In Briefs

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		Editorial
Paul E. Terry	156	In what direction has workplace wellness research been evolving over the past twenty years? What proportion of occupational health researchers have been focusing on how health impacts work compared to researchers who ask how work affects health? This editorial poses an audacious, albeit largely subjective, question. That is, what have been the most important research studies about workplace wellness? Readers are invited to respond with their opinions about seminal studies we missed. Readers are also challenged with a thought experiment and exercise designed to organize the past decades of workplace wellness studies into a table that identifies trends in this research domain. Based on trends, I posit that researchers are waning in their interest in how health affects work productivity and healthcare costs and waxing in their considerations of how work affects well-being.
The Science of Individual and Collective Well-being
		Critical Issues and Trends
Karen J. Campoverde Reyes, Shreya Sabharwal, Fatima Cody Stanford	164	Legal Evolution of a Law Against Weight Discrimination in the United States: A Focus on MassachusettsObesity is a societal matter plagued by stigma. Biases and discrimination against people with obesity lead to healthcare inequalities, social disparities, socioeconomic disadvantages, and psychological distress. While discrimination is an intrinsic cultural issue that will not halt by law alone, legal protection will help increase awareness. Awareness begins with people’s social involvement with their community and representatives. In the US, only the state of Michigan has an anti-weight discrimination law. Since 2009, no locations in the US have passed a law to provide legal protection based on weight, height, or physical appearance. This pilot study aims to examine the legal evolution of laws against weight discrimination in the United States, explore knowledge regarding weight bias among lawmakers in the Commonwealth of Massachusetts, and raise awareness about weight-based discrimination’s repercussions on people with obesity.
		Quantitative Research
Rebecca Kelly, Amy Hanus, Pamela Payne-Foster, Janet Calhoun, Ron Stout, Bruce W Sherman	168	Health Benefits of a 16-Week Whole Food, High Fiber, Plant Predominant Diet among U.S. EmployeesThe article explores eating behaviors and health measures of 4,477 adults participating in a 16-week whole food plant predominant diet, the Full Plate Living (FPL) program, over a three-year period (2017-19). Participants received a FPL nutrition guide, and weekly online video lessons. Paired t-tests and mixed-effects models were used to examine program impact, further segmented by generational cohorts.Significant improvements were demonstrated in all pre-post 16-week self-reported measurements to include self-perceived health status and energy, and confidence in healthy eating (P <.001). Improvements included servings of fruits (0.80), vegetables (0.82), and beans (0.36) (P <.001). Mean weight loss was 3.5 pounds (P <.001). Improvements were also significant across all generations (P <.001). The FPL study adds to the body of literature on the health benefits of a plant-predominant approach to healthy living in a workplace population across generations.
		Quantitative Research
Christie L. Martin, Barbara J. McMorris, Marla E. Eisenberg, Renee E. Sieving, Carolyn M. Porta, Michelle A. Mathiason, Sarah M. Espinoza, Yazmin A. Cespedes, Jayne A. Fulkerson	177	Weight Status Among Minnesota Hispanic or Latino/a Youth: An Exploration of Protective FactorsOur cross-sectional study utilized an assets-oriented approach to explore protective factors associated with weight status among Minnesota Hispanic or Latino/a adolescents (N = 5442). Specifically, we used stepwise logistic regression models (fruit and vegetable [F&V]; physical activity [PA]), stratified by biological sex, to (1) determine prevalence rates and ascertain whether (2) individual (ie, meeting F&V and PA recommendations), (3) familial (ie, family caring), and (4) cultural (ie, family country/region of origin) factors were associated with lower odds of having overweight/obesity (BMI ≥ 85th percentile) among 9th and 11th graders. Prevalence rates of meeting F&V and PA recommendations were 11.0% and 11.8%, respectively. Meeting F&V recommendations was not protective in either sex; however, meeting PA recommendations was associated with lower odds of having overweight/obesity among males (P < .05) and females (P < .05). In both models, family caring was associated with lower odds of having overweight/obesity among females (P < .05), and family country/region of origin was associated with lower odds of having overweight/obesity among males (P < .05) and females (P < .05). Our findings demonstrate that continued interdisciplinary research efforts are needed to advance the science of this understudied population in pediatric obesity literature and to promote culturally appropriate public health initiatives for Hispanic or Latino/a youth.
		Quantitative Research
Meiqi Xin, Sitong Luo, Suhua Wang, Junfeng Zhao, Guohua Zhang, Lijuan Li, Liping Li, Joseph Tak-Fai Lau	189	The Roles of Information Valence, Media Literacy and Perceived Information Quality on the Association Between Frequent Social Media Exposure and COVID-19 Vaccination IntentionA multi-city survey was conducted among 6,922 Chinese university students. The results showed that higher exposure to positive but not negative information about vaccine efficacy/safety on social media was significantly associated with increased COVID-19 vaccination intention. Higher net exposure to negative versus positive information was associated with decreased vaccination intention. High media literacy was further found to attenuate the effect of negative information exposure and strengthen that of positive information exposure. It is suggested that the valence of social media information and individuals’ media literacy jointly shape COVID-19 vaccination intention. The findings can contribute to the promotion of COVID-19 vaccination to combat the ongoing pandemic.
		Qualitative Research
Anthony Spadaro, Anish K. Agarwal, Hareena K. Sangha, Jeanmarie Perrone, Mucio Kit Delgado, Margaret Lowenstein	200	Motivation to Carry Naloxone: A Qualitative Analysis of Emergency Department PatientsOur aim was to explore perspectives of patients who received naloxone in the emergency department (ED) via semi-structured interviews of patients prescribed naloxone at ED discharge. 25 participants were recruited from three urban academic EDs in Philadelphia, PA. We found several key factors influenced motivation to carry naloxone, including ease of naloxone acquisition and comfort with use, prior personal experience with OUD or overdose and perceived future risk of encountering and overdose, and social influences such as stigma on naloxone carrying behaviors. In particular, those with personal history of overdose or close friends or family at risk were motivated to carry naloxone. Stigma associated with being seen carrying naloxone was a barrier to more frequent naloxone carrying. EDs, health systems, and public health officials should consider these factors influencing motivation when designing future interventions to increase access, carrying, and use of naloxone.
		Qualitative Research
Marc T Braverman, Karen M Volmar, Diana J Govier	210	“The Pain Doesn’t Have to Control You.” A Qualitative Evaluation of Three Pain Clinics Teaching Nonopioid Pain Management StrategiesThis qualitative study was an evaluation of a nonpharmacological educational program delivered at three rural Oregon clinics for opioid-dependent patients suffering with chronic pain. The program incorporated cognitive-behavioral therapy, movement therapy, mindfulness, and other skills. Across the sites, we conducted nine individual interviews with clinic staff and three focus group interviews with 34 patients. Thematic analysis of the interviews revealed that the program produced several important benefits for patients, including improved quality of life and increased skills in pain self-management, among others. Clinics permitted patients to set their own opioid reduction-related goals, and many reported success in reducing opioid dependence. However, patients’ primary providers were not always clear about this approach. These results provide supportive evidence for the effectiveness of nonpharmacological pain treatments and provide practice-based insights on how to make them successful. There should be consistency in treatment goals as understood by patients, their primary providers, and the clinic.
		Applied Research Brief
Zaher Nazzal, Ahmad Mohammad, Lama Qub, Hadeel Masri, Ibtesam Abdullah, Hala Qasrawi, Beesan Maraqa	222	Coverage and Determinants of COVID-19 Vaccination Among Pregnant Women: An Experience From a Low-Income Country
		Given the current COVID-19 crisis, there is little tolerance for low vaccination rates assuming appropriate safety and efficacy. When it comes to pregnant women, vaccine anxiety and long term side effects challenges significantly impair vaccine uptake. Only 219 of the 860 pregnant women in this study reported being vaccinated, resulting in vaccination coverage of 25.5%, which is low, even lower than previously predicted. For pregnant women, vaccination uptake is significantly influenced by factors such as their perceived knowledge of the vaccine and their perceived benefits/barriers to vaccination. In addition to their own safety, pregnant mothers worry about protecting their unborn babies. Therefore, they requested extensive research to ensure that the vaccination was safe and effective for pregnant women before exposing their unborn children to it.In conclusion, all pregnant women, regardless of gestational age, should be encouraged to receive COVID-19 vaccination. Concerns about the safety of the COVID-19 vaccine for infants must be addressed, as they significantly impact vaccine uptake in pregnant women. Employee vaccination requirements for COVID-19, as well as legislative nudges, are critical for vaccination promotion. Additionally, it is recommended that targeted health education and increased awareness be implemented.
		Applied Research Brief
Caitlin Turbyfill, Isabel Thomas, Namita Agravat, Joanna M Prasher, Randall J Nett, Melody Stevens, Jessica N Ricaldi, Tambra M Dunams, Latasha Brickhouse-Frazier, Melissa D Carter, Yonathan Gebru, Ashley King, Coral S May, Joseph D Miller, Chigo Oguh, Amanda Pullman, Kaylin Roman, Charles Rose, Robert Scherr, Turquoise Sidibe, Rieza Soelaeman, Jonathan Weinstein, Todd Wilson, Cuc H Tran	228	The Impact of Community-Based Testing Sites and Gift Incentives on COVID-19 Testing Uptake in Maryland, April 29 – May 9, 2021Incentives have been a method of encouraging desired health behaviors in public health promotion, yet little is known about motivating factors for COVID-19 testing. During April 29 – May 9, 2021, we used a financial and material incentive to promote free, walk-up, COVID-19 rapid antigen testing in two cities that had low COVID-19 testing rates. In this brief, we describe the characteristics of survey participants who received an incentive after performing a rapid antigen test from a convenience sample of 553 adults (≥18 years). Among participants, the most common reasons for seeking testing were the need or desire to be tested (54%), followed by the convenience of the location (28%) regardless of race, ethnicity, age, or employment status. Information on the use of incentives for COVID-19 testing is needed to understand underlying motivations and effective practices that encourage testing uptake to help mitigate transmission.
		Applied Research Brief
Youngdeok Kim, R. Lee Franco, Alexander R. Lucas, Arnethea L. Sutton, Jessica G. LaRose, Jonathan Kenyon, Jeremy Via, Richard K. Cheng, Ralph, B. D’Agostino Jr, Vanessa B. Sheppard, W. Gregory Hundley	233	Prevalence of Cardiovascular Diseases Among Breast Cancer Survivors: Findings From the NHANES 2003-2018Breast cancer (BC) is the second leading cause of cancer deaths in women. Fortunately, with advances in cancer treatment and therapy, the BC survival rate has been steadily increasing; yet, therapy-induced cardiotoxicity that increases the risk of developing cardiovascular disease (CVD) has become a growing health concern for BC survivors. We examined the 2003-2018 National Health and Nutrition Examination Survey data to estimate the population-level prevalence of cardiovascular diseases (CVD) among breast cancer (BC) survivors. Self-reported CVD status (i.e., coronary artery disease (CAD), heart failure, and stroke) and time of the CVD diagnosis were used to categorize BC survivors into three groups: No CVD, preexisting CVD, and post-acquired CVD after BC diagnosis. A total of 658 BC survivors were identified, representing 3.01% (≈3.4 million) of the US women aged ≥18 years old. Of those, ≈6% (≈0.2 million) had preexisting CVD and ≈11% (≈0.4 million) had at least one CVD diagnosed after BC diagnosis, with an average time elapsed ranging from ≈5 years for heart failure to ≈9 years for CAD and stroke. The prevalence of CVD among BC survivors differed by demographic characteristics including age, education, marital status, menopausal, and physical activity levels. Our findings suggest that BC survivors are at risk of suffering from CVD and public health strategies for the long-term management of CVD risk factors in this vulnerable population group is recommended.
		Applied Research Brief
Jordan Pennington, Erika Rasnick, Lisa J. Martin, Jocelyn M. Biagini, Tesfaye B. Mersha, Allison Parsons, Gurjit K. Khurana Hershey, Patrick Ryan, Cole Brokamp	239	Racial Fairness in Precision Medicine: Pediatric Asthma Prediction AlgorithmsThe purpose of this study was to quantify and examine the racial fairness of two widely used childhood asthma predictive precision medicine algorithms: the asthma predictive index (API) and the pediatric asthma risk score (PARS). By applying the API and PARS to a prospective birth cohort in Cincinnati, OH, USA, we found differences in model performance between Black and White children. Using the PARS, Black children were more likely to be identified as high risk for asthma, but were also incorrectly identified more compared to White children. Instead of using race as a proxy, future algorithms should directly incorporate estimated exposures and community characteristics to ultimately maximize predictive ability for all.
		Literature Review
Francisco Santos, Honorato Sousa, Élvio Ŕubio Gouveia, Helder Lopes, Miguel Peralta, João Martins, Eugenia Murawska-Ciałowicz, Grzegorz Źurek, Adilson Marques	243	School-Based Family-Oriented Health Interventions to Promote Physical Activity in Children and Adolescents: A Systematic ReviewThere is still no systematized evidence that reports the influence of School-based interventions involving the family on children and adolescents’ PA levels. This systematic review provides new information on how PA interventions centred on the family at the school can increase PA and reduce SB. We considered the level of PA, SB, and fitness/skills at the school context as the pillars of this research. Given this three-dimensional scenario, it was possible to identify some standardised dynamics concerning how successful interventions should be structured.School-based interventions involving the family seem to effectively promote PA behaviour, reduce SB, and improve fitness/skills. This approach requires a multicomponent and multidisciplinary method, integrating PA, nutrition education, and general education for a healthier lifestyle. Also, interventions designed based on simultaneous participation and pursuit of goals by the family and children, making commitments to change behaviour together, are the most sustainable.
Knowing Well, Being Well
Rachel Mosher Henke	KWBW(263)	The COVID-19 Pandemic and Children: Implications for Future HealthAs life in the US returns to pre-pandemic norms, there is a nagging concern captured by the frequently used headline: “The Kids are Not Alright”.
Bonnie D. Kerker, Erica Willheim, J. Rebecca Weis	KWBW(265)	The COVID-19 Pandemic: Implications for Maternal Mental Health and Early Childhood DevelopmentWomen are particularly susceptible to mental health challenges during the perinatal period. With the onset of the COVID-19 pandemic in 2020, much concern was raised about the impact that the associated isolation, uncertainty, grief, loss and economic upheaval would have on mental health. Women experienced a disproportionate amount of environmental strain during this time, including economic stress and challenges associated with being essential workers; stressors were perhaps most prevalent in communities of color and immigrant groups. For women who were pregnant during the height of the pandemic, it is clear that stress, anxiety, and depression were increased due to changes in medical care and decreases in social support. Increased mental health challenges in the perinatal period have been shown to impact social-emotional, cognitive and behavioral health in infants and children, so the potential consequences of the COVID-19 era are great. This paper discusses these potential impacts and describes important pathways for future research.
Bonnie D. Kerker, Natalia M. Rojas, Spring Dawson-McClure, Cristina Gonzalez	KWBW(270)	Re-imagining Early Childhood Education and School Readiness for Children and Families of Color in the Time of COVID-19 and BeyondHigh quality and culturally responsive early childhood education and care (ECEC) for young children before kindergarten is seen as a way to ensure that all children enter school ready to learn. ECEC is even more crucial in the context of recovery from the COVID-19 pandemic and the disproportionate burden of trauma and stress borne by families of color in disinvested neighborhoods. Remote learning and repeated disruptions to in-person instruction as protocols shifted during waves of the pandemic placed an extra strain on families, and may have increased educational disparities in the U.S. Taken together, these challenges have implications for children’s school readiness due to their impact on opportunities for learning at home and in the classroom. This paper explores how ECEC programs can be strengthened to better meet children’s needs, and ways in which future research can shed light on these important issues.
Erum Nadeem, Anna R. Van Meter	KWBW(274)	The Impact of the COVID-19 Pandemic on Adolescents: An Opportunity to Build Resilient SystemsThe impact of the COVID-19 pandemic on adolescents is significant. Educational progress and mental health, in particular, have been negatively affected. Among youth from vulnerable communities, pre-existing academic and health disparities have been exacerbated. Youth outcomes are often attributed to individual resilience – or lack thereof; in this paper, we describe how failure to adapt and effectively cope at the system level (ie, lack of system resilience) is implicated in the current dual educational and mental crisis. We describe opportunities to make our systems more nimble and better-equipped to support youth moving forward.
Whitney Perkins Witt, Nicole Harlaar, Ashley Palmer	KWBW(282)	The Impact of COVID-19 on Pregnant Women and Children: Recommendations for Health PromotionCOVID-19 continues to have severe repercussions on children and pregnant women. The repercussions include not only the direct impact of COVID-19 (ie, children getting infected by COVID-19) but also indirect impacts (eg, safeguarding from child maltreatment, obesogenic behaviors, language and socioemotional development, educational consequences [eg, interrupted learning]; social isolation; mental health; behavioral health [eg, increased substance use in adolescence]; health and economic impact of COVID-19 on caregivers and family relationships. It has also shed light on long-standing structural and socioeconomic issues, including equity in nutrition and food security, housing, childcare, and internet access. Using a socioecological, life course, and population health approach, we discuss the implications for pregnant women and children’s health and well-being and give recommendations for mitigating the short and long-term deleterious impact COVID-19 on women, children, and their families.