In Briefs

OPEN IN VIEWER

Paul Terry	1087	Editorial Fifty Observations About the Health Promotion Discipline: Ambitions, Polemics and Inspiration (Part Two) In part one of this editorial covering fifty observations about the history and evolution of the health promotion discipline I shared twenty five observations relating to societal trends, definitional nuances and seminal studies and resources that have contributed to the trajectory of the field. In this, part two of the editorial, I list an additional twenty five observations focused on polemics and controversies and on the importance of effective teaching, research and writing. I reflect on the different approaches used by public sector and private sector health promotion experts respectively. I also share inspirational quotes that I consider closely aligned with the vision and mission of our profession.
Monica L. Wang, Olivia Poulin, Hannah McKinney	1091	Editorial Aligning Employee Health and Diversity, Equity, and Inclusion Initiatives in the Workplace: A Call for Synchronization Reports of burnout and poor mental health are at all-time highs among working U.S. adults. Simultaneously, failure to promote diversity, equity, and inclusion (DEI) is among the top characteristics of an unhealthy work culture and has contributed to high rates of employee attrition. Though many organizations across multiple sectors have made pledges to prioritize employee health and invest in DEI in recent years, few have explicitly addressed these two issues as interconnected. The link between the workplace as a determinant of mental and physical health is well-established. Several studies demonstrate that experiencing discrimination in the workplace is associated with detrimental physical and mental health outcomes. Additionally, the way work is structured directly and indirectly contributes to employee health inequities. In this commentary, we make the connection between employee health and organizational DEI and propose guiding principles to synchronize DEI and employee health initiatives in the workplace. These include: investing in DEI as a cornerstone for developing a healthy workforce for all; recognizing differences in employee experiences, needs, and their connection to health; prioritizing systemic approaches to promote employee health and organizational DEI. Embedding employee health and DEI efforts into broader organizational strategy is a crucial step towards fostering equitable practices that promote inclusive work environments and positive employee well-being.
the Science of individual and collective Well-Being
Lei Chai	1095	Quantitative Research Exploring the Impact of Length of Residence and Food Insecurity on Weight Status Among Canadian Immigrants Purpose: While the individual impacts of long-term residence and food insecurity on overweight/obesity are well-documented, their combined effect on immigrants’ weight status is less understood. This study examines the interaction between length of residence and food insecurity in predicting overweight/obesity among immigrants and investigates whether this relationship is gender-specific. Design: A national cross-sectional survey. Setting: The 2017-2018 Canadian Community Health Survey. Subjects: Immigrants aged 18 and older (N = 13 680). Measures: All focal variables were self-reported. Analysis: Logistic regression models were employed. Results: Long-term immigrants were more likely to report overweight/obesity than their short-term counterparts (OR = 1.39; P < .001). Moreover, immigrants from food-insecure households were at a higher risk of reporting overweight/obesity (OR = 1.27; P < .05) compared to those from food-secure households. The analysis further revealed that food insecurity exacerbated the detrimental association between length of residence and overweight/obesity in men (OR = 2.63; P < .01) but not in women (OR = .66; P > .05). Conclusion: The findings suggest that long-term immigrant men may be especially susceptible to the compounded chronic stressors of extended residence and food insecurity. Health professionals and policymakers should advocate for psychosocial resources to help mitigate these adverse effects and support the well-being of immigrant populations.
Sang Qin, Carla Kundert, Carlo Vittorio Palermo, Reshma Rolle, Esha Raut, Lindsay Sheehan	1104	Quantitative Research Scale Validation and Attributional Analysis of Public Stigma in Early-Pandemic COVID-19 Purpose: To test the validity of a COVID-19 public stigma scale and an attributional model of stigma during the early stages of the pandemic. Design: We administered a cross-sectional survey that included scales related to COVID-19 stigma to U.S. adults. Setting: We used Amazon MTurk online survey panel to recruit participants in June 2020. Subjects: U.S. adults (N = 170) participated in the study. Participants were average age of 37 and majority were men (61.2%) and White (77.6%). Measures: The Stigma Towards Disease Scale (SDS) was adapted to measure public stigma directed towards COVID-19 (SDSC19). Additional stigma-related measures were adapted for this study. Analysis: Factorial structure of SDS-C19 was assessed using confirmatory factor analysis (CFA). Validity of SDS was examined using Pearson correlations with other stigma measures. We evaluated the attributional model of stigma using structural equation modeling. Results: Internal consistency of SDS-C19 was high and a three-factor model reflecting cognitive, affective, and behavioral factors was supported (χ2 [71, N = 170] =140.954, P = .00, CFI= .946, TLI = .931, RMSEA = .076, SRMR = .087). The SDS-C19 had strong correlations with other stigma-related measures. A blame-mediated attribution model was supported (χ2 [8, N = 170] = 21.793, P = .00, CFI = .976, TLI =.956, RMSEA = .101, SRMR = .058). Conclusion: The SDS-C19 is a valid tool for assessing COVID-19 stigma. SDS-C19 and the attribution model can guide public health communication.
Cen Chen, Takafumi Saito, Lefei Wang, Tsubasa Yokote, Harukaze Yatsugi, Xin Liu, Hiro Kishimoto Kishimoto	1112	Quantitative Research The Relationships Among Chronic Pain Subtypes, Motor Function, and Physical Activity in Community-Dwelling Japanese Older Adults: A Cross-Sectional Study Purpose: We investigated the relationships among motor function, physical activity, and the characteristics of chronic pain (the number of pain sites, pain intensity, and pain-type). Design: Cross-sectional study. Setting: An ongoing community-based prospective study conducted in Itoshima, Japan. Subjects: Community-dwelling Japanese aged 65-75 years (n = 805; 401 men, 404 women). Measures: Chronic pain subtypes were examined in terms of the number of pain sites, pain intensity, and pain type. Motor function was evaluated by handgrip strength, walking speed, and the 5 Times Stand-up and Sit Test (FTSST). Locomotive activity, non-locomotive activity, and sedentary time were evaluated by a tri-axial accelerometer as physical-activity parameters. Analysis: Multiple regression model adjusting for age, sex, education level, employment status, subjective economic status, body mass index, cognitive function, comorbidity, current tobacco use, current alcohol consumption, and regular exercise. Results: In a multivariate analysis, the subjects’ walking speed was negatively associated with multisite, moderate-to-severe, and neuropathic-like pain. The FTSST was positively associated with single-site, moderate-to-severe, and neuropathic-like pain. There was no significant association between handgrip strength and any chronic pain subtypes. Locomotive activity was negatively related to multisite, moderate-to-severe, and neuropathic-like pain, but there was no clear association between the amount of non-locomotive activity, sedentary time, and chronic pain subtypes. Conclusion: Severe chronic pain was associated with decreased locomotion-related motor function and physical activity.
Shu Ping Chuang, Jo Yung-Wei Wu, Chien Shu Wang	1121	Quantitative Research Self-Compassion, Resilience and Mental Health in Community Adults Purpose: To investigate the associations among self-compassion, resilience and mental health of community residents. Design: Cross-sectional study. Setting: Voluntary survey of web-based, posters-based platform. Participants: 453 community residents. Methods: Participants living in Kaohsiung, Taiwan were recruited from posters, online advertisements based platforms and were assessed with the self-compassion scale (SCS), Connor-Davidson Resilience Scale (CD-RISC-25), Center for Epidemiological Studies Depression Scale (CES-D), The Satisfaction with Life Scale (SWLS) and The Positive Mental Health Scale (PMH-scale) measures during the period from March 1 to October 31, 2023. Results: After adjusting for age, gender and education, stepwise regression analysis revealed that isolation, self-judgment, and control accounted for 14% of the variance in depressive symptoms (CES-D) (adjusted R2 = .149, P < .05). Over-identification, self-kindness and control accounted for 26% of the variance in satisfaction with life (SWLS) (adjusted R2 = .263, P < .001). Overidentification, self-kindness, isolation, control and personal competence and tenacity accounted for 37% of the variance in positive mental health (PMH-scale) (adjusted R2 = .375, P < .05). Conclusions: Findings suggested that components of self-compassion and resilience may be important factors that promote positive mental health and provide potential interventions for professionals to increase the well-being of community residents.
Alyssa Lederer, Sara B Oswalt, Mary Hoban, Melissa Rosenthal	1129	Quantitative Research Health-Related Behaviors and Academic Achievement Among College Students Purpose: College students’ academic achievement has crucial implications for their future success. Students’ health may be a key determinant of academic performance, but more research is needed to understand this relationship. Design/Setting/Subjects: Secondary analysis of the American College Health Association-National College Health Assessment III pre-COVID-19 Spring 2020 dataset. N = 39 146 undergraduates at 75 higher education institutions (14% mean response rate, comparable with other large-scale national college health surveys). Measures: Self-reported grade point average (GPA) and 33 health behaviors in the categories of dietary behavior, physical activity, sedentary behavior, substance use, sexual risk behavior, violence-related behavior, mental health, and sleep behavior. Analysis: Weighted cross-tabulations examining the association between GPA and health behaviors; multinomial logistic regressions assessing if behaviors predicted GPA, controlling for year, sex/gender, and race/ethnicity. Individual GPA categories were also compared to a D/F referent group. Results: There were gradient trends across GPA categories for A through D/F (18 behaviors) or A through C (12 behaviors) (P < .001). Each health behavior predicted GPA differences (P < .001), except heroin use (P = .052). The A GPA group was significantly different from the D/F GPA group for 27 behaviors (P < .001). In general, protective behaviors corresponded with higher GPAs and most risk behaviors were associated with lower GPAs. Conclusions: There is a link between numerous health behaviors and academic performance. Stakeholders invested in college students’ health and academics should engage in mutually beneficial strategies to safeguard students’ current and future wellbeing and success.
Gillian Tiralla, Nauris Tamulevicius, Mary Martinasek, Willie Leung	1140	Quantitative Research Examining the Relationship Between E-Cigarette Status and Wearable Device Use on Physical Activity Levels in U.S. Adults Purpose: The aim of this analysis is to investigate physical activity levels amongst e-cigarette users based on their wearable device use. Design: Cross-sectional secondary data analysis using 2017 Behavioral Risk Factor Surveillance Survey (BRFSS). Setting: Data from the 2017 BRFSS were used. Sample: 5,562 U.S. adults (age 18+). Measures: Self-reported physical activity related variables from U.S. adults (age 18+). Analysis: Separate unadjusted and adjusted linear regression models were performed for each of the dependent variables using survey analysis. Results: Non-users of wearable devices and e-cigarettes account for 96.6% (95%CI [95.7, 97.6]) of the sample, whereas users of wearable devices and e-cigarettes account for 3.3% (95%CI [1.2, 5.4]) of the sample. Those who use e-cigarettes participate in almost 50% less vigorous physical activityminutes per week than nonusers, 46 (95%CI [0.43, 91.57]) and 93 (95%CI [80.59, 106.34]) minutes respectively. Individuals who use e-cigarettes and use wearable devices were found to spend significantly more time in total physical activity per week in both the unadjusted and adjusted linear regressions, P = =0.01 and P = =0.04 respectively. Conclusion: The use of e-cigarettes, wearable devices, or both technologies may influence the physical activity levels of its users. Additional research is needed to better understand the association between physical activity levels and the usage of these technologies.
Michelle C Yang, Gurkaran Singh, Brodie M Sakakibara	1147	Quantitative Research Social Cognitive Predictors of Health Promotion Self-Efficacy Among Older Adults During the COVID-19 Pandemic Purpose: To examine the relative importance of social cognitive predictors (ie, performance accomplishment, vicarious learning, verbal persuasion, affective state) on health promotion self-efficacy among older adults during COVID-19. Design: Cross-sectional. Setting: Data collected online from participants in British Columbia (BC), Canada. Subjects: Seventy-five adults (n = 75) aged ≥65 years. Measures: Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale. Performance accomplishment was assessed using the health directed behavior subscale of the Health Education Impact Questionnaire; vicarious learning was measured using the positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS); verbal persuasion was assessed using the informational support subscale from the MOS-SSS; and affective state was assessed using the depression subscale from the Depression Anxiety Stress Scale (DASS-21). Analysis: Multiple linear regression was used to investigate the relative importance of each social cognitive predictor on selfefficacy, after controlling for age. Results: Our analyses revealed statistically significant associations between self-efficacy and performance accomplishment (health-directed behavior; β = .20), verbal persuasion (informational support; β = .41), and affective state (depressive symptoms; β = _.44) at P < .05. Vicarious learning (β = _.15) did not significantly predict self-efficacy. The model was statistically significant (P < .001) explaining 43% of the self-efficacy variance. Conclusion: Performance accomplishment experiences, verbal persuasion strategies, and affective states may be the target of interventions to modify health promotion self-efficacy among older adults, in environments that require physical and social distancing.
Zhi-Qi Ying, Dan-Lin Li, Gang Liang, Zhi-Jian Yin, Yue-Zu Li, Rong Ma, Yu Qin, Ya-Jie Zheng, Pei Wang, Chen-Wei Pan	1153	Quantitative Research Reduced Health-Related Quality of Life Due to Mobile Phone Dependence in a Sample of Chinese College Students: The Mediating Role of Chronotype and Sleep Quality Purpose: Presenting a chain mediation model to investigate whether mobile phone dependence results in a reduction in healthrelated quality of life (HRQoL) among Chinese college students, through the mediating effect of chronotype and sleep quality. Design and Setting: A cross-sectional survey was conducted on students from a Chinese university using a validated structured questionnaire. Sample: 2014 freshmen. Measures: The study measured the students’ level of mobile phone dependence using the Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use. Chronotype and sleep quality were measured by the Chinese version of the Morningness-Eveningness Questionnaire (MEQ) and the Pittsburgh Sleep Quality Index (PSQI), respectively. HRQoL was evaluated using the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L), including a descriptive system and a visual analog scale (VAS). Analysis: Descriptive statistical analysis, correlation analysis, and mediation analysis. Results: Mobile phone dependence had a significant negative effect on HRQoL as indicated by both the EQ-5D-5L index score and EQ-VAS score (P < .001 for both). Additionally, it was found to significantly predict chronotype (MEQ score) (β = _.546, P < .001) and sleep quality (PSQI score) (β = .163, P < .001). Chronotype negatively predict sleep quality (β = _.058, P < .001), and sleep quality was a significant negative predictor of HRQoL (EQ-5D-5L index score, β = _.008, P < .001; EQ-VAS score, β = _1.576, P < .001). Conclusion: Mobile phone dependence negatively impacts students’ HRQoL through chronotype and sleep quality, and there is a chain mediating effect. Students should consider making lifestyle changes to improve their HRQoL and promote health.
Qian Huang, Wei Peng, Jihae Han, Bingjing Mao	1163	Quantitative Research Characterizing the Perceived Need for CRC Screening among the Elderly Living in Rural Areas in the Pacific Northwest US: Roles of Miscommunication, Experience of Discrimination, and Dependence Purpose: Increasing the perceived need for CRC screening can facilitate undertaking CRC screening. This study aims to identify factors associated with the need for CRC screening in rural populations. Design: A cross-sectional online survey. Setting: The survey was conducted in June - September 2022 in the rural areas of Alaska, Idaho, Oregon, and Washington, US. Subjects: The subjects of this study were 250 adults (completion rate: 65%) aged 45-75 residing in rural Alaska, Idaho, Oregon, and Washington. Measures: Perceived need for CRC screening, internet usage for health purposes, demographics, and intrapersonal, interpersonal, community, and environmental characteristics. Results: Perceived need for CRC screening were negatively associated with patient-provider miscommunication (β = _.23, P < .001) and perceived discrimination (β = _.21, P < .001), cancer fatalism (β = _.16, P < .05), individualism (β = _.15, P < .05), and dependence on community (β = _.11, P < .05), but positively with compliance with social norms (β = .16, P < .05), trust in health care providers (β = .16, P < .05), knowledge about colorectal cancer (β = .12, P < .05). Conclusions: Our study showed potential individual and situational characteristics that might help increase colorectal cancer screening. Future efforts might consider addressing discrimination in health care settings, improving patient-provider communication, and tailoring messaging to reflect the rural culture.
Zerleen S Quader, Sarah Sliwa, Regine Haardörfer, Shakira Suglia, Julie Gazmararian	1170	Quantitative Research School Poverty Level Moderates the Effectiveness of a Physical Activity Intervention Purpose: To explore whether school poverty level and funding modified the effectiveness of an evidence-based Comprehensive School Physical Activity Program called Health Empowers You! implemented in elementary schools in Georgia. Design: Secondary data analysis of a multi-level, cluster-randomized controlled trial. Setting: 40 elementary schools in Georgia in 2018-2019. Subjects: 4th grade students in Georgia. Measures: Intervention schools implemented the Health Empowers You! program to increase school-day physical activity. The outcome was average daily moderate-to-vigorous physical activity, school free-reduced price lunch (FRPL) percentage and per pupil expenditures were effect modifiers. Analysis: Separate linear mixed regression models estimated the effect of the intervention on average daily moderate-tovigorous physical activity, with interaction terms between intervention status and (1) school FRPL percentage or (2) per pupil expenditures. Results: The effect of the intervention was significantly higher in schools with higher FRPL percentage (intervention*school % FRPL β (95% CI): .06 (.01, .12)), and was modestly, but not statistically significantly, higher in schools with lower per pupil expenditures. Conclusion: Findings support the use of the Health Empowers You! intervention, which was effective in lower income schools, and may potentially reduce disparities in students’ physical activity levels.
Nikhil Ashok Ahuja, Satish K Kedia, Kenneth D. Ward, Yu Jiang, Patrick J Dillon	1176	Quantitative Research Predictors of Adolescents’ Transition Through the Stages of Change for Quitting E-Cigarettes: Findings From the Population Assessment of Tobacco and Health Study Purpose: To identify predictive factors associated with US adolescents’ transition through the stages of change for potentially quitting e-cigarettes using the Trans-theoretical model of behavior change. Design: Prospective cohort study. Setting: United States. Subjects: We utilized data from adolescents (12-17 years) in Wave 3 of the Population Assessment of Tobacco and Health study who used e-cigarettes exclusively over the past 30 days (n = 177) and were followed up with in Wave 4. Measures: Outcome variables were 3 transition categories: those who remained stagnant, those who progressed, and those who regressed in their stage of quitting e-cigarettes. Predictor variables were socio-demographics, e-cigarette harm perception, e-cigarette use at home or by important people, social norms, e-cigarette and anti-tobacco advertisements, and e-cigarette health warnings. Analysis: Weighted-adjusted multinomial regression analysis was performed to determine the association between predictor and outcome variables. Results: From Wave 3 to Wave 4, 19% of adolescents remained stagnant; 73.3% progressed; and 7.7% regressed. Adolescents were less likely to progress in their stage of change if they perceived nicotine in e-cigarettes to be “not at all/slightly harmful” (AOR = .26 [95% CI: .25, .27], P < .001); reported important people’s use of e-cigarettes (AOR = .18 [95% CI: .05, .65, P = .009); and “rarely” noticed e-cigarette health warnings (AOR = .28 [95% CI: .08, .98, P = .054). Conclusion: Intervention efforts must target specific predictive factors that may help adolescents quit e-cigarettes.
Safa Elkefi, Alicia K Matthews	1188	Quantitative Research Disparities in the Care Disruption During COVID-19 and in its Impacts on the Mental and Physical Well-Being of Cancer Survivors Purpose: Our study explores cancer care disruption among different demographic subgroups. It also investigates these disruptions’ impacts on cancer survivors’ mental and physical well-being. Design: Pooled cross-sectional survey data. Setting: Health Information Trends Survey for Surveillance Epidemiology and End Results, HINTS-SEER. Participation: n = 1234 cancer survivors participated in the study and completed the survey. Measures: Outcome variables were treatment disruption in cancer care, mental health and physical health perceptions, age, race, education, income, and sexual orientation. Analysis: Multiple imputations were used to address missing data. Descriptive statistics were conducted to understand the perceptions of care disruption. Partial least squares structural equation models were employed for data analysis, adjusted for socio-demographics. Results: COVID-19 impacted cancer treatment and follow-up appointments (69.45%), routine cancer screening (60.70%), and treatment plans (73.58%), especially among elderly patients. It changed the interactions with health care providers (HCP) for 28.03% of the participants. Older adults were 2.33 times more likely to experience treatment appointment disruptions. People who thought their contact with their doctors changed during COVID-19 were more likely to be older adults (65 or more) (OR = 3.85, P = .011), white (OR >1, P = .002), and with higher income (OR = 1.81, P = .002). The changes to cancer treatment and follow-up medical appointments negatively impacted the well-being of the patients (mental: β = _.006, P = .043; physical: β = _.001, P = .006), routine screening and preventative care visits (mental: β = _.029, P = .031; physical: β = _.003, P = .008), and cancer treatment plans (mental: β = _.044, P = .024; physical: β = _.021, P = .040). Conclusions: Our findings underscore the crucial requirement for implementing focused interventions aimed at alleviating the discrepancies in the accessibility of cancer care across diverse demographic groups, particularly during times of emergency, in order to mitigate any potential disruptions in care.
Bhaskar Thakur, Chance Strenth, Elizabeth Mayfield Arnold, David Schneider	1199	Quantitative Research Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States Purpose: This study explores the relationship between depression and cardiovascular disease (CVD) in the US adult population, focusing on sex differences. Design: Cross-sectional study. Setting: National Health and Nutrition Examination Survey data (2013-2018). Participants: A total of 14 699 community-dwelling adults (≥20 years). Measure: The Patient Health Questionnaire (PHQ-9) depression screening tool assessed depressive symptoms. CVD events included heart failure, coronary heart disease, angina, heart attack, or stroke. Analysis: Adjusted prevalence ratios were estimated using a Poisson regression model. Results: The study finds a positive association between CVD incidents and both mild to moderate depressive symptoms (aPR: 1.42, P = .002) and moderately severe to severe depression (aPR:1.72, P = .024). Overall, females exhibit a 47% lower likelihood of CVD incidents compared to males. However, in a subgroup analysis, increased depressive symptoms correlate with higher CVD incidents in females (aPRs range: 2.09 to 3.43, P < .001) compared to males (aPRs range: 1.45 to 1.77, P < .001). Conclusion: Depression is associated with increased cardiovascular disease (CVD) risk. Females generally have a lower CVD risk than males, but more severe depressive symptoms elevate CVD risk in females. These findings emphasize the significance of considering sex differences. Further research is needed to understand the underlying mechanisms.
Danyel Chermon, orel Gelman, RUTH BIRK BIRK	1210	Qualitative Research Blending Towards Healthier Lifestyles: The Impact of Regular Fruit and Vegetable Smoothie Consumption on Dietary Patterns and Sustainable Health Behaviors Purpose: This research aimed to characterize the nutritional, health and basic sustainability practices among regular smoothies’ consumers (RSC; ≥ 1-2 servings/week for ≥ 2 months). Design: Cross-sectional survey. Setting: Self-report online multiple-choice questionnaire survey of random sample of adults from online retailer database and community. Sample: 193 healthy Israeli adults (75.6% females, mean age 40.65 ± 14.36) completed an online multiple-choice validated survey from May 2022 to August 2023. Measures: Demographic, anthropometric, and lifestyle habits, including physical activity, FV consumption, and sustainability practices. Analysis: Data were analyzed using chi-square tests for categorical variables and Mann-Whitney tests for non-normally distributed continuous variables. The level of statistical significance was set at .05. Results: RSC were significantly older (P < .001) and more physically active (P = .025) than occasional smoothie consumers (OSC). They consumed more FV, reaching nutritional recommendations, and exhibited significant lifestyle changes, including reduced meat (P = .013) and processed food consumption (P = .013), and regular meal consumption (P = .045). RSC used fewer disposables (P = .002) compared to OSC and non-smoothie consumers (P = .001). RSC demonstrated a higher incidence of weight reduction compared to weight gain. Conclusion: RSC is significantly associated with health and nutritional sustainability.
Akshitha Adhiyaman, Melanie Jay, Un Young Chung, Andres Gronda, Chi-Hong Tseng, Judith Wylie-Rosett, Sandra Wittleder, Soma Wali, Joseph Ladapo, Stephanie Orstad	1217	Qualitative Research Low-Income Participants’ Preference Between Financial Incentives for Behavioral Goals vs Weight Loss Targets and Associations With Behavioral Goal Adherence Purpose: Examine associations between whether participants’ were matched to their preferred financial incentive design and behavioral goal adherence in a weight management intervention. Design: Secondary quantitative analysis incorporating qualitative survey data. Setting: Primary care clinics in socioeconomically disadvantaged communities in New York City and Los Angeles. Subjects: 668 participants (mean age 47.7 years, 81.0% female, 72.6% Hispanic) with obesity were enrolled in the Financial Incentives foR Weight Reduction (FIReWoRk) intervention. Measures: We explored qualitatively participant’s reasons for hypothetically choosing a behavioral goal-directed vs a weight loss outcome-based financial incentive program. Additionally, behavioral adherence to different goals was collected at the 6-month timepoint, categorized by match to preferred financial incentive design. Analysis: Logistic regression was used to examine if participants with certain demographic and higher psychosocial factors were more likely to choose goal-directed over outcome-based incentives. Additionally, logistic regression was used to test for associations between preference and behavioral adherence, using incentive type as an interaction term. Results: 60.2% of participants preferred the goal-directed incentive, with the majority stating that it was more structured. Married participants were more likely to prefer goal-directed incentives (OR = 1.57, CI = 1.06-2.33, P = .025). Moderation analysis revealed that participants who preferred goal-directed and were matched to goal-directed had greater rates of behavioral adherence for program attendance and self-weighing, but not dietary tracking and physical activity tracking, compared to those who preferred outcome-based and were matched to outcome-based. Conclusion: Receiving one’s preferred incentive design may not play a strong role in behavioral goal adherence during financially incentivized weight loss interventions.
Ekaterina Anderson, Makayla Dones, Adena Cohen-Bearak, Anna Barker, Justeen Hyde, Barbara Bokhour	1229	Qualitative Research Promoting Health and Wellbeing Through Non-Clinical Arts Programming: Multi-Stakeholder Perspectives From the Veterans Health Administration Purpose: While the value of art therapy is well-established and arts are increasingly leveraged to promote health and wellbeing more broadly, little is known about the impacts of non-clinical arts programs. In this preliminary investigation, we sought to fill this gap by exploring diverse stakeholders’ perspectives on the impacts of non-clinical arts programming on Veterans receiving care at the Veterans Health Administration (VA). Design: Semi-structured qualitative interviews with Veterans, VA staff, and community partners. Setting: Interviewees were recruited from 7 VA medical centers that have recently implemented non-clinical arts programming to promote Veterans’ health and wellbeing, some of them in partnership with community organizations. Participants: 33 individuals were interviewed, including 9 Veterans, 14 VA staff, and 10 community partners involved in nonclinical arts program implementation. Method: Interview transcripts were analyzed using iterative rounds of qualitative content analysis. Results: The following impacts on Veterans were described: (1) mental health improvements, (2) renewed sense of purpose; (3) increased social connectedness, (4) improved self-esteem, and (5) self-driven engagement in art activities. Conclusion: Non-clinical arts programming was perceived by diverse stakeholders to offer important benefits for Veterans’ health and well-being. Offering non-clinical arts programming inside and outside healthcare facilities’ walls is a promising direction for the field of public health undergoing a shift towards holistic approaches to improving individual and population health outcomes.
Temitope Emmanuel Ibiyemi, Wasiuddin Najam, Wilna oldewage-theron	1238	Applied Research Brief Hungry, Stressed, and Away From “Home”: Predictors of Food Security and Perceived Stress Among International Students Purpose: Examine the predictors of food security and perceived stress among international students. Design: Cross-sectional Design. Settings: A public university in the Southwest United States. Subjects: Sample size of Seventy-three participants (≥18 years). Measures: Self-report measures of food insecurity and perceived stress. The U.S. Department of Agriculture (USDA) Adult Food Security Survey Module (AFSSM) to assess food security status, and the Perceived Stress Scale (PSS-10) questionnaire to evaluate stress levels. Analysis: Logistic regression was performed to identify predictors of food security and perceived stress. Results: Duration of stay in the U.S. was a predictor of food security status, while gender was a predictor of perceived stress. International students in the U.S. for less than a year had a lower chance of being food secure [OR (95% CI) = 0.22 (0.05 - 0.74)]. Female international students had a lower chance of experiencing low perceived stress [OR (95% CI) = 0.07 (0.00 - 0.51)]. Conclusion: In supporting international students, targeted nutrition and stress management interventions should be emphasized, particularly for females and those who recently moved to the U.S.
Knowing Well, Being Well
Andreas Ault-Brutus and Sashane John	KWBW(1243)	The Role of Health Systems in Cross-Sector Collaboration in Addressing Social Determinants of Health and Promoting Health and Well-Being It is evident that where people live, work, play, learn, and age matters when it comes to health outcomes in the US and the world.i These social determinants of health help to explain the health inequities that are experienced in the US. For decades, health care systems relatively stayed out of the business of addressing social determinants of health, despite the impact on health outcomes. However, in recent years, health care organizations are starting to see the importance of addressing the social needs of their patients.
David Nemiroff, Julie Harnisher, Bernice Baronville-Jaboin, and Andreas Ault-Brutus	KWBW(1245)	Collaborating for Health Equity: A Perspective of an FQHC’s Community Partnerships and Initiatives Harmony Healthcare Long Island (HHLI), a Federally Qualified Health Center based in Nassau County, New York, engages in collaborative strategies to address health inequities in underserved populations. The paper discusses HHLI's initiatives, such as the Perinatal Infant Community Health Collaborative, which aims to improve maternal and infant health outcomes through comprehensive, community-based interventions. Additionally, it examines HHLI's partnerships with local organizations, managed care companies, and government agencies to enhance access to care and address social determinants of health while navigating challenges such as funding and capacity limitations. Through these collaborative efforts, HHLI seeks to advance health equity and improve outcomes for its diverse patient population.
Jack Tocco, Isma Chaudhry, Olushola Latus-Olaifa, Stephanie Kubow, Christine Essig, Elisabeth Kac, Sonia Jacome, and Debbie Salas-Lopez	KWBW(1252)	A Health System—Community Partnership to Advance Health Equity Northwell Health and more than one hundred community organizations established a Health Equity Taskforce (HET) in 2021 to support the equitable distribution of COVID-19 vaccines on Long Island. Grounded in community partnership, several principles of public health and social justice, and data-driven decision making, the HET has grown to encompass the greater New York City metropolitan region and address a wider array of health disparities. In this article, we describe the HET’s formation, guiding framework, challenges encountered, accomplishments to date, and our vision of a durable health system—community partnership to advance health equity.