Showing papers in "Health Education & Behavior in 2015"

Upending the Social Ecological Model to Guide Health Promotion Efforts Toward Policy and Environmental Change

Abstract: Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.

From Broken Windows to Busy Streets A Community Empowerment Perspective

Abstract: In the present article, we introduce a community empowerment perspective to understanding neighborhoods. A preponderance of literature exists on neighborhood risk factors for crime. Yet less is known about positive factors that make neighborhoods safe and desirable. We propose community empowerment as a conceptual foundation for understanding neighborhood factors that promote social processes, and ultimately, lead to an improvement in structural factors. We suggest that neighborhoods are empowered because they include processes and structures for positive social interactions to emerge and develop. We present busy streets as a mechanism that creates a positive social context, in which social cohesion and social capital thrive. Thus, empowered communities are characterized by climates that promote busy streets. Our article underscores the need to examine both the broader, structural context and social processes operating within this context. Such an integrative perspective is necessary to fully understand how to empower neighborhoods, particularly in the face of structural challenges.

The Digital Health Divide Evaluating Online Health Information Access and Use Among Older Adults

Abstract: Objective. Innovations in health information technology (HIT) provide opportunities to reduce health care spending, improve quality of care, and improve health outcomes for older adults. However, concerns relating to older adults’ limited access and use of HIT, including use of the Internet for health information, fuel the digital health divide debate. This study evaluated the potential digital health divide in relation to characteristic and belief differences between older adult users and nonusers of online health information sources. Methods. A cross-sectional survey design was conducted using a random sample of older adults. A total of 225 older adults (age range = 50-92 years, M = 68.9 years, SD = 10.4) participated in the study. Results. Seventy-six percent of all respondents had Internet access. Users and nonusers of online health information differed significantly on age (M = 66.29 vs. M = 71.13), education, and previous experience with the health care system. Users and nonusers of online health in...

Use of Medicare’s Diabetes Self-Management Training Benefit

Abstract: Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to determine DSMT utilization. Multivariate logistic regression analyses evaluated the association of demographic, health status, and provider availability factors with DSMT utilization. Approximately 5% of Medicare beneficiaries with newly diagnosed diabetes used DSMT services. The adjusted odds of any utilization were lower among men compared with women, older individuals compared with younger, non-Whites compared with Whites, people dually eligible for Medicare and Medicaid compared with nondual eligibles, and patients with comorbidities compared with individuals without those conditions. Additionally, the adjusted odds of utilizing DSMT increased as the availability of providers who offered DSMT services increased and varied by Census region. Utilization of DSMT among Medicare beneficiaries with newly diagnosed diabetes is low. There appear to be marked disparities in access to DSMT by demographic and health status factors and availability of DSMT providers. In light of the increasing prevalence of diabetes, future research should identify barriers to DSMT access, describe DSMT providers, and explore the impact of DSMT services. With preventive services being increasingly covered by insurers, the low utilization of DSMT, a preventive service benefit that has existed for almost 15 years, highlights the challenges that may be encountered to achieve widespread dissemination and uptake of the new services.

The Collective Impact Model and Its Potential for Health Promotion Overview and Case Study of a Healthy Retail Initiative in San Francisco

Abstract: As resources for health promotion become more constricted, it is increasingly important to collaborate across sectors, including the private sector. Although many excellent models for cross-sector collaboration have shown promise in the health field, collective impact (CI), an emerging model for creating larger scale change, has yet to receive much study. Complementing earlier collaboration approaches, CI has five core tenets: a shared agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and a central infrastructure. In this article, we describe the CI model and its key dimensions and constructs. We briefly compare CI to community coalition action theory and discuss our use of the latter to provide needed detail as we apply CI in a critical case study analysis of the Tenderloin Healthy Corner Store Coalition in San Francisco, California. Using Yin's multimethod approach, we illustrate how CI strategies, augmented by the community coalition action theory, are being used, and with what successes or challenges, to help affect community- and policy-level change to reduce tobacco and alcohol advertising and sales, while improving healthy, affordable, and sustainable food access. We discuss the strengths and weaknesses of CI as a framework for health promotion, as well as the benefits, challenges, and initial outcomes of the healthy retail project and its opportunities for scale-up. Implications for health promotion practice and research also are discussed.

New Approaches for Moving Upstream How State and Local Health Departments Can Transform Practice to Reduce Health Inequalities

Abstract: Growing evidence shows that unequal distribution of wealth and power across race, class, and gender produces the differences in living conditions that are "upstream" drivers of health inequalities. Health educators and other public health professionals, however, still develop interventions that focus mainly on "downstream" behavioral risks. Three factors explain the difficulty in translating this knowledge into practice. First, in their allegiance to the status quo, powerful elites often resist upstream policies and programs that redistribute wealth and power. Second, public health practice is often grounded in dominant biomedical and behavioral paradigms, and health departments also face legal and political limits on expanding their scope of activities. Finally, the evidence for the impact of upstream interventions is limited, in part because methodologies for evaluating upstream interventions are less developed. To illustrate strategies to overcome these obstacles, we profile recent campaigns in the United States to enact living wages, prevent mortgage foreclosures, and reduce exposure to air pollution. We then examine how health educators working in state and local health departments can transform their practice to contribute to campaigns that reallocate the wealth and power that shape the living conditions that determine health and health inequalities. We also consider health educators' role in producing the evidence that can guide transformative expansion of upstream interventions to reduce health inequalities.

The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults

Abstract: Background. Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonrandomized one-arm design. Methods. Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL™) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre–post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. Results. Inclinometer measured sitting time dec...

A Natural Experiment Opportunity in Two Low-Income Urban Food Desert Communities Research Design, Community Engagement Methods, and Baseline Results

Abstract: A growing body of evidence has highlighted an association between a lack of access to nutritious, affordable food (e.g., through full-service grocery stores [FSGs]), poor diet, and increased risk for obesity. In response, there has been growing interest among policy makers in encouraging the siting of supermarkets in "food deserts," that is, low-income geographic areas with low access to healthy food options. However, there is limited research to evaluate the impact of such efforts, and most studies to date have been cross-sectional. The Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) is a longitudinal quasi-experimental study of a dramatic change (i.e., a new FSG) in the food landscape of a low-income, predominantly Black neighborhood. The study is following a stratified random sample of households (n = 1,372), and all food venues (n = 60) in both intervention and control neighborhoods, and the most frequently reported food shopping venues outside both neighborhoods. This article describes the study design and community-based methodology, which focused simultaneously on the conduct of scientifically rigorous research and the development and maintenance of trust and buy-in from the involved neighborhoods. Early results have begun to define markers for success in creating a natural experiment, including strong community engagement. Baseline data show that the vast majority of residents already shop at a FSG and do not shop at the nearest one. Follow-up data collection will help determine whether and how a new FSG may change behaviors and may point to the need for additional interventions beyond new FSGs alone.

Influencing Organizations to Promote Health Applying Stakeholder Theory

Abstract: Stakeholder theory may help health promoters to make changes at the organizational and policy level to promote health. A stakeholder is any individual, group, or organization that can influence an organization. The organization that is the focus for influence attempts is called the focal organization. The more salient a stakeholder is and the more central in the network, the stronger the influence. As stakeholders, health promoters may use communicative, compromise, deinstitutionalization, or coercive methods through an ally or a coalition. A hypothetical case study, involving adolescent use of harmful legal products, illustrates the process of applying stakeholder theory to strategic decision making.

Using the Theory of Planned Behavior to Understand Cervical Cancer Screening Among Latinas

Abstract: To reduce the high incidence of cervical cancer among Latinas in the United States it is important to understand factors that predict screening behavior. The aim of this study was to test the utility of theory of planned behavior in predicting cervical cancer screening among a group of Latinas. A sample of Latinas (N = 614) completed a baseline survey about Pap test attitudes subjective norms, perceived behavioral control, and intention to be screened for cervical cancer. At 6 months postbaseline, cervical cancer screening behavior was assessed. Structural equation modeling was used to test the theory. Model fit statistics indicated good model fit: χ(2)(48) = 54.32, p = .246; comparative fit index = .992; root mean square error of approximation = .015; weighted root mean square residual = .687. Subjective norms (p = .005) and perceived behavioral control (p < .0001) were positively associated with intention to be screened for cervical cancer, and the intention to be screened predicted actual cervical cancer screening (p < .0001). The proportion of variance (R2) in intention accounted for by the predictors was .276 and the R2 in cervical cancer screening accounted for was .130. This study provides support for the use of the theory of planned behavior in predicting cervical cancer screening among Latinas. This knowledge can be used to inform the development of a theory of planned behavior-based intervention to increase cervical cancer screening among Latinas and reduce the high incidence of cervical cancer in this group of women.

HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention

Abstract: Background. Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships. Methods. To assess the feasibility, acceptability, and preliminary outcomes, a 1-month pilot trial of HMP among 15 YBMSM/TW was conducted. Results. Retention was 100%. Mean age was 26 years, 60% were HIV-infected, 87% earned <$21,000, and 67% were uninsured. Despite the small sample size and limited intervention length, statistically significant improvements were seen in social support (p = .012), social isolation (p = .050), and depressive symptoms (p = .045). Conclusion. The HMP pilot trial demonstrated feasibility and acceptability. Given the burden of the epidemic among YBMSM/TW, there is an imperative to develop, test, and scale up culturally appropriate interventions to both preve...

The Association of Social Support and Education With Breast and Cervical Cancer Screening

Abstract: Background. Disparities in breast and cervical cancer screening by socioeconomic status persist in the United States. It has been suggested that social support may facilitate screening, especially among women of low socioeconomic status. However, at present, it is unclear whether social support enables mammogram and Pap test compliance. Purpose. This study examines the association between social support and compliance with mammogram and Pap test screening guidelines, and whether social support provides added value for women of low education. Method. Data were from a countywide 2009-2010 population-based survey, which included records of 2,588 women 40 years and older (mammogram) and 2,123 women 21 to 65 years old (Pap test). Compliance was determined using the guidelines in effect at the time of data collection. Results. Social support was significantly related to mammogram (adjusted odds ratio = 1.43; 95% confidence interval [1.16, 1.77]) and Pap test (adjusted odds ratio = 1.71; 95% confidence interval ...

Impact of Baltimore Healthy Eating Zones: An Environmental Intervention to Improve Diet Among African American Youth

Abstract: This study assessed the impact of a youth-targeted multilevel nutrition intervention in Baltimore City. The study used a clustered randomized design in which 7 recreation centers and 21 corner stores received interventions and 7 additional recreation centers served as comparison. The 8-month intervention aimed to increase availability and selection of healthful foods through nutrition promotion and education using point-of purchase materials such as posters and flyers in stores and interactive sessions such as taste test and cooking demonstrations. Two hundred forty-two youth-caregiver dyads residing in low-income areas of Baltimore City recruited from recreation centers were surveyed at baseline using detailed instruments that contained questions about food-related psychosocial indicators (behavioral intentions, self-efficacy, outcome expectancies, and knowledge), healthful food purchasing and preparation methods, and anthropometric measures (height and weight). The Baltimore Healthy Eating Zones intervention was associated with reductions in youth body mass index percentile (p = .04). In subgroup analyses among overweight and obese girls, body mass index for age percentile decreased significantly in girls assigned to the intervention group (p = .03) and in girls with high exposure to the intervention (p = .013), as opposed to those in comparison or lower exposure groups. Intervention youth significantly improved food-related outcome expectancies (p = .02) and knowledge (p < .001). The study results suggest that the Baltimore Healthy Eating Zones multilevel intervention had a modest impact in reducing overweight or obesity among already overweight low-income African American youth living in an environment where healthful foods are less available. Additional studies are needed to determine the relative impact of health communications and environmental interventions in this population, both alone and in combination.

Effectiveness of a Walking Group Intervention to Promote Physical Activity and Cardiovascular Health in Predominantly Non-Hispanic Black and Hispanic Urban Neighborhoods Findings From the Walk Your Heart to Health Intervention

Abstract: Objectives. The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012. Method. WYHH was a 32-week community health promoter–facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control...

Individual, Social, and Environmental Correlates of Healthy and Unhealthy Eating

Abstract: Background. Few studies use comprehensive ecological approaches considering multilevel factors to understand correlates of healthy (and unhealthy) dietary intake. The aim of this study was to examine the association between individual, social, and environmental factors on composite measures of healthy and unhealthy dietary intake in adults. Method. Participants (n = 565) of the Australian RESIDential Environments (RESIDE) project self-reported dietary intake, home food availability, and behavioral and perceived social and physical environmental influences on food choices. A geographic information system measured proximity of supermarkets from each participant’s home. “Healthy” and “unhealthy” eating scores were computed based on adherence to dietary guidelines. Univariate and multivariate models were constructed using linear regression. Results. After full adjustment, “healthy” eating (mean = 6.25, standard deviation [SD] = 1.95) was significantly associated with having confidence to prepare healthy meals ...

Pilot Randomized Evaluation of Publically Available Concussion Education Materials: Evidence of a Possible Negative Effect

Abstract: Many states and sports leagues are instituting concussion policies aimed at reducing risk of morbidity and mortality; many include mandates about the provision of concussion education to youth athletes. However, there is limited evidence if educational materials provided under these typically vague mandates are in fact effective in changing concussion risk-related behavior or any cognition predictive of risk-related behavior. The purpose of this pilot randomized controlled study was to conduct a theory-driven evaluation of three publically available concussion education materials: two videos and one informational handout. Participants were 256 late adolescent males from 12 teams in a single league of ice hockey competition in the United States. Randomization of educational condition occurred at the team level. Written surveys assessing postimpact symptom reporting behavior, concussion knowledge, and concussion reporting cognitions were completed by participants immediately before receiving their educational intervention, 1 day after, and 1 month after. Results indicated no change in any measure over any time interval, with the exception of perceived underreporting norms. In one of the video conditions, perceived underreporting norms increased significantly 1 day after viewing the video. Possible content and viewing environment-related reasons for this increase are discussed. Across all conditions, perceived underreporting norms increased 1 month after intervention receipt, raising the possibility that late in the competitive season underreporting may be perceived as normative. The need for the development of theory-driven concussion education materials, drawing on best practices from health behavior scholars, is discussed.

Development of an Interactive Social Media Tool for Parents With Concerns About Vaccines

Abstract: Objective. Describe a process for designing, building, and evaluating a theory-driven social media intervention tool to help reduce parental concerns about vaccination. Method. We developed an interactive web-based tool using quantitative and qualitative methods (e.g., survey, focus groups, individual interviews, and usability testing). Results. Survey results suggested that social media may represent an effective intervention tool to help parents make informed decisions about vaccination for their children. Focus groups and interviews revealed four main themes for development of the tool: Parents wanted information describing both benefits and risks of vaccination, transparency of sources of information, moderation of the tool by an expert, and ethnic and racial diversity in the visual display of people. Usability testing showed that parents were satisfied with the usability of the tool but had difficulty with performing some of the informational searches. Based on focus groups, interviews, and usability...

A Dyadic Approach Applying a Developmental-Conceptual Model to Couples Coping With Chronic Illness

Abstract: The purpose of the present study was to apply Berg and Upchurch's developmental-conceptual model toward a better understanding of how couples cope with chronic illness. Specifically, a model was hypothesized in which proximal factors (relational quality), dyadic appraisal (illness interference), and dyadic coping (partner support) influence adjustment (health condition management). The study was cross-sectional and included 308 dyads in which one partner has a chronic health condition. The actor partner interdependence model shows how congruence and noncongruence in relational quality, dyadic appraisal, and dyadic coping influence dyadic adjustment.

Impact Evaluation of Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial.

Abstract: Background. The family and home environment is an influential antecedent of childhood obesity. The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention; a newly developed, theory-based, online program for prevention of childhood obesity. Method. The two-arm, parallel group, randomized, participant-blinded trial targeted mothers with children between 4 and 6 years of age. Measures were collected at baseline, 4 weeks, and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory (SCT) and obesity-related behaviors. Process evaluation transpired concurrently with each intervention session. Results. Fifty-seven participants were randomly assigned to receive either experimental EMPOWER (n = 29) or active control Healthy Lifestyles (n = 28) intervention. Significant main effects were identified for child physical activity, sugar-free beverage consumption, and screen time, in...

Long-Term Refugee Health Health Behaviors and Outcomes of Cambodian Refugee and Immigrant Women

Abstract: Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently little information about how the combined effects of the refugee experience and the U.S. health environment are related to health practices of refugees in the years and decades after resettlement. We examined cross-sectional survey data for Cambodian refugee and immigrant women 35 to 60 years old (n = 160) from an established refugee community in Lowell, Massachusetts, to examine the potential contributors to health behaviors and outcomes among refugees and immigrants postresettlement. In our representative sample, we found that smoking and betel nut use were very low (4% each). Fewer than 50% of respondents walked for at least 10 minutes on 2 or more days/week. Using World Health Organization standards for overweight/obese for Asians, 73% of respondents were overweight/obese and 56% were obese, indicating increased risk of chronic disease. Depression was also high in this sample (41%). In multivariate models, higher acculturation and age were associated with walking more often; lower education and higher acculturation were related to higher weight; and being divorced/separated or widowed and being older were related to higher risk of depression. The interrelated complex of characteristics, health behaviors, and health outcomes of refugees merits a multifaceted approach to health education and health promotion for long-term refugee health.

The Impact of Policy, Environmental, and Educational Interventions A Synthesis of the Evidence From Two Public Health Success Stories

Abstract: Motor vehicle safety and tobacco control are among the greatest public health achievements of the 20th century, according to the Centers for Disease Control and Prevention. As the number of miles traveled in the United States multiplied 10 times from the 1920s to the 1990s, the annual motor vehicle crash death rate per vehicle mile traveled decreased by 90%. Similarly, tobacco-related deaths from heart disease, stroke, and cancer were rapidly mounting over the first two thirds of the 20th century. Then, in the last third of the century, tobacco consumption decreased by more than 50%, and rates of heart disease and stroke deaths, and later cancer deaths, declined similarly. This analysis addresses the central question of what lessons can be learned from these success stories that will help public health professionals successfully tackle new and emerging health behavior problems of today and tomorrow? Surveillance, research, multilevel interventions, environmental modifications, and strong policies were key to reducing motor vehicle- and tobacco-related health problems. Generating public support and advocacy, and changing social norms also played critical roles in promoting the safer and smoke-free behaviors. Lessons learned include the need for evidence-based practices and interventions that are ecologically comprehensive with an emphasis on changing environmental determinants and capitalizing on the concept of reciprocal determinism. The analysis concludes with a description of how the PRECEDE-PROCEED planning framework can be used to apply the lessons from motor vehicle safety and tobacco control to other public health threats.

The U.S. National Tips From Former Smokers Antismoking Campaign: Promoting Awareness of Smoking-Related Risks, Cessation Resources, and Cessation Behaviors

Abstract: Objective. Evaluate the second flight of the U.S. Tips From Former Smokers (Tips) campaign. Method. Data were analyzed from an online consumer panel of U.S. adult smokers before (n = 1,404) and after (n = 1,401) the 2013 Tips campaign launch. Generalized estimating equation models assessed whether the Tips advertisement recall was associated with knowledge about smoking-related risks in the Tips advertisements, awareness and use of a toll-free quitline and cessation websites, and quit attempts. Results. Seventy-one percent of participants at Wave 2 reported that they recalled seeing at least one Tips advertisement. Smokers who recalled seeing a Tips advertisement were more likely to (a) show increases over baseline in knowledge of health risks such as amputation: 65% versus 34%, p < .001; blindness: 27% versus 12%, p < .001; and (b) to be aware of a quitline (41% vs. 30%, p < .001) and cessation website (28% vs. 20%, p < .001). Recall of Tips advertisements was also associated with greater likelihood of r...

Sugar-Sweetened Beverage Consumption by Adult Caregivers and Their Children The Role of Drink Features and Advertising Exposure

Abstract: Objective. To examine how parents’ beliefs about beverage attributes and exposure to sugar-sweetened beverage (SSB) advertising are associated with parents’ and their children’s SSB consumption. Design. Cross-sectional representative telephone survey of Philadelphia parents in households with children between the ages of 3 and 16 years. Participants. Three hundred and seventy-one randomly selected survey respondents. The response rate was 27% using the American Association for Public Opinion Research RR3 formula. Main Outcome Measures. SSB consumption, health ratings of SSBs, exposure to SSB ads, and exposure to anti-SSB public service advertisements. Analysis. Seemingly unrelated regression was used to correct for Type I error and significance levels were set at .05 or less. Results. Assessment of SSB “healthiness” was associated with the increased adult consumption of SSBs for three of the five SSBs and associated with children’s consumption for all four SSBs with child consumption data. For both groups...

Using Community Insight to Understand Physical Activity Adoption in Overweight and Obese African American and Hispanic Women A Qualitative Study

Abstract: Ecologic models suggest that multiple levels of influencing factors are important for determining physical activity participation and include individual, social, and environmental factors. The purpose of this qualitative study was to use an ecologic framework to gain a deeper understanding of the underlying behavioral mechanisms that influence physical activity adoption among ethnic minority women. Eighteen African American and Hispanic women completed a 1-hour in-depth interview. Verbatim interview transcripts were analyzed for emergent themes using a constant comparison approach. Women were middle-aged (age M = 43.9 ± 7.3 years), obese (body mass index M = 35.0 ± 8.9 kg/m(2)), and of high socioeconomic status (88.9% completed some college or more, 41.2% reported income >$82,600/year). Participants discussed individual factors, including the need for confidence, motivation and time, and emphasized the importance of environmental factors, including their physical neighborhood environments and safety of and accessibility to physical activity resources. Women talked about caretaking for others and social support and how these influenced physical activity behavior. The findings from this study highlight the multilevel, interactive complexities that influence physical activity, emphasizing the need for a more sophisticated, ecologic approach for increasing physical activity adoption and maintenance among ethnic minority women. Community insight gleaned from this study may be used to better understand determinants of physical activity and develop multilevel solutions and programs guided by an ecologic framework to increase physical activity in ethnic minority women.

Preparatory Behavior for Condom Use Among Heterosexual Young Men A Longitudinal Mediation Model

Abstract: Objective. Motivation is not sufficient to actually use condoms, as self-regulatory processes are needed to translate motivation into action. Buying condoms and carrying them constitute preparatory behaviors that may serve as proximal predictors of action. Whether or not such preparatory behaviors operate as mediators between intention and action within a broader behavior change framework has been examined. Method. A sample of 150 heterosexual men between ages 18 and 25 years responded at three points in time to a computer-based survey that assessed behavior as well as social-cognitive antecedents. A structural equation model was specified that included preparatory behaviors and self-efficacy as mediators at Time 2. Results. Preparatory behaviors were the most proximal predictors of condom use, and they were, themselves, predicted by self-efficacy and intention. The latter was partly determined by positive emotional outcome expectancies. Conclusion. To bridge the intention-behavior gap, preparatory behavi...

Active Commuting to School, Weight Status, and Cardiometabolic Risk in Children From Rural Areas: The Cuenca Study

Abstract: Purpose. The aim of this study was to examine (a) whether distance from home to school is a determinant of active commuting to school (ACS), (b) the relationship between distance from home to heavily used facilities (school, green spaces, and sports facilities) and the weight status and cardiometabolic risk categories, and (c) whether ACS has a positive impact on schoolchildren’s health. Method. A cross-sectional study was conducted with 956 schoolchildren aged 10 to 12 years from the province of Cuenca, Spain. Height, weight, fat mass, waist circumference, blood pressure, fasting plasma lipid profile, insulin, fitness, physical activity, and ACS were measured. Distances from home to facilities were measured by a geographic information system, and a validated metabolic syndrome index was used. Findings. Children living closer to school (less than 600 m) commuted actively to school more frequently than children living further away (more than 800 m). Normoweight boys lived further away from sports facilitie...

Dissecting an Online Intervention for Cancer Survivors: Four Exploratory Analyses of Internet Engagement and Its Effects on Health Status and Health Behaviors

Abstract: The Internet has been used extensively to offer health education content and also for social support. More recently, we have seen the advent of Internet-based health education interventions that combine content with structured social networking. In many ways this is the Internet equivalent to small group interventions. While we have some knowledge about the efficacy of these interventions, few studies have examined how participants engage with programs and how that might affect outcomes. This study seeks to explore (a) the content of posts and (b) the nature of participant engagement with an online, 6-week workshop for cancer survivors and how such engagement may affect health outcomes. Using methodologies related to computational linguistics (latent Dirichlet allocation) and more standard statistical approaches, we identified (a) discussion board themes; (b) the relationship between reading and posting messages and outcomes; (c) how making, completing, or not completing action plans is related to outcome; and (d) how self-tailoring relates to outcomes. When considering all posts, emotional support is a key theme. However, different sets of themes are expressed in the first workshop post where participants are asked to express their primary concern. Writing posts was related to improved outcomes, but reading posts was less important. Completing, but not merely making, action plans and self-tailoring are statistically associated with future positive health outcomes. The findings from these exploratory studies can be considered when shaping future electronically mediated social networking interventions. In addition, the methods used here can be used in analyzing other large electronically mediated social-networking interventions.

The Illicit Use of Prescription Stimulants on College Campuses: A Theory-Guided Systematic Review

Abstract: The illicit use of prescription stimulants (IUPS) is a substance use behavior that remains prevalent on college campuses As theory can guide research and practice, we provide a systematic review of the college-based IUPS epidemiological literature guided by one ecological framework, the theory of triadic influence (TTI) We aim to assess prevalence, elucidate the behavior's multietiological nature, and discuss prevention implications Peer-reviewed studies were located through key phrase searches (prescription stimulant misuse and college, "prescription stimulant misuse" and "college," illicit use of prescription stimulants in college, and nonmedical prescription stimulant use in college students) in electronic databases (PubMed, PubMed Central, and EBSCO Host) for the period 2000 to 2013 Studies meeting inclusion criteria had their references reviewed for additional eligible literature Statistically significant correlates of IUPS in the 62 retrieved studies were organized using the three streams of influence and four levels of causation specified in the TTI Results show that the prevalence of IUPS varies across campuses Additionally, findings suggest the behavior is multifaceted, as correlates were observed within each stream of influence and level of causation specified by the TTI We conclude that IUPS is prevalent in, but varies across, colleges and is influenced by intrapersonal and broader social and societal factors We discuss implications for prevention and directions for future research

Policy, Systems, and Environmental Change in the Mississippi Delta: Considerations for Evaluation Design

Abstract: Community-level policy, systems, and environmental (PSE) change strategies may offer an economical and sustainable approach to chronic disease prevention. The rapidly growing number of untested but promising PSE strategies currently underway offers an exciting opportunity to establish practice-based evidence for this approach. This article presents lessons learned from an evaluation of a community-based PSE initiative targeting stroke and cardiovascular disease prevention in the Mississippi Delta. Its purpose is to describe one approach to evaluating this type of PSE initiative, to stimulate discussion about best practices for evaluating PSE strategies, and to inform future evaluation and research efforts to expand practice-based evidence. The evaluation used a descriptive mixed-methods design and focused on the second year of a multisectoral, multiyear initiative. Cross-sectional data were collected in the summer and fall of 2010 using four data collection instruments: a grantee interview guide (n = 32), a health council member survey (n = 256), an organizational survey (n = 60), and a grantee progress report (n = 26). Fifty-eight PSE changes were assessed across five sectors: health, faith, education, worksite, and community/city government. PSE strategies aligned with increased access to physical activity opportunities, healthy food and beverage options, quality health care, and reduced exposure to tobacco. Results showed that grantees were successful in completing a series of steps toward PSE change and that sector-specific initiatives resulted in a range of PSE changes that were completed or in progress. Considerations for designing evaluations of community-based PSE initiatives are discussed.

Physical and social-motivational contextual correlates of youth physical activity in underresourced afterschool programs

Abstract: Afterschool programs (ASPs) have become increasingly recognized as a key context to support youth daily physical activity (PA) accrual The purpose of the present study was to assess the physical and social-motivational climate characteristics of ASPs associated with youth PA, and variations in contextual correlates of PA by youth sex Systematic observations of 7 ASPs serving underserved youth (minority, low income) was conducted using the System for Observing Play and Leisure Activity in Youth and a social-motivational climate observation tool founded on self-determination theory For five program days at each site, teams of two coders conducted continuous observations of youth PA (sedentary, moderate, vigorous), five physical features (eg, equipment availability), eight staff interactions (eg, encourage PA), and seven motivational climate components (eg, inclusive) Aligned with previous research, regressions controlling for variations by site indicated that organized PA, provision of portable eq