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Paul Terry	459	Editorial Research Findings Journalists Cannot Resist: A Tale of Three Mental Health and Well-Being Studies Addressing employee mental health needs and fostering organizations that enable thriving has become a priority for most workplace health and well-being initiatives. While mental health issues for the nation were of growing concern before COVID-19, the pandemic amplified concerns about loneliness, burnout and deaths of despair. A recent study that garnered attention from the popular press found that participants of individual-level mental health interventions were no better off than nonparticipants. This editorial reviews that study, summarizes limitations and beneficial learnings from the research, and argues that organizational factors have been shown to mitigate or amplify the effectiveness of mental health services. Tenets of ‘patientcentered care’ and the principles behind Total Worker Health® will need to be more broadly embraced so that the voice of employees can better inform workplace well-being strategies and strategic plans.
the Science of individual and collective Well-Being
Sara Singer and Stephen J. Downs	464	Critical Issues and Trends The ‘Product Environment’ is an Important Driver of Health. It’s Time to Measure It Through their products and services, businesses have a meaningful impact on their customers’ health. When markets reward products that induce unhealthy behaviors, like poor diet and limited physical activity, they fuel the chronic disease epidemic. For market mechanisms to reward positive, and to punish negative, influences on healthy behaviors, companies’ influences will need to be measured. Inspired by the technique of health impact assessment, we propose an approach to measuring these influences, based on examining usage patterns and the activities that result from a given product or service and then mapping those experiences to a core set of health behaviors.
Elizabeth K.Elizabeth K. Do, Kathleen Aarvig, Gargi Panigrahi, and Elizabeth C. Hair	468	Quantitative Research Past-Year Mental Illness Diagnosis and E-cigarette Use Status Among a College-Aged Sample: Findings From the National College Health Assessment (2017-2019) Purpose: To examine associations between past-year mental illness (MI) diagnoses and e-cigarette use status. Design: Data were obtained from the National College Health Assessment, a nationally recognized cross-sectional survey of university students. Setting: Participants were recruited from 2-year and 4-year public and private universities across the United States from 2017-2019. Subjects: The analytic sample included 277 291 university students. Measures: Self-reported past-year MI diagnosis, binarily coded, served as the primary predictor. The outcome was e-cigarette use status (never, noncurrent, and current user). Analysis: Multinomial logistic regression models were used to estimate relative risk ratios (RRR) of e-cigarette use, as predicted by past-year MI diagnoses, age, race/ethnicity, sex and gender, sexual identity, geographic region, and other combustible tobacco, alcohol, and marijuana use. Results: Compared to those who had never received any MI diagnosis in the past year, those who did had a 16% higher relative risk (RRR = 1.16, 95% CI: 1.11, 1.20) of being a noncurrent e-cigarette user and a 33% higher relative risk (RRR = 1.33, 95% CI: 1.28, 1.38) of being a current e-cigarette user. Schizophrenia, substance use or addiction, bipolar disorder, and attention deficit and hyperactivity disorder (ADHD) diagnoses demonstrated the strongest associations with noncurrent and current e-cigarette use. Conclusion: Results suggest the need to screen young adults for e-cigarette use and mental health indicators to facilitate early detection and timely intervention for at-risk university students.
Yuichiro Matsumura, Ryohei Yamamoto, Maki Shinzawa, Naoko Otsuki, Masayuki Mizui, Isao Matsui, Yusuke Sakaguchi, Makoto Nishida, Kaori Nakanishi, Seiko Ide, Chisaki Ishibashi, Takashi Kudo, Keiko Yamauchi-Takihara, Izumi Nagatomo, and Toshiki Moriyama	478	Quantitative Research Living Arrangements Predict Frequent Alcohol Consumption Among University Students: A Retrospective Cohort Study Purpose: This study aimed to confirm the clinical impact of living arrangements on incidence of frequent alcohol consumption in university students. Design: A retrospective cohort study. Setting: A national university in Japan. Subjects: 17,774 university students. Measures: The association between living arrangements on admission and the incidence of frequent alcohol consumption (≥4 days/week) was assessed using multivariable-adjusted Cox proportional-hazards models. Results: Among 5,685, 692, and 5,151 male students living with family, living in the dormitory, and living alone, 5.0%, 6.2%, and 5.8% reported frequent alcohol consumption during the median observational period of 3.0 years, respectively. Living in the dormitory and living alone were identified as significant predictors of frequent alcohol consumption (multivariable-adjusted hazard ratios: 1.00 [reference], 1.39 [1.01-1.92], and 1.21 [1.03-1.42], respectively). On the contrary, living arrangements were not associated with the incidence of frequent alcohol consumption among of 6,091 female students, partly because of low incidence of frequent alcohol consumption (2.3%, 1.4%, and 2.6%, respectively). Conclusions: Living arrangements predicted frequent alcohol consumption among male university students, whereas not among female university students.
Melissa J. Slotnick, Saba Ansari, Lindsey Parnarouskis, Ashley N. Gearhardt, Julia A. Wolfson, and Cindy W. Leung	483	Quantitative Research Persistent and Changing Food Insecurity Among Students at a Midwestern University is Associated With Behavioral and Mental Health Outcomes Purpose: To assess associations between persistent and changing food insecurity and behavioral and mental health outcomes in college students. Design: Online surveys conducted November 2018 and March 2019 (freshman year), and March 2020 (sophomore year) were used to assess food insecurity, which was then used to create 4 food security transitions: persistent food insecurity, emergent food insecurity, emergent food security, and persistent food security. Setting: Large Midwestern university. Sample: 593 students completing all 3 surveys. Measures: Dietary intake and behavioral and mental health outcomes (eating disorders, anxiety, depression, sleep quality) were assessed using validated instruments. Analysis: Associations between food security transitions and dietary intake, behavioral, and mental health outcomes were examined using generalized linear models. Results: Compared to persistent food security, emergent and persistent food insecurity was associated with lower (7% and 13% respectively) intake of fruits and vegetables combined; persistent food insecurity was associated with 17% lower intake of fruits, 6% lower intake of fiber and 10% higher intake of added sugar from beverages. Compared to persistent food secure students, eating disorder symptom risk was higher for emergent food insecure (OR = 7.61, 95% CI: 3.32, 17.48), and persistent food insecure (OR = 6.60, 95% CI: 2.60, 16.72) students; emergent (OR = 2.05, 95% CI: 1.14, 3.71) and persistent (OR = 2.55, 95% CI: 1.34, 4.87) food insecure students had higher odds of poor sleep quality, and persistent food insecure, emergent food insecure, and emergent food secure students had higher odds of anxiety and depression (OR range 2.35-2.85). Conclusion: Food security transitions were associated with aspects of low diet quality and poorer behavioral and mental health outcomes among college students.
Catherine E. Yepez, Christopher E. Anderson, Erin Frost, Shannon E. Whaley, and Maria Koleilat	492	Quantitative Research Sleep Duration Is Associated with Household Food Insecurity and Sugar-Sweetened Beverage Intake Among Women, Infants and Children Participating Children Ages 0-5 Purpose: To determine associations between child and household characteristics and sleep duration among low-income children in Los Angeles County. Design: Cross-sectional study. Setting: Survey data collected in 2017 and 2020 in Los Angeles County, California. Sample: Special Supplemental Nutrition Program for Women, Infants and Children (WIC) households with children ages 4- 60 months. Measures: Sleep duration for children 4-60 months old (less than recommended (LTR), recommended range, more than recommended (MTR)), household food insecurity (HFI), sociodemographics, and daily servings of sugar-sweetened beverages (SSB). Analysis: Multinomial logistic regression, stratified by child age, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between household/child characteristics and LTR or MTR sleep compared to recommended duration among WIC participating children 4-60 months old. Results: The final sample included 3512 children ages 4-23 months and 6035 children ages 24-60 months. In the study population, 32% (3-5 years old) to 44% (4-11months) of children under 5 did not meet the recommended hours of sleep per night. HFI was associated with higher odds of LTR (OR 1.27, CI 1.12-1.45) and MTR (OR 1.46, CI 1.15-1.87) sleep among 24-60 month-old children. Each additional daily SSB serving was associated with higher odds of LTR sleep (4-23 months: OR 1.10, CI 1.02-1.19; 24-59 months: OR 1.12, CI 1.08-1.17). Conclusions: HFI and SSB intake are associated with not getting the recommended amount of sleep among low-income WIC participating children. Nutrition assistance program participants may benefit from receiving information about recommended sleep duration for young children and how to establish sleep routines to optimize sleep duration.
Masahiro Yamamoto, Archana Krishnan, Annis Golden, Gregory Owen, Lawrence M. Schell, Olivia Mata, and Elizabeth A. Holdsworth	503	Quantitative Research Correlates of COVID-19 Information Overload and Information Seeking: Evidence from a Community Survey Purpose: To examine the relationships among health literacy, risk perceptions, COVID-19 information overload, health information seeking, and race/ethnicity. Design: A cross-sectional non-probability community survey conducted between December 2020 and January 2021. A questionnaire was developed in collaboration with a local minority health task force. Setting: Albany, New York, USA. Sample: 331 adults residing in Albany, NY and neighboring areas (80.3% completion rate). Measures: Multi-item scales were used to measure health literacy, perceived severity, perceived susceptibility, information overload, and health information seeking frequency and types. Analysis: We conducted multivariate regression analysis. Results: Health literacy (standardized β = .33, P < .001) and perceived severity (β = .23, P < .001) were negatively associated with information overload. Information overload was negatively associated with health information seeking frequency (β = .16, P < .05) and types (β = .19, P < .01). A further analysis shows several factors, including information overload and race (African Americans), were negatively related to seeking specific types of information. Conclusion: We find that low health literacy and perceived severity contribute to information overload and that information overload adversely affects health information seeking. Black individuals are less likely to search for certain types of information. The cross-sectional study design limits our ability to determine causality. Future research should employ panel data to determine the directionality of the observed relationships.
U¨ lkü Yıldız, Emel Kuruog˘ lu, Tolga Günvar, Og˘ulcan Ço¨me, and Vildan Mevsim	513	Quantitative Research The Relationship Between Obesity and Internet Addiction in University Students: A Cross-Sectional Study Purpose: The purpose of this study was to investigate the relationship between obesity and internet addiction in first-year university students (aged 18-25 years). Design: The study was designed using a cross-sectional analytic model. Setting: Data collection took place at Dokuz Eylul University, involving a diverse group of first-year students from different faculties. Subjects: The study population comprised 12,365 students, with 2890 individuals selected using cluster sampling. Measures: Internet addiction was evaluated using the Online Cognition Scale (OCS). Data on obesity-related variables and demographic details were collected through a questionnaire. Descriptive statistics, chi-square analysis, t test, and ANOVA were applied for statistical evaluation. Results: The study included 2105 participants, with 43.8% males and 56.2% females. A significant positive correlation was found between body mass index (BMI) and OCS scores (P = .000), indicating a higher prevalence of internet addiction among individuals with higher BMI. Males had higher mean OCS scores (91.19 ± 35.14) than females (80.21 ± 30.51) (P = .00). Overweight and obese individuals exhibited higher scores on OCS sub-dimensions (P < .005). Notably, individuals with a BMI over 25 were categorized as overweight, and those with a BMI over 30 were classified as obese. Conclusions: The findings demonstrate a noteworthy relationship between internet addiction and obesity among university students. The study emphasizes the necessity of increased attention to this issue in Turkey for the implementation of effective interventions and preventive measures.
Courtney Kimi Suh, Abigail Huliganga, Jeriann Collymore, Naomi Desai,Mary Mora, and Lena Hatchett	522	Qualitative Research Participants’ Experiences With a Community Based Participatory Research Produce Prescription Program: Findings From a Qualitative Study Purpose: The purpose of this study was to explore a food-insecure, low income, predominantly African American community’s experiences with a produce prescription program (PPP). Design: Researchers conducted 3 focus groups and 4 individual interviews with Maywood Veggie Rx (VRxM) participants asking questions about the logistics of the program while also exploring ideas around health, food, and community. Setting: This produce prescription program took place in Maywood, Illinois which is an urban underserved community with 23.5 K people, most of whom are Black/African American (61%) and Hispanic (32%). Participants: The 24 participants interviewed through focus groups and individual interviews were enrolled in the 2021-2022 VRxM program. Participants were mainly female, with only three participants being males. Ages ranged between 34 and 74 years of age with a mean age of 56.3. Method: Qualitative data from transcripts were then coded via a grounded theory approach to identify common themes. Results: A research team of seven including the two Co-PIs, three medical students and two dietetic interns identified 278 codes which were then condensed into 117 codes and then placed into 9 categories. Researchers identified three recurrent themes among the experiences of VRxM participants: (1) trust building, (2) culturally relevant and adaptive nutrition education, and (3) bidirectional feedback. These three themes mirror many of the principles of Community Based Participatory Research (CBPR). Conclusion: The study findings identify common themes among the experiences of VRxM which are in line with the collaborative approach of CBPR principles. Produce Prescription Programs should utilize CBPR principles in the creation and implementation of programming to improve the participant experience. Future research should include additional focus groups on new iterations of VRxM and should also include those people who chose not to participate in VRxM to explore barriers to participation.
Alyssa M. Lederer, Mary T. Hoban, and Christine Kukich	528	Applied Research Brief An Investigation of COVID-19 Outcomes and College Student Demographics: Results from a National Sample Purpose: To assess the effects of COVID-19 on college students and any differential outcomes across collegiate subpopulations towards the beginning of the pandemic. Design: Cross-sectional survey. Setting: Fall 2020 American College Health Association-National College Health Assessment. Subjects: N = 13 373 undergraduate/graduate/professional students; 22 colleges/universities. Measures: Six COVID-19 outcomes; 10 demographics. Analysis: Campus-specific weights for student enrollment/sex distribution. Cross-tabulations/Pearson χ2 test; Cramer’s V/effect size; Bonferroni multiple testing correction (P < .0009). Results: 5.6% of students had been diagnosed with COVID-19. Compared to counterparts within each demographic category, rates were significantly higher among many BIPOC student groups (e.g., Native Hawaiian/Other Pacific Islander: 15.0%); cisgender women (5.9%) and men (5.6%); heterosexuals (6.1%); undergraduates (6.3%); and sorority/fraternity members (13.7%). Due to COVID-19, 8.8% of students had lost a loved one; 14.6% had a loved one with long term effects from COVID; 38.6% had increased stress; 61.4% had more financial concerns; and 52.7% had more difficulty accessing mental healthcare. Students identifying as BIPOC; cisgender women and transgender/gender non-conforming (TGNC); queer-spectrum; undergraduate; first-generation; having a disability; and taking courses online were significantly more affected by most of these outcomes (all comparisons P < .0009). Conclusions: Students were widely impacted by COVID-19 with substantive differences across sub-populations. Future research should examine trends over time and explore ways to reduce health disparities.
Kimberly H. Nguyen, Siyu Chen, Yingjun Bao, Yang Lu, Robert A. Bednarczyk, and Lavanya Vasudevan	534	Applied Research Brief COVID-19 Diagnosis, Severity, and Long COVID Among U.S. Adolescents, National Health Interview Survey, 2022 Purpose: Understanding disparities in COVID-19 outcomes, overall and stratified by vaccination status, is important for developing targeted strategies to increase vaccination coverage and protect adolescents from COVID-19. Design: The 2022 National Health Interview Survey (NHIS) is a cross-sectional nationally representative household survey of U.S. adults. Setting: A probability sample of households in the U.S. Sample: One child aged 12-17 years is randomly selected from each family in the household. A knowledgeable adult (eg, parent or guardian), responds on behalf of the child through an in-person interview (response rate = 49.9%). Measures: Input measures-sociodemographic characteristics and COVID-19 vaccination status; output measures-ever had COVID-19, moderate/severe COVID-19, long COVID. Analysis: Prevalence of COVID-19 outcomes was assessed for adolescents aged 12-17 years. Factors associated with each COVID-19 outcome were assessed with multivariable logistic regression analyses. Results: Among 2758 adolescents aged 12-17 years in 2022, 60.5% had received ≥1 dose of COVID-19 vaccine, 30.2% had ever been diagnosed by a doctor that they had COVID-19, 29.5% had moderate/severe COVID-19, and 6.2% had long COVID. Adolescents who were vaccinated with ≥1 dose were less likely to be diagnosed with COVID-19 (aOR = .79) and less likely to have long COVID (aOR = .30). Conclusion: Targeted messaging to highlight the importance of early treatment, the harms of long COVID-19, and the benefits of vaccination in protecting against long-term effects may be necessary to ensure that all adolescents and their families are adequately protected.
Mary T. Imboden, Emily Wolfe, Kerry Evers, Arline Ferrão, Heidi Mochari-Greenberger, Sara Johnson, Wolf Kirsten, and Erin L. D. Seaverson	540	Literature Review Evaluating Workforce Mental Health and Well-Being: A Review of Assessments The disruption, trauma, and stressors brought by COVID-19 have increased recognition and normalization of workforce mental health needs. Objective: Given the importance of mental health and well-being assessments to employers’ efforts to optimize employee health and well-being, this paper reviews mental health assessments that have utility in the workplace. Data Source: A review of publicly available mental health and well-being assessments was conducted with a primary focus on burnout, general mental health and well-being, loneliness, psychological safety, resilience, and stress. Inclusion Criteria: Assessments had to be validated for adult populations; available in English as a stand-alone tool; have utility in an employer setting; and not have a primary purpose of diagnosing a mental health condition. Data Extraction: All assessments were reviewed by a minimum of two expert reviewers to document number of questions, subscales, fee structure, international use, translations available, scoring/reporting, respondent (ie, employee or organization), and the target of the assessment (ie, mental health domain and organizational or individual level assessments. Data Synthesis & Results: Sixty-six assessments across the six focus areas met inclusion criteria, enabling employers to select assessments that meet their self-identified measurement needs. Conclusion: This review provides employers with resources that can help them understand their workforce’s mental health and well-being status across multiple domains, which can serve as a needs assessment, facilitate strategic planning of mental health and well-being initiatives, and optimize evaluation efforts.
Brent Emerson, Menaka Reddy, Paul L. Reiter, Abigail B. Shoben, Maryanna Klatt, Subhankar Chakraborty, and Mira L. Katz	560	Literature Review Mindfulness-based Interventions Across the Cancer Continuum in the United States: A Scoping Review Objective: To review mindfulness-based interventions (MBIs) tested in randomized controlled trials (RCT) across the cancer continuum. Data Source: Articles identified in PubMed, CINAHL, Web of Science, PsycINFO, and Embase. Study Inclusion and Exclusion Criteria: Two independent reviewers screened articles for: (1) topic relevance; (2) RCT study design; (3) mindfulness activity; (4) text availability; (5) country (United States); and (6) mindfulness as the primary intervention component. Data Extraction: Twenty-eight RCTs met the inclusion criteria. Data was extracted on the following variables: publication year, population, study arms, cancer site, stage of cancer continuum, participant demographic characteristics, mindfulness definition, mindfulness measures, mindfulness delivery, and behavioral theory. Data Synthesis: We used descriptive statistics and preliminary content analysis to characterize the data and identify emerging themes. Results: A definition of mindfulness was reported in 46% of studies and 43% measured mindfulness. Almost all MBIs were tested in survivorship (50%) or treatment (46%) stages of the cancer continuum. Breast cancer was the focus of 73% of cancersite specific studies, and most participants were non-Hispanic white females. Conclusion: The scoping review identified 5 themes: (1) inconsistency in defining mindfulness; (2) differences in measuring mindfulness; (3) underrepresentation of racial/ethnic minorities; (4) underrepresentation of males and cancer sites other than breast; and (5) the lack of behavioral theory in the design, implementation, and evaluation of the MBI.
Knowing Well, Being Well
Mary Imboden	KWBW(576)	Maintaining Brain Health: An Imperative for Successful Aging and Business Performance Successful aging relies on brain health, as cognitive function has a significant impact on our physical and mental health. Research over the last few decades has increased our understanding of prevention and intervention mechanisms to promote a healthy brain, suggesting that lifestyle plays a large role in our cognitive functioning. As more organizations are implementing health and well-being programs and policies, including those around lifestyle behaviors, they should do so considering initiatives that will promote brain health in their employees.
Kelly O’Brien	KWBW(580)	Unlocking Workplace Brain Health to Fuel Prosperity and Healthy Longevity Advances in neuroscience hold promise for workers and their employers to develop more effective strategies to improve brain health and build the cognitive skills necessary to meet present and future human capital challenges. In today’s knowledge economy,cultivating brain health can promote human flourishing, economic competitiveness, and business success. Focusing on brain health in the workplace prepares us for demographic aging and offers us an opportunity to build prosperous, inclusive, multigenerational workplaces and communities.
Jack Groppel, Patty Purpur de Vries, and Diana Thomas	KWBW(584)	Applying Neuro-Literacy to Improve Workplace Well-Being As leaders, we have an unprecedented opportunity to become neuro-literate, truly understand ourselves, align our behaviors, and share this wisdom within our circle of influence. There is immense value for leaders to positively impact their teams by identifying mental blocks and understanding counter-productive behaviors that interfere with being the most productive. Focusing on brain health in the workplace allows us to build prosperous, inclusive, multigenerational workplaces and stronger communities.
Laurie P. Whitsel, Elizabeth Ablah, Nicolaas P. Pronk, Robert E. Anderson III, Mary T. Imboden, Michael Hosking	KWBW(586)	Physical Activity and Brain Health: Integrating the Evidence Base into Workplace Health Promotion Regular physical activity helps prevent and manage chronic disease and associated risk factors, has positive effects on mental health and cognitive function across the lifespan, 1,2 and can reduce the risk of cognitive decline.3 There is substantial literature now pointing to the benefits of physical activity on brain health and therefore it is of critical importance that physical activity promotion, policy, and environmental supports are integrated into worksite health promotion efforts to help employees and their families on their journey toward active living and healthy aging.