.84 0.291 0.773 [-2.068, 2.756] Relatedness (BPNSFS) 22.56 24.19 1.169 0.2512 [-1.209, 4.459] Note: PA, Physical Activity; Canadian Assessment of Physical Literacy Second Edition (CAPL-2); Bergen Social Media Addiction Scale (BSMAS); Social Media Information Literacy Scale (SMIL); BSQ, Body Satisfaction Questionnaire; BAS-2, Body Appreciation Scale 2; Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS); * p < 0.05, ** p < 0.01 Additionally, a series of repeated-measures ANCOVAs were conducted using linear mixed-effects models to evaluate the main and interaction effects of time (pre vs. post) and behavioral change scores (i.e., changes in PA and social media use from pre- to post-intervention) on key body image aspects, while controlling for age and gender. All predictors were included in the same model, allowing for the assessment of how behavioral changes influenced outcomes over time. For body dissatisfaction (BSQ), there was a significant main effect of time, with post-intervention scores significantly lower than pre-intervention scores (Estimate = -23.65, p = .0016), indicating a reduction in body dissatisfaction following the intervention. Social media use was a significant predictor of BSQ scores (Estimate = 1.64, p = .031), with increases in social media use (i.e., change scores from pre to post) associated with greater body dissatisfaction overall. However, neither changes in PA nor changes in social media use (entered as continuous predictors representing pre-to-post change scores) significantly moderated the effect of time on BSQ scores, indicating that the observed reduction in body dissatisfaction was not significantly influenced by these behavioral changes. Age and gender were not significant predictors. Effect size analysis revealed a large reduction in body dissatisfaction (Cohen’s d = 0.978, 95% CI [0.44, 1.51]). For body appreciation (BAS), there was a significant main effect of time ( p = .011), with post-intervention scores 10.36 points higher than pre-intervention, indicating improved body appreciation. Increases in PA, entered as a pre-to-post change score, were significantly associated with higher overall BAS scores (p = .014). Additionally, a significant interaction between time and PA change ( p = .022) indicated that the effect of time on BAS scores was moderated by changes in PA—specifically, participants who increased their PA showed greater improvements in body appreciation from pre- to post-intervention. Age was also a significant predictor ( p = .017), with older participants reporting lower body appreciation, while gender and social media use were not significant. The effect size for BAS was moderate to large (Cohen’s d = -0.796, 95% CI [-1.32, -0.272]), indicating meaningful change. Correlation Analyses This analysis examined the relationships between baseline (pre-intervention) social media literacy (SMIL), PA literacy (CAPL-2 Score), and psychological needs (autonomy, competence, and relatedness). Social media literacy (SMIL) was moderately and positively associated with autonomy (r = 0.53, p = 0.008), suggesting that higher social media literacy was linked to higher feelings of autonomy at baseline. However, SMIL had weak, non-significant correlations with competence (r = 0.27, p = 0.269) and relatedness (r = 0.18, p = 0.315). PA literacy had weak, non-significant positive correlations with autonomy (r = 0.11, p = 0.536), competence (r = 0.25, p = 0.210), and relatedness (r = 0.21, p = 0.301), suggesting no strong relationship between PA literacy and need satisfaction at baseline. Additionally, correlation analyses indicated that greater social media time was negatively associated with autonomy (r = -0.15, p = 0.532), competence (r = -0.14, p = 0.568), and relatedness (r = -0.12, p = 0.633), although these associations did not reach significance. In contrast, total PA was positively correlated with relatedness (r = 0.37, p = 0.038). Strong positive correlations were observed between autonomy and competence (r = 0.68, p < 0.001) and competence and relatedness (r = 0.60, p = 0.001), while autonomy and relatedness showed a moderate but non-significant association (r = 0.41, p = 0.084). Finally, baseline social media addiction (BSMAS score) was correlated with baseline social media usage (average hours/day) (r = 0.38, p = 0.033), while baseline motivation to exercise (CAPL-2 motivation sub-scale) was correlated with baseline PA levels (r = 0.40, p = 0.025). Discussion This pilot study evaluated the feasibility and preliminary outcomes of Hoosier Sport Re-Social, a school-based intervention designed to improve body image, enhance social media literacy, and increase PA among rural adolescents. Four key findings emerged: (1) the 4-week intervention, delivered through PE and health classes in a middle school, demonstrated high feasibility, acceptability, and appropriateness as reported by participating adolescents; (2) the program led to improved health behaviors, including increased daily PA and reduced social media use; (3) participants showed gains in body satisfaction and body appreciation from pre- to post-intervention, although older adolescents consistently reported lower body appreciation than younger peers; and (4) baseline satisfaction of psychological needs and exercise motivation were positively associated with physical activity levels, while social media literacy was moderately correlated with baseline autonomy. These findings suggest that Hoosier Sport Re-Social holds promise as a feasible and impactful approach to promoting holistic adolescent health in rural school settings, warranting further investigation through larger and more rigorous trials. This study demonstrated high feasibility, acceptability, and appropriateness of the intervention, as reported by adolescent participants, suggesting that integrating PA and social media literacy into middle school curricula is both practical and well-received. Prior research also supports the feasibility of addressing mental health outcomes through school-based programs delivered in health class settings [ 43 , 44 ], indicating that this approach may be particularly effective for promoting adolescent mental health. The positive participant experiences align with observed behavioral outcomes, notably a significant increase in PA levels and a concurrent reduction in social media usage, highlighting the potential effectiveness of the intervention in fostering healthier lifestyle behaviors among adolescents. Likewise, PE classes have been shown to be a feasible avenue for promoting PA among middle schoolers [ 45 , 46 ], with research indicating that interventions leveraging PE can effectively increase daily PA levels in this population [ 28 , 47 ]. The present study is unique in providing preliminary support for integrating social media literacy training within health class settings to decrease daily time spent on social media. Future research is needed to further explore the potential impact of social media literacy on adolescent health and development across more diverse and larger samples. Aspects of body image also improved following the intervention, with participants reporting meaningful gains in both body satisfaction and body appreciation. Notably, post-intervention increases in PA were significantly associated with higher body appreciation scores, and a significant interaction between time and PA change indicated that those who increased their PA experienced greater improvements in body appreciation. In contrast, social media use did not significantly moderate changes in body image over time, though higher overall use was associated with lower body satisfaction. Hoosier Sport Re-Social targeted body image through two primary avenues: (1) PE, which has been shown to positively influence body image, particularly among female adolescents [ 48 – 50 ], and (2) social media literacy content delivered in a health class setting. The latter represents a more novel approach, with only one other known school-based program examining the impact of social media literacy on body image outcomes—though that 12-month intervention did not observe significant changes [ 51 ]. Differences in findings may be attributed to variations in curriculum content, such as the frequency, delivery style, or relevance of the material—for example, whether social media literacy was emphasized, how engaging the lessons were, or who delivered them. It's possible that programs led by older adults felt less relatable to adolescents compared to those facilitated by near-peer role models like college students, which may have influenced how the content was received. Future research should further examine the use of resources like the Youth Toolkit from the Center for Humane Technology and the Body Confidence curriculum developed by Nike and Dove, both of which were integrated into the present study’s health class component. Correlation analyses provided additional insights towards initial associations among key constructs prior to intervention exposure. Specifically, these analyses demonstrated that higher baseline PA was positively associated with feelings of autonomy and relatedness, while higher baseline social media literacy was linked to greater feelings of autonomy. These findings align with existing research on basic psychological needs, which suggests that satisfying these needs supports increased PA engagement. For instance, longitudinal studies have shown that greater autonomy in PA enhances motivation, and autonomy support within PE classes fosters sustained participation in leisure-time PA [ 52 , 53 ]. Similarly, relatedness plays a key role in shaping PA engagement—positive relationships with teachers and peers in PE contribute to perceptions of relatedness, motivation, enjoyment, and overall well-being [ 54 ]. In contrast, the relationship between social media and basic psychological needs has been less extensively studied. However, work in philosophy and technology suggests that individuals with higher social media literacy may experience greater autonomy, as they are better equipped to resist manipulative or coercive features of digital platforms [ 55 ]. Adolescent-focused research supports this perspective, with qualitative studies indicating that emphasizing autonomy-supportive features of social media may enhance well-being [ 56 ]. These findings highlight the need for future research to further explore the relationship between social media use, psychological needs satisfaction, and adolescent well-being, particularly in the context of school-based health interventions. Despite promising findings, several limitations should be acknowledged. First, this pilot study was conducted with a relatively small, homogenous sample from a single rural middle school, which may limit the generalizability of the results. Second, the short duration of the intervention (4 weeks) may not have been sufficient to facilitate long-term and durable behavioral changes. Third, the reliance on self-reported data for some measures, such as body image and mental health, may be subject to bias. Additionally, the absence of a control group limits the ability to draw causal conclusions about the intervention’s effects. Additionally, the absence of a control group limits the ability to draw causal conclusions about the intervention’s effects. Without a comparison group, it is difficult to determine whether the observed improvements were due to the intervention itself or other external factors. Lastly, while associations were explored for how changes in PA and social media appeared to relate more specifically to key outcomes, more robust designs are needed to understand the mechanisms driving observed improvements. In conclusion, Hoosier Sport Re-Social demonstrates strong feasibility and may hold promise as an innovative, school-based intervention for promoting holistic adolescent health, particularly in underserved rural settings. The integration of PA and social media literacy into existing school activities (i.e., PE and health classes) was well-received and showed early signs of improving PA levels, body image, and mental and cognitive outcomes. Future research should employ larger, more diverse samples, include comparison groups, and explore the long-term impacts and mechanisms of this intervention to inform broader implementation and sustainability. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Indiana University Institutional Review Board (protocol #21473). Written informed consent was obtained from parents/guardians, and assent was obtained from all participating adolescents prior to data collection. Consent for publication Not applicable. No individual identifying information is included in this manuscript. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available due to participant privacy considerations but are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding to declare. Authors' contributions JW conceived and designed the study, oversaw implementation, performed analyses, and drafted the manuscript. 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Front Psychol. https://doi.org/10.3389/fpsyg.2020.00491 García-Ceberino JM, Feu S, Gamero MG, Ibáñez SJ (2023) Structural Relationship between Psychological Needs and Sport Adherence for Students Participating in Physical Education Class. Sustainability 15:9686 Vansteenkiste M, Ryan RM, Soenens B (2020) Basic psychological need theory: Advancements, critical themes, and future directions. Motiv Emot 44:1–31 Qualtrics software (2025) Qualtrics. Dove (2024) Dove x Nike: Our Body Confident Sport program. In: Unilever. Center of Humane Technology (2022) Foundations of Humane Technology. In: Center for Humane Technology. Greeven SJ, Fernández Solá PA, (Martinez) Kercher VM, Coble CJ, Pope KJ, Erinosho TO, Grube A, Evanovich JM, Werner NE, Kercher KA (2023) Hoosier Sport: a research protocol for a multilevel physical activity-based intervention in rural Indiana. Front Public Health. https://doi.org/10.3389/fpubh.2023.1243560 Watkins JM, Goss JM, Major MG, Kwaiser MM, Medellin AM, Hobson JM, Martinez Kercher VM, Kercher KA (2024) Refined Feasibility Testing of an 8-Week Sport and Physical Activity Intervention in a Rural Middle School. Int J Environ Res Public Health 21:913 Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H (2017) Psychometric assessment of three newly developed implementation outcome measures. Implementation Science 12:108 Bowen DJ, Kreuter M, Spring B, et al (2009) How We Design Feasibility Studies. Am J Prev Med 36:452–457 Longmuir PE, Woodruff SJ, Boyer C, Lloyd M, Tremblay MS (2018) Physical Literacy Knowledge Questionnaire: feasibility, validity, and reliability for Canadian children aged 8 to 12 years. BMC Public Health 18:1035 Mendoza-Muñoz M, Carlos-Vivas J, Castillo-Paredes A, Parraca JA, Raimundo A, Alegrete J, Pastor-Cisneros R, Gomez-Galan R (2023) Portuguese translation and validation of the questionnaires from the Canadian Physical Literacy Assessment-2: a pilot study. Front Psychol. https://doi.org/10.3389/fpsyg.2023.1244566 Hedayatrad L, Stewart T, Duncan S (2021) Concurrent Validity of ActiGraph GT3X+ and Axivity AX3 Accelerometers for Estimating Physical Activity and Sedentary Behavior. J Meas Phys Behav 4:1–8 Brønd JC, Grøntved A, Andersen LB, Arvidsson D, Olesen LG (2020) Simple Method for the Objective Activity Type Assessment with Preschoolers, Children and Adolescents. Children 7:72 Heiss R, Nanz A, Matthes J (2023) Social media information literacy: Conceptualization and associations with information overload, news avoidance and conspiracy mentality. Comput Human Behav 148:107908 Shin NY (2022) Psychometric Properties of the Bergen Social Media Addiction Scale in Korean Young Adults. Psychiatry Investig 19:356–361 Zarate D, Hobson BA, March E, Griffiths MD, Stavropoulos V (2023) Psychometric properties of the Bergen Social Media Addiction Scale: An analysis using item response theory. Addictive Behaviors Reports 17:100473 Evans C, Dolan B (1993) Body shape questionnaire: Derivation of shortened “alternate forms.” International Journal of Eating Disorders 13:315–321 Zarate D, Marmara J, Potoczny C, Hosking W, Stavropoulos V (2021) Body Appreciation Scale (BAS-2): measurement invariance across genders and item response theory examination. BMC Psychol 9:114 Laporte N, Soenens B, Brenning K, Vansteenkiste M (2021) Adolescents as active managers of their own psychological needs: The role of psychological need crafting in adolescents’ mental health. J Adolesc 88:67–83 Westera JJ, van der Molen MJ, Schuengel C (2024) Basic Psychological Needs and Mental Health in Adolescents with a Mild to Borderline Intellectual Disability. J Ment Health Res Intellect Disabil 17:138–157 Olafsen AH, Halvari H, Frølund CW (2021) The Basic Psychological Need Satisfaction and Need Frustration at Work Scale: A Validation Study. Front Psychol. https://doi.org/10.3389/fpsyg.2021.697306 Johnstone JM, Ribbers A, Jenkins D, Atchley R, Gustafsson H, Nigg JT, Wahbeh H, Oken B (2020) Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study. J Restor Med. https://doi.org/10.14200/jrm.2020.0101 Bluth K, Lathren C, Park J, Lynch C, Curry J, Harris‐Britt A, Gaylord S (2024) Feasibility, acceptability, and depression outcomes of a randomized controlled trial of Mindful Self‐Compassion for Teens (MSC‐T) for adolescents with subsyndromal depression. J Adolesc 96:322–336 Burgeson CR, Wechsler H, Brener ND, Young JC, Spain CG (2001) Physical Education and Activity: Results from the School Health Policies and Programs Study 2000. Journal of School Health 71:279–293 Alderman BL, Benham-Deal T, Beighle A, Erwin HE, Olson RL (2012) Physical Education’s Contribution to Daily Physical Activity Among Middle School Youth. Pediatr Exerc Sci 24:634–648 Sevil-Serrano J, Aibar A, Abós Á, Generelo E, García-González L (2022) Improving motivation for physical activity and physical education through a school-based intervention. The Journal of Experimental Education 90:383–403 Jankauskiene R, Urmanavicius D, Baceviciene M (2022) Association between Motivation in Physical Education and Positive Body Image: Mediating and Moderating Effects of Physical Activity Habits. Int J Environ Res Public Health 20:464 Kennedy AK, Ramseyer Winter V, Corbin MM (2019) Physical Education Class and Body Image Perception: Are They Related? The Physical Educator 76:467–484 Kerner C, Prescott A, Smith R, Owen M (2022) A systematic review exploring body image programmes and interventions in physical education. Eur Phy Educ Rev 28:942–967 Gordon CS, Jarman HK, Rodgers RF, McLean SA, Slater A, Fuller-Tyszkiewicz M, Paxton SJ (2021) Outcomes of a Cluster Randomized Controlled Trial of the SoMe Social Media Literacy Program for Improving Body Image-Related Outcomes in Adolescent Boys and Girls. Nutrients 13:3825 Tilga H, Kalajas-Tilga H, Hein V, Raudsepp L, Koka A (2021) Perceived Autonomy Support from Peers, Parents, and Physical Education Teachers as Predictors of Physical Activity and Health-Related Quality of Life among Adolescents—A One-Year Longitudinal Study. Educ Sci (Basel) 11:457 Schneider J, Polet J, Hassandra M, Lintunen T, Laukkanen A, Hankonen N, Hirvensalo M, Tammelin TH, Törmäkangas T, Hagger MS (2020) Testing a physical education-delivered autonomy supportive intervention to promote leisure-time physical activity in lower secondary school students: the PETALS trial. BMC Public Health 20:1438 Cox A, Duncheon N, McDavid L (2009) Peers and Teachers as Sources of Relatedness Perceptions, Motivation, and Affective Responses in Physical Education. Res Q Exerc Sport 80:765–773 Sahebi S, Formosa P (2022) Social Media and its Negative Impacts on Autonomy. Philos Technol 35:70 West M, Rice S, Vella-Brodrick D (2025) Mid-Adolescents’ Social Media Use: Supporting and Suppressing Autonomy. J Adolesc Res 40:448–482 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7365890","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515568747,"identity":"aac00a51-e2e9-469c-8e1b-2e7eb56e708e","order_by":0,"name":"Janette M. Watkins","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYBACxoYD7D8SDGzkIFw24rQwSDyoSDMmXgsISD44czixgWgtzI1nDAwS25jTt/OfMWD4UHaYGIedMUhIbGPL3Tkjx4BxxjmitJzdcCCxjSd3ww0eA2beNuK0bGxIbJNINzh/xoD5L5FaNjMkAB1ncCDHgJmROC3nvzEkVCQY7pyRVnCw51w6YS2GM46lMf4w+C9vzn9444MfZdbEaDkAYRgA8QHC6oFAnr8BoWUUjIJRMApGAVYAAPVBQlI8/XslAAAAAElFTkSuQmCC","orcid":"","institution":"Pennsylvania State University","correspondingAuthor":true,"prefix":"","firstName":"Janette","middleName":"M.","lastName":"Watkins","suffix":""},{"id":515568748,"identity":"b4386b4f-8d6f-4a8a-8a08-1268f17de0f9","order_by":1,"name":"Janelle Goss","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Janelle","middleName":"","lastName":"Goss","suffix":""},{"id":515568749,"identity":"749b58d2-c474-4cb4-ac7b-efc25263b5c3","order_by":2,"name":"Autumn Schigur","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Autumn","middleName":"","lastName":"Schigur","suffix":""},{"id":515568750,"identity":"2fcdf17d-24d2-4762-98e2-2efb31991525","order_by":3,"name":"Megan Kwaiser","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"","lastName":"Kwaiser","suffix":""},{"id":515568751,"identity":"c053a2ca-0b7d-440b-9e55-4cf89bb25af0","order_by":4,"name":"McKenna Major","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"McKenna","middleName":"","lastName":"Major","suffix":""},{"id":515568752,"identity":"485ebd52-3cf1-4ef1-b805-7ee652888517","order_by":5,"name":"Cassandra Coble","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Cassandra","middleName":"","lastName":"Coble","suffix":""},{"id":515568753,"identity":"7fdd2fd8-7d2f-40e2-9583-0e1e8355e014","order_by":6,"name":"Krista Wisner","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Krista","middleName":"","lastName":"Wisner","suffix":""},{"id":515568754,"identity":"d339aa7c-4084-42af-bed9-1a3947e7d517","order_by":7,"name":"David Koceja","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Koceja","suffix":""},{"id":515568755,"identity":"dec3816a-841a-4b7d-abbf-274620294747","order_by":8,"name":"Vanessa Kercher","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Kercher","suffix":""},{"id":515568756,"identity":"20c64723-bba3-45dc-bf72-7351032b96c3","order_by":9,"name":"Kyle Kercher","email":"","orcid":"","institution":"Indiana University","correspondingAuthor":false,"prefix":"","firstName":"Kyle","middleName":"","lastName":"Kercher","suffix":""}],"badges":[],"createdAt":"2025-08-13 14:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7365890/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7365890/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91527627,"identity":"d6e7bfed-be49-4aa3-a7e7-28164fc0d6b0","added_by":"auto","created_at":"2025-09-17 11:20:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154029,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eIntervention Structure Using Frameworks\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConceptual framework guiding the Hoosier Sport Re-Social intervention. The framework integrates Basic Psychological Needs Theory (BPNT), Goal Contents Theory (GCT), Social Cognitive Theory (SCT), and Social Comparison Theory (SOCO) to address autonomy, competence, relatedness, intrinsic and extrinsic motivation, and social comparison in the context of adolescent physical activity, body image, and social media use.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7365890/v1/d872b5c2e1eb8736b4dda601.png"},{"id":91526958,"identity":"102eb801-9278-4e5f-a76f-f824b9b9dda5","added_by":"auto","created_at":"2025-09-17 11:12:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127387,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eStudy Timeline\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOverview of program delivery and data collection across the 5-week intervention. Measures included the Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS), Canadian Assessment of Physical Literacy–2 (CAPL-2), Generalized Anxiety Disorder–7 (GAD-7), Sport Health Action Plan survey (SHAPs), Body Appreciation Scale–2 (BAS-2), Body Shape Questionnaire (BSQ), Social Media Impact Likert scale (SMIL), Bergen Social Media Addiction Scale (BSMAS), Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), Intervention Appropriateness Measure (IAM), and Axivity accelerometer (AX3). Note: Mental health measures are reported in a separate manuscript.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7365890/v1/fcd520a034a833e089f4bcb2.png"},{"id":91528566,"identity":"356a1c31-263b-4724-a451-fca2fb31037c","added_by":"auto","created_at":"2025-09-17 11:28:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1022397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7365890/v1/c9c97f20-d111-402c-b029-e63632cf08bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility and Preliminary Outcomes of a School-Based Intervention to Promote Body Image in Rural Adolescents: The Hoosier Sport Re-Social Pilot Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdolescents in rural communities encounter challenges that uniquely impact their physical and mental health, such as limited access to healthcare, recreational facilities, and social support systems, creating disparities in health outcomes compared to their urban counterparts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These challenges are increasingly compounded by growing reliance on social media platforms, which have transformed the way adolescents connect, communicate, and perceive themselves [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While social media offers potential benefits such as fostering connections and promoting self-expression, it also poses significant risks to mental health, particularly through its impact on body image and self-esteem [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor adolescent girls, in particular, the pervasive nature of curated and idealized images on social media has been linked to the development of negative body image [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This phenomenon is concerning as poor body image is associated with a range of adverse outcomes, including reduced self-worth, higher levels of anxiety, and disordered eating behaviors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, negative body image has profound implications for health behaviors, notably contributing to disengagement from physical activity (PA) and organized sports [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Sports participation is a critical factor in promoting physical health and psychological resilience, offering potential benefits such as improved cardiovascular fitness, reduced stress, and enhanced social connections [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, body image concerns, such as feeling self-conscious about their bodies, often discourage adolescent girls from participating in sports [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], particularly in rural areas where opportunities for structured PA may already be limited [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Indeed, research shows that 45% of females will quit sports by the age of 14, due to poor body image [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDisengagement from PA not only hinders physical health, but also exacerbates mental health challenges, including heightened anxiety. PA plays a critical role in promoting mental well-being by reducing symptoms of anxiety and depression, enhancing self-esteem, and fostering resilience in adolescents [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies have demonstrated that regular PA triggers the release of endorphins and other neurochemicals that improve mood, while also reducing physiological stress markers such as cortisol levels [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, engaging in sports or recreational activities can provide adolescents with a sense of accomplishment and social connection, both of which are protective factors against mental health difficulties [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Conversely, reduced participation in PA can lead to a vicious cycle of declining physical health and worsening mental well-being. Adolescents who disengage from PA are at greater risk of developing chronic health conditions such as obesity and cardiovascular disease, which can negatively impact self-esteem and further contribute to mental health challenges [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, sedentary behavior has been linked to increased screen time, particularly on social media, which can amplify body image concerns and feelings of social isolation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This cycle is especially pronounced in rural areas, where adolescents often face structural barriers to participation in PA, including limited access to recreational facilities, organized sports, and transportation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHoosier Sport Re-Social is a school-based intervention for rural adolescents (grades 6\u0026ndash;8) designed to reduce high social media use and increase physical activity (PA). Using a multilevel approach, it promotes body positivity, social media literacy (the ability to access, analyze, evaluate, create, and act using all forms of communication) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and sport skill development through PE and health classes, along with take-home activities. At the individual level, it enhances knowledge, motivation, and self-efficacy for PA and media literacy, supporting positive body image. Interpersonally, it fosters peer support, family engagement, and healthy social norms to reduce high social media use (defined as 3\u0026thinsp;+\u0026thinsp;hours daily) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and encourage sport participation. At the community level, it integrates evidence-based curricula to promote inclusive, body-positive environments. By teaching media literacy and body appreciation, it helps adolescents resist harmful online comparisons and validation-seeking behaviors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, Self-Determination Theory (SDT) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] was used to create the framework of the Hoosier Sport Re-Social. SDT examines human motivation by identifying conditions that foster optimal engagement and those that inhibit or undermine self-motivation, social functioning, and personal well-being. Both unstructured and structured PA have been effective in satisfying basic psychological needs among adolescents [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Moreover, satisfying basic psychological needs has been linked to increased participation in PA among adolescents [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This alignment not only enhances their overall well-being but also contributes to positive developmental outcomes during the critical developmental period of adolescence [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Indeed, adolescents who are able to satisfy their psychological needs through PA may be more likely to participate in that behavior. Therefore, SDT was a key part of the proposed intervention framework (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis pilot study evaluated the feasibility and preliminary outcomes of \u003cem\u003eHoosier Sport Re-Social\u003c/em\u003e, a school-based intervention designed to improve body image, enhance social media literacy, and increase PA among rural adolescents. Feasibility was assessed through participant engagement, adherence, and feedback. We hypothesized that the intervention would improve body satisfaction, reduce high social media use, and increase PA, with potential variations in outcomes by sex and age. We first assessed baseline satisfaction of basic psychological needs and examined its associations with social media and physical literacy, time spent on social media or in PA, and related baseline knowledge. Additionally, we explored changes in mental health outcomes over time and separately examined changes in cognitive outcomes. Findings from this pilot will inform the intervention\u0026rsquo;s scalability and future adaptations for rural communities.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eDesign and Procedure\u003c/h2\u003e\n \u003cp\u003eParental consent was obtained remotely via an informed consent document distributed through Qualtrics survey software [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Adolescents provided in-person assent and completed surveys using Qualtrics to ensure understanding, improve compliance, and address any questions. The study was approved by the institutional review board at Indiana University (#21473). The full youth survey is available upon request. The intervention was implemented over four weeks, totaling approximately 12 sessions\u0026mdash;one 45-minute health class session and two 45-minute PE classes each week\u0026mdash;resulting in roughly 540 minutes of structured programming. The structured curriculum combined lessons on body confidence, social media literacy, and sport skill development to address the intervention\u0026apos;s objectives of improving body image, reducing the negative influence of social media, and increasing PA among rural youth. Data collection occurred at week 0 and week 5 (one week pre- and post-intervention). Figure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the timeline for all procedures.\u003c/p\u003e\n \u003cp\u003eThe intervention utilized the Body Confidence curriculum developed by Nike and Dove [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], which focuses on fostering body positivity, enhancing self-esteem, and challenging unrealistic societal beauty standards through interactive discussions and reflection-based activities. This curriculum was delivered in a classroom setting and adapted to be developmentally appropriate for middle school youth, including modules on media literacy, peer pressure, and positive self-talk. Along with the PA curriculum, the intervention integrated the Youth Toolkit from the Center of Humane Technology [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] to address social media literacy. This component taught students to recognize persuasive design, set healthy boundaries with screen time, and reflect on how online content influences their mental health and body image. For the PA component, the intervention incorporated sport skill development activities from Hoosier Sport [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e], which promote inclusive, non-competitive participation across various sports (e.g., soccer, floor hockey) and emphasize physical literacy and enjoyment of movement. Full lesson plans and survey tools are available upon request.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSetting and Sample\u003c/h3\u003e\n\u003cp\u003eThe sample for this pilot study was comprised of female and male adolescents from a rural community. Specifically, 6th-8th grade students from a Midwestern middle school were recruited to participate in the study. A total of 32 participants were included, comprising 53.12% females (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17) and 46.87% males (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15), with ages ranging from 11 to 14 (\u003cem\u003em\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.69, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.95) years. Participant characteristics can be found in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eParticipant Characteristics\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValue\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e# from 6th Grade\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (43.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e# from 7th Grade\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (12.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e# from 8th Grade\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (43.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBoys\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (40.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGirls\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (59.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eWhite, non-Hispanic\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (71.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBlack or African American\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (9.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHispanic or Latino\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (18.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eFeasibility was assessed using adolescent-adapted versions of the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. Each measure has demonstrated adequate psychometric properties in adult populations, including content validity, reliability, structural validity, structural invariance, known-groups validity, and responsiveness to change [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. Retention and attendance were measured to assess the intervention\u0026apos;s feasibility, using a 75\u0026ndash;80% benchmark for successful participation. Although norms are not fully established, this range is based on literature and reflects a balance between rigorous expectations and realistic outcomes [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eMeasures of PA included daily PA and physical literacy. These were assessed using a combination of validated tools to capture multiple dimensions of movement behaviors. Physical literacy was assessed using the Canadian Assessment of Physical Literacy Second Edition (CAPL-2) [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e], a 22-item tool measuring physical literacy across four domains: physical competence, motivation and confidence, knowledge and understanding, and engagement in activities. It demonstrated high reliability (\u0026alpha;: 0.71\u0026ndash;0.97) in youth under 15, with higher scores indicating greater physical literacy [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. Additionally, PA levels were captured using Axivity AX3 accelerometers (Axivity, Newcastle upon Tyne, UK). The AX3 is a highly accurate triaxial devices in youth (97.3%) [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e], tracked daily steps and activity levels over seven days, with participants wearing them on their non-dominant wrist to ensure accuracy and compliance.\u003c/p\u003e\n\u003cp\u003eMeasures of social media included screen time, addiction, and literacy. Social media usage was evaluated through smartphone-recorded screen time. The Social Media Information Literacy (SMIL) survey, which has shown high reliability in youth (\u0026alpha;: 0.97) [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e], was used to measure social media literacy. The SMIL consists of six domains: navigation, curation, appraisal, understanding, creation, and interaction. The SMIL was administered as a separate survey as an in-class activity during health. The Bergen Social Media Addiction Scale (BSMAS) [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e] measured social media addiction levels across platforms, demonstrating strong reliability in young adults (\u0026alpha;: 0.86), with higher scores reflecting greater addiction [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eBody image measures included body satisfaction and body appreciation. Body image was assessed using the Body Satisfaction Questionnaire (BSQ), a 34-item tool with high reliability in young adults (\u0026alpha;: 0.93), where higher scores indicated greater dissatisfaction [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e]. Body appreciation was measured using the 13-item Body Appreciation Scale 2 (BAS-2), which evaluated acceptance, respect, and functionality, showing strong reliability in adult populations (\u0026alpha;\u0026thinsp;\u0026gt;\u0026thinsp;0.80) [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e]. Higher scores indicated greater body appreciation. Using both measures allowed for a more comprehensive understanding of body image by capturing both negative perceptions (dissatisfaction) and positive attitudes (appreciation) toward the body, offering a fuller picture of participants\u0026rsquo; body-related experiences.\u003c/p\u003e\n\u003cp\u003ePsychosocial factors included psychological needs, which were assessed using the 24-item Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS), which includes six subscales\u0026mdash;three for need satisfaction (Autonomy, Competence, Relatedness) and three for need frustration [\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]. Participants rated items on a 1\u0026ndash;5 Likert scale, with higher scores indicating greater satisfaction or frustration. The BPNSFS has demonstrated strong internal consistency (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.70\u0026ndash;0.90) across diverse populations [\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eDescriptive statistics, including means and standard deviations, were calculated for the FIM, AIM, and IAM. Median scores were assessed against the a priori success threshold of 16 out of 20 to evaluate intervention feasibility. Attendance and retention rates were recorded as additional feasibility indicators and reported as percentages. To examine changes in measures, paired-sample t-tests were conducted to compare pre- and post-intervention scores. Additionally, linear mixed-effects models were used to conduct repeated-measures analyses of covariance (ANCOVAs), evaluating the main and interaction effects of Time (pre vs. post) and changes in physical activity and social media use on body image outcomes, while adjusting for age and gender. Change scores (i.e., post minus pre values) were used as behavioral predictors to assess their influence on outcome trajectories over time. These models included a random intercept for participant ID to account for within-subject correlation across time points. Type III sums of squares and Satterthwaite\u0026rsquo;s method were used to estimate fixed effects and associated degrees of freedom. Correlation analyses were used to explore baseline relationships between satisfaction of basic psychological needs (autonomy, competence, relatedness), health behaviors (social media time and PA levels), and knowledge (social media literacy and physical literacy). These baseline analyses were conducted to understand initial associations among key constructs prior to intervention exposure, helping to inform potential targets for behavior change. Additionally, social media addiction (BSMAS ranking) was explored with social media literacy (SMIL score), and exercise motivation (CAPL sub-scale) with physical literacy (CAPL score). These analyses aimed to assess whether knowledge and literacy in each domain were meaningfully related to relevant behavioral outcomes. Pearson correlations were computed to assess associations, with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The Holm correction was applied to adjust for multiple comparisons.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eFeasibility Indicators\u003c/h2\u003e\u003cp\u003eFeasibility indicators reported by the adolescent participants surpassed the success threshold (median\u0026thinsp;=\u0026thinsp;16), as did indicators reported by implementers. All feasibility indicators can be seen in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Attendance of the students was 92.97% across health classes, and 92.71% for all PE classes. The primary reason for absents were sick days (accounting for 83.67% of absents), and state testing (16.33%). Attendance for implementers was 99.87% across both health and PE classes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eFeasibility Scores\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eAdolescent Scores\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFIM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAIM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eIAM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImplementer Scores\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFIM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAIM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eIAM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePre- to Post-Intervention Changes\u003c/h3\u003e\n\u003cp\u003eA series of paired-samples t-tests were conducted to evaluate the impact of the intervention on PA, social media usage, on cognitive, mental health, and body image outcomes. A summary of the statistical results, including t-values, p-values, mean differences, and confidence intervals, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Results indicated a statistically significant increase in total PA from pre- to post-intervention using the accelerometer (AX3) data, as well as a significant decrease in social media usage over the same period using data pulled directly from participants\u0026rsquo; phone settings to obtain objective measures of screen time. Social media addiction scores did not statistically differ. For psychological measures, no significant changes were observed in self-reported autonomy, competence, relatedness, or satisfaction from the BPNSFS. Moreover, BSQ scores significantly decreased, suggesting reduced body dissatisfaction; also, BAS scores significantly increased, indicating an improvement in body appreciation following the intervention.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eT-Tests Summary\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003ePhysical Activity-Related Outcomes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAX3 PA (mins/day)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e135.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.656\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[3.947, 16.912]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePhysical Literacy (CAPL-2)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[-1.413, 4.538]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial Media-Related Outcomes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSocial Media Usage (hrs./week)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e(Phone Settings)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.794\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.008*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[-7.605, -1.182]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBSMAS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.608\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[-6.024, 0.711]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSMIL\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[3.743, 11.382]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePsychosocial-Related Outcomes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAutonomy\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e(BPNSFS)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[-1.131, 2.881]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCompetence\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e(BPNSFS)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[-2.068, 2.756]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eRelatedness\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e(BPNSFS)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[-1.209, 4.459]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote: PA, Physical Activity; Canadian Assessment of Physical Literacy Second Edition (CAPL-2); Bergen Social Media Addiction Scale (BSMAS); Social Media Information Literacy Scale (SMIL); BSQ, Body Satisfaction Questionnaire; BAS-2, Body Appreciation Scale 2; Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS); * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditionally, a series of repeated-measures ANCOVAs were conducted using linear mixed-effects models to evaluate the main and interaction effects of time (pre vs. post) and behavioral change scores (i.e., changes in PA and social media use from pre- to post-intervention) on key body image aspects, while controlling for age and gender. All predictors were included in the same model, allowing for the assessment of how behavioral changes influenced outcomes over time. For body dissatisfaction (BSQ), there was a significant main effect of time, with post-intervention scores significantly lower than pre-intervention scores (Estimate = -23.65, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.0016), indicating a reduction in body dissatisfaction following the intervention. Social media use was a significant predictor of BSQ scores (Estimate\u0026thinsp;=\u0026thinsp;1.64, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.031), with increases in social media use (i.e., change scores from pre to post) associated with greater body dissatisfaction overall. However, neither changes in PA nor changes in social media use (entered as continuous predictors representing pre-to-post change scores) significantly moderated the effect of time on BSQ scores, indicating that the observed reduction in body dissatisfaction was not significantly influenced by these behavioral changes. Age and gender were not significant predictors. Effect size analysis revealed a large reduction in body dissatisfaction (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.978, 95% CI [0.44, 1.51]). For body appreciation (BAS), there was a significant main effect of time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.011), with post-intervention scores 10.36 points higher than pre-intervention, indicating improved body appreciation. Increases in PA, entered as a pre-to-post change score, were significantly associated with higher overall BAS scores (p\u0026thinsp;=\u0026thinsp;.014). Additionally, a significant interaction between time and PA change (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.022) indicated that the effect of time on BAS scores was moderated by changes in PA\u0026mdash;specifically, participants who increased their PA showed greater improvements in body appreciation from pre- to post-intervention. Age was also a significant predictor (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017), with older participants reporting lower body appreciation, while gender and social media use were not significant. The effect size for BAS was moderate to large (Cohen\u0026rsquo;s d = -0.796, 95% CI [-1.32, -0.272]), indicating meaningful change.\u003c/p\u003e\n\u003ch3\u003eCorrelation Analyses\u003c/h3\u003e\n\u003cp\u003eThis analysis examined the relationships between baseline (pre-intervention) social media literacy (SMIL), PA literacy (CAPL-2 Score), and psychological needs (autonomy, competence, and relatedness). Social media literacy (SMIL) was moderately and positively associated with autonomy (r\u0026thinsp;=\u0026thinsp;0.53, p\u0026thinsp;=\u0026thinsp;0.008), suggesting that higher social media literacy was linked to higher feelings of autonomy at baseline. However, SMIL had weak, non-significant correlations with competence (r\u0026thinsp;=\u0026thinsp;0.27, p\u0026thinsp;=\u0026thinsp;0.269) and relatedness (r\u0026thinsp;=\u0026thinsp;0.18, p\u0026thinsp;=\u0026thinsp;0.315). PA literacy had weak, non-significant positive correlations with autonomy (r\u0026thinsp;=\u0026thinsp;0.11, p\u0026thinsp;=\u0026thinsp;0.536), competence (r\u0026thinsp;=\u0026thinsp;0.25, p\u0026thinsp;=\u0026thinsp;0.210), and relatedness (r\u0026thinsp;=\u0026thinsp;0.21, p\u0026thinsp;=\u0026thinsp;0.301), suggesting no strong relationship between PA literacy and need satisfaction at baseline. Additionally, correlation analyses indicated that greater social media time was negatively associated with autonomy (r = -0.15, p\u0026thinsp;=\u0026thinsp;0.532), competence (r = -0.14, p\u0026thinsp;=\u0026thinsp;0.568), and relatedness (r = -0.12, p\u0026thinsp;=\u0026thinsp;0.633), although these associations did not reach significance. In contrast, total PA was positively correlated with relatedness (r\u0026thinsp;=\u0026thinsp;0.37, p\u0026thinsp;=\u0026thinsp;0.038). Strong positive correlations were observed between autonomy and competence (r\u0026thinsp;=\u0026thinsp;0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and competence and relatedness (r\u0026thinsp;=\u0026thinsp;0.60, p\u0026thinsp;=\u0026thinsp;0.001), while autonomy and relatedness showed a moderate but non-significant association (r\u0026thinsp;=\u0026thinsp;0.41, p\u0026thinsp;=\u0026thinsp;0.084). Finally, baseline social media addiction (BSMAS score) was correlated with baseline social media usage (average hours/day) (r\u0026thinsp;=\u0026thinsp;0.38, p\u0026thinsp;=\u0026thinsp;0.033), while baseline motivation to exercise (CAPL-2 motivation sub-scale) was correlated with baseline PA levels (r\u0026thinsp;=\u0026thinsp;0.40, p\u0026thinsp;=\u0026thinsp;0.025).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis pilot study evaluated the feasibility and preliminary outcomes of Hoosier Sport Re-Social, a school-based intervention designed to improve body image, enhance social media literacy, and increase PA among rural adolescents. Four key findings emerged: (1) the 4-week intervention, delivered through PE and health classes in a middle school, demonstrated high feasibility, acceptability, and appropriateness as reported by participating adolescents; (2) the program led to improved health behaviors, including increased daily PA and reduced social media use; (3) participants showed gains in body satisfaction and body appreciation from pre- to post-intervention, although older adolescents consistently reported lower body appreciation than younger peers; and (4) baseline satisfaction of psychological needs and exercise motivation were positively associated with physical activity levels, while social media literacy was moderately correlated with baseline autonomy. These findings suggest that Hoosier Sport Re-Social holds promise as a feasible and impactful approach to promoting holistic adolescent health in rural school settings, warranting further investigation through larger and more rigorous trials.\u003c/p\u003e\u003cp\u003eThis study demonstrated high feasibility, acceptability, and appropriateness of the intervention, as reported by adolescent participants, suggesting that integrating PA and social media literacy into middle school curricula is both practical and well-received. Prior research also supports the feasibility of addressing mental health outcomes through school-based programs delivered in health class settings [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], indicating that this approach may be particularly effective for promoting adolescent mental health. The positive participant experiences align with observed behavioral outcomes, notably a significant increase in PA levels and a concurrent reduction in social media usage, highlighting the potential effectiveness of the intervention in fostering healthier lifestyle behaviors among adolescents. Likewise, PE classes have been shown to be a feasible avenue for promoting PA among middle schoolers [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], with research indicating that interventions leveraging PE can effectively increase daily PA levels in this population [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The present study is unique in providing preliminary support for integrating social media literacy training within health class settings to decrease daily time spent on social media. Future research is needed to further explore the potential impact of social media literacy on adolescent health and development across more diverse and larger samples.\u003c/p\u003e\u003cp\u003eAspects of body image also improved following the intervention, with participants reporting meaningful gains in both body satisfaction and body appreciation. Notably, post-intervention increases in PA were significantly associated with higher body appreciation scores, and a significant interaction between time and PA change indicated that those who increased their PA experienced greater improvements in body appreciation. In contrast, social media use did not significantly moderate changes in body image over time, though higher overall use was associated with lower body satisfaction. Hoosier Sport Re-Social targeted body image through two primary avenues: (1) PE, which has been shown to positively influence body image, particularly among female adolescents [\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], and (2) social media literacy content delivered in a health class setting. The latter represents a more novel approach, with only one other known school-based program examining the impact of social media literacy on body image outcomes\u0026mdash;though that 12-month intervention did not observe significant changes [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Differences in findings may be attributed to variations in curriculum content, such as the frequency, delivery style, or relevance of the material\u0026mdash;for example, whether social media literacy was emphasized, how engaging the lessons were, or who delivered them. It's possible that programs led by older adults felt less relatable to adolescents compared to those facilitated by near-peer role models like college students, which may have influenced how the content was received. Future research should further examine the use of resources like the Youth Toolkit from the Center for Humane Technology and the Body Confidence curriculum developed by Nike and Dove, both of which were integrated into the present study\u0026rsquo;s health class component.\u003c/p\u003e\u003cp\u003eCorrelation analyses provided additional insights towards initial associations among key constructs prior to intervention exposure. Specifically, these analyses demonstrated that higher baseline PA was positively associated with feelings of autonomy and relatedness, while higher baseline social media literacy was linked to greater feelings of autonomy. These findings align with existing research on basic psychological needs, which suggests that satisfying these needs supports increased PA engagement. For instance, longitudinal studies have shown that greater autonomy in PA enhances motivation, and autonomy support within PE classes fosters sustained participation in leisure-time PA [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Similarly, relatedness plays a key role in shaping PA engagement\u0026mdash;positive relationships with teachers and peers in PE contribute to perceptions of relatedness, motivation, enjoyment, and overall well-being [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. In contrast, the relationship between social media and basic psychological needs has been less extensively studied. However, work in philosophy and technology suggests that individuals with higher social media literacy may experience greater autonomy, as they are better equipped to resist manipulative or coercive features of digital platforms [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Adolescent-focused research supports this perspective, with qualitative studies indicating that emphasizing autonomy-supportive features of social media may enhance well-being [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. These findings highlight the need for future research to further explore the relationship between social media use, psychological needs satisfaction, and adolescent well-being, particularly in the context of school-based health interventions.\u003c/p\u003e\u003cp\u003eDespite promising findings, several limitations should be acknowledged. First, this pilot study was conducted with a relatively small, homogenous sample from a single rural middle school, which may limit the generalizability of the results. Second, the short duration of the intervention (4 weeks) may not have been sufficient to facilitate long-term and durable behavioral changes. Third, the reliance on self-reported data for some measures, such as body image and mental health, may be subject to bias. Additionally, the absence of a control group limits the ability to draw causal conclusions about the intervention\u0026rsquo;s effects. Additionally, the absence of a control group limits the ability to draw causal conclusions about the intervention\u0026rsquo;s effects. Without a comparison group, it is difficult to determine whether the observed improvements were due to the intervention itself or other external factors. Lastly, while associations were explored for how changes in PA and social media appeared to relate more specifically to key outcomes, more robust designs are needed to understand the mechanisms driving observed improvements.\u003c/p\u003e\u003cp\u003eIn conclusion, Hoosier Sport Re-Social demonstrates strong feasibility and may hold promise as an innovative, school-based intervention for promoting holistic adolescent health, particularly in underserved rural settings. The integration of PA and social media literacy into existing school activities (i.e., PE and health classes) was well-received and showed early signs of improving PA levels, body image, and mental and cognitive outcomes. Future research should employ larger, more diverse samples, include comparison groups, and explore the long-term impacts and mechanisms of this intervention to inform broader implementation and sustainability.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003e The study was conducted in accordance with the Declaration of Helsinki and approved by the Indiana University Institutional Review Board (protocol #21473). Written informed consent was obtained from parents/guardians, and assent was obtained from all participating adolescents prior to data collection.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e Not applicable. No individual identifying information is included in this manuscript.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cbr\u003e The datasets generated and analyzed during the current study are not publicly available due to participant privacy considerations but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e No funding to declare.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003cbr\u003e JW conceived and designed the study, oversaw implementation, performed analyses, and drafted the manuscript. AS, MM, MK, and JG contributed to conceptualization, data collection, and manuscript preparation. DK, CC, and KW assisted with methodology, data interpretation, and critical review. VK provided methodology and manuscript review. KK contributed resources, conceptual input, and manuscript review. All authors approved the final manuscript.\u003c/p\u003e\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRural Health Information Hub (2024) Social Determinants of Health for Rural People. In: Rural Health Information Hub. \u003c/li\u003e\n\u003cli\u003eAmerican Psychological Association (2023) Health advisory on social media use in adolescence. In: American Psychological Association. \u003c/li\u003e\n\u003cli\u003eTwenge JM, Campbell WK (2018) Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. 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Curr Opin Psychol 9:1\u0026ndash;5\u003c/li\u003e\n\u003cli\u003eDeci EL, Ryan RM (1985) Intrinsic Motivation and Self-Determination in Human Behavior, 1st ed. https://doi.org/10.1007/978-1-4899-2271-7\u003c/li\u003e\n\u003cli\u003eFraguela-Vale R, Varela-Garrote L, Carretero-Garc\u0026iacute;a M, Peralbo-Rubio EM (2020) Basic Psychological Needs, Physical Self-Concept, and Physical Activity Among Adolescents: Autonomy in Focus. Front Psychol. https://doi.org/10.3389/fpsyg.2020.00491\u003c/li\u003e\n\u003cli\u003eGarc\u0026iacute;a-Ceberino JM, Feu S, Gamero MG, Ib\u0026aacute;\u0026ntilde;ez SJ (2023) Structural Relationship between Psychological Needs and Sport Adherence for Students Participating in Physical Education Class. Sustainability 15:9686\u003c/li\u003e\n\u003cli\u003eVansteenkiste M, Ryan RM, Soenens B (2020) Basic psychological need theory: Advancements, critical themes, and future directions. 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Int J Environ Res Public Health 21:913\u003c/li\u003e\n\u003cli\u003eWeiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H (2017) Psychometric assessment of three newly developed implementation outcome measures. Implementation Science 12:108\u003c/li\u003e\n\u003cli\u003eBowen DJ, Kreuter M, Spring B, et al (2009) How We Design Feasibility Studies. Am J Prev Med 36:452\u0026ndash;457\u003c/li\u003e\n\u003cli\u003eLongmuir PE, Woodruff SJ, Boyer C, Lloyd M, Tremblay MS (2018) Physical Literacy Knowledge Questionnaire: feasibility, validity, and reliability for Canadian children aged 8 to 12 years. BMC Public Health 18:1035\u003c/li\u003e\n\u003cli\u003eMendoza-Mu\u0026ntilde;oz M, Carlos-Vivas J, Castillo-Paredes A, Parraca JA, Raimundo A, Alegrete J, Pastor-Cisneros R, Gomez-Galan R (2023) Portuguese translation and validation of the questionnaires from the Canadian Physical Literacy Assessment-2: a pilot study. Front Psychol. https://doi.org/10.3389/fpsyg.2023.1244566\u003c/li\u003e\n\u003cli\u003eHedayatrad L, Stewart T, Duncan S (2021) Concurrent Validity of ActiGraph GT3X+ and Axivity AX3 Accelerometers for Estimating Physical Activity and Sedentary Behavior. J Meas Phys Behav 4:1\u0026ndash;8\u003c/li\u003e\n\u003cli\u003eBr\u0026oslash;nd JC, Gr\u0026oslash;ntved A, Andersen LB, Arvidsson D, Olesen LG (2020) Simple Method for the Objective Activity Type Assessment with Preschoolers, Children and Adolescents. Children 7:72\u003c/li\u003e\n\u003cli\u003eHeiss R, Nanz A, Matthes J (2023) Social media information literacy: Conceptualization and associations with information overload, news avoidance and conspiracy mentality. Comput Human Behav 148:107908\u003c/li\u003e\n\u003cli\u003eShin NY (2022) Psychometric Properties of the Bergen Social Media Addiction Scale in Korean Young Adults. Psychiatry Investig 19:356\u0026ndash;361\u003c/li\u003e\n\u003cli\u003eZarate D, Hobson BA, March E, Griffiths MD, Stavropoulos V (2023) Psychometric properties of the Bergen Social Media Addiction Scale: An analysis using item response theory. Addictive Behaviors Reports 17:100473\u003c/li\u003e\n\u003cli\u003eEvans C, Dolan B (1993) Body shape questionnaire: Derivation of shortened \u0026ldquo;alternate forms.\u0026rdquo; International Journal of Eating Disorders 13:315\u0026ndash;321\u003c/li\u003e\n\u003cli\u003eZarate D, Marmara J, Potoczny C, Hosking W, Stavropoulos V (2021) Body Appreciation Scale (BAS-2): measurement invariance across genders and item response theory examination. BMC Psychol 9:114\u003c/li\u003e\n\u003cli\u003eLaporte N, Soenens B, Brenning K, Vansteenkiste M (2021) Adolescents as active managers of their own psychological needs: The role of psychological need crafting in adolescents\u0026rsquo; mental health. J Adolesc 88:67\u0026ndash;83\u003c/li\u003e\n\u003cli\u003eWestera JJ, van der Molen MJ, Schuengel C (2024) Basic Psychological Needs and Mental Health in Adolescents with a Mild to Borderline Intellectual Disability. J Ment Health Res Intellect Disabil 17:138\u0026ndash;157\u003c/li\u003e\n\u003cli\u003eOlafsen AH, Halvari H, Fr\u0026oslash;lund CW (2021) The Basic Psychological Need Satisfaction and Need Frustration at Work Scale: A Validation Study. Front Psychol. https://doi.org/10.3389/fpsyg.2021.697306\u003c/li\u003e\n\u003cli\u003eJohnstone JM, Ribbers A, Jenkins D, Atchley R, Gustafsson H, Nigg JT, Wahbeh H, Oken B (2020) Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study. J Restor Med. https://doi.org/10.14200/jrm.2020.0101\u003c/li\u003e\n\u003cli\u003eBluth K, Lathren C, Park J, Lynch C, Curry J, Harris‐Britt A, Gaylord S (2024) Feasibility, acceptability, and depression outcomes of a randomized controlled trial of Mindful Self‐Compassion for Teens (MSC‐T) for adolescents with subsyndromal depression. J Adolesc 96:322\u0026ndash;336\u003c/li\u003e\n\u003cli\u003eBurgeson CR, Wechsler H, Brener ND, Young JC, Spain CG (2001) Physical Education and Activity: Results from the School Health Policies and Programs Study 2000. Journal of School Health 71:279\u0026ndash;293\u003c/li\u003e\n\u003cli\u003eAlderman BL, Benham-Deal T, Beighle A, Erwin HE, Olson RL (2012) Physical Education\u0026rsquo;s Contribution to Daily Physical Activity Among Middle School Youth. Pediatr Exerc Sci 24:634\u0026ndash;648\u003c/li\u003e\n\u003cli\u003eSevil-Serrano J, Aibar A, Ab\u0026oacute;s \u0026Aacute;, Generelo E, Garc\u0026iacute;a-Gonz\u0026aacute;lez L (2022) Improving motivation for physical activity and physical education through a school-based intervention. The Journal of Experimental Education 90:383\u0026ndash;403\u003c/li\u003e\n\u003cli\u003eJankauskiene R, Urmanavicius D, Baceviciene M (2022) Association between Motivation in Physical Education and Positive Body Image: Mediating and Moderating Effects of Physical Activity Habits. Int J Environ Res Public Health 20:464\u003c/li\u003e\n\u003cli\u003eKennedy AK, Ramseyer Winter V, Corbin MM (2019) Physical Education Class and Body Image Perception: Are They Related? The Physical Educator 76:467\u0026ndash;484\u003c/li\u003e\n\u003cli\u003eKerner C, Prescott A, Smith R, Owen M (2022) A systematic review exploring body image programmes and interventions in physical education. Eur Phy Educ Rev 28:942\u0026ndash;967\u003c/li\u003e\n\u003cli\u003eGordon CS, Jarman HK, Rodgers RF, McLean SA, Slater A, Fuller-Tyszkiewicz M, Paxton SJ (2021) Outcomes of a Cluster Randomized Controlled Trial of the SoMe Social Media Literacy Program for Improving Body Image-Related Outcomes in Adolescent Boys and Girls. Nutrients 13:3825\u003c/li\u003e\n\u003cli\u003eTilga H, Kalajas-Tilga H, Hein V, Raudsepp L, Koka A (2021) Perceived Autonomy Support from Peers, Parents, and Physical Education Teachers as Predictors of Physical Activity and Health-Related Quality of Life among Adolescents\u0026mdash;A One-Year Longitudinal Study. Educ Sci (Basel) 11:457\u003c/li\u003e\n\u003cli\u003eSchneider J, Polet J, Hassandra M, Lintunen T, Laukkanen A, Hankonen N, Hirvensalo M, Tammelin TH, T\u0026ouml;rm\u0026auml;kangas T, Hagger MS (2020) Testing a physical education-delivered autonomy supportive intervention to promote leisure-time physical activity in lower secondary school students: the PETALS trial. BMC Public Health 20:1438\u003c/li\u003e\n\u003cli\u003eCox A, Duncheon N, McDavid L (2009) Peers and Teachers as Sources of Relatedness Perceptions, Motivation, and Affective Responses in Physical Education. Res Q Exerc Sport 80:765\u0026ndash;773\u003c/li\u003e\n\u003cli\u003eSahebi S, Formosa P (2022) Social Media and its Negative Impacts on Autonomy. Philos Technol 35:70\u003c/li\u003e\n\u003cli\u003eWest M, Rice S, Vella-Brodrick D (2025) Mid-Adolescents\u0026rsquo; Social Media Use: Supporting and Suppressing Autonomy. J Adolesc Res 40:448\u0026ndash;482\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"health promotion, body positivity, social media literacy, physical activity","lastPublishedDoi":"10.21203/rs.3.rs-7365890/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7365890/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdolescents in rural communities face unique barriers to physical and mental well-being, including limited recreational resources and high exposure to social media, which can negatively affect body image. Hoosier Sport Re-Social is a school-based program designed to improve body image, enhance social media literacy, and increase physical activity among rural middle school students. This pilot study evaluated the program’s feasibility and explored preliminary behavioral and psychosocial outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 4-week intervention was delivered during health and physical education classes to students in grades 6–8 at a rural Midwestern middle school. The program integrated sport skill development, body confidence lessons, and social media literacy activities. Feasibility was assessed through the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure, along with attendance and retention rates. Outcomes included daily physical activity (accelerometry), social media usage (phone-recorded screen time), social media literacy, body satisfaction, body appreciation, and basic psychological needs satisfaction. Paired-sample t-tests examined pre- to post-intervention changes, and linear mixed-effects models explored behavioral predictors of body image change, adjusting for age and gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirty-two students (53% female; mean age 12.7 years) participated. Median feasibility scores exceeded the a priori success threshold for both adolescents and implementers. Attendance averaged 93% for participants and 99% for implementers. From pre- to post-intervention, daily physical activity increased (p = .002) and social media use decreased (p = .008). Body dissatisfaction decreased (p = .002; large effect size), and body appreciation increased (p = .011; moderate-to-large effect size), with greater improvements observed in participants who increased physical activity (interaction p = .022). Social media literacy scores significantly improved (p \u0026lt; .001), while social media addiction and basic psychological needs satisfaction showed no significant change.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Hoosier Sport Re-Social program was feasible, well-received, and associated with positive changes in physical activity, social media use, and body image among rural adolescents. Findings support further evaluation with larger, more diverse samples and longer follow-up to assess sustainability and scalability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003cbr\u003e\nRetrospectively registered at ClinicalTrials.gov (NCT06556719; registration date: February 3, 2025).\u003c/p\u003e","manuscriptTitle":"Feasibility and Preliminary Outcomes of a School-Based Intervention to Promote Body Image in Rural Adolescents: The Hoosier Sport Re-Social Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 11:12:26","doi":"10.21203/rs.3.rs-7365890/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-10T10:55:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-19T10:36:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-18T07:35:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-18T07:35:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-13T14:13:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0022354-16e6-432f-8b4d-caf05a3c604e","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-17T11:12:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 11:12:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7365890","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7365890","identity":"rs-7365890","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}