American Journal of Health Promotion

The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing the influence of physical exercise interventions during pregnancy on some neonatal outcomes.

Key words were used to conduct a computerized search in six databases: Cochrane Library Plus, Science Direct, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov.

RCTs that included an exercise program for healthy pregnant women who were sedentary or had low levels of physical activity were selected.

Two independent reviewers extracted data and assessed the quality of the studies included. Of 4296 articles retrieved, 14 RCTs (3044 pregnant women) met the inclusion criteria.

Pooled effect sizes (ESs) were calculated using a fixed model.

Overall, physical exercise programs during pregnancy produced a small reduction in neonatal birth weight (ES = −.10; p = .04). The Apgar score at 1 minute was also weakly increased with combined exercise (aerobic, strength, and flexibility) (ES = .09; p = .048) and no differences between groups were observed in gestational age at delivery and Apgar score at 5 minutes.

Structured physical exercise programs during pregnancy appear to be safe for the neonate, mainly favoring a lower birth weight within normal range. However, more studies are needed to establish recommendations.

Researchers examined college students’ financial health and other health indicators to determine whether the integration of financial health into undergraduate health courses is justified and justify financial health as the newest dimension of health within the field of health promotion.

The study utilized a cross-sectional design.

The study was conducted at a large public university located in the western region of the United States. Participants completed the survey from any computer with Internet access.

A sample of 3000 undergraduate students was selected. A total of 686 surveys were completed (22.9% response rate). Data were collected from college students ages 18 to 30 during the first 2 weeks of June 2013.

Participants completed an online survey regarding their financial health and other dimensions of health.

SPSS version 19.0 was used to examine the relationships between financial health and individual health variables using χ², independent t-test, analysis of variance, Pearson R, point-biserial correlation, and nonparametric analyses.

Every dimension of health was impacted significantly by lower levels of financial health. Participants’ emotional health was impacted far more than any other dimension, with significant impacts on concentration (p = .005), usefulness (p = .006), decision making (p = .014), and happiness (p < .001) by the mere presence of a budget.

Findings indicate an apparent relationship between financial health and other health indicators and support the need for financial education by parents and middle/high schools and the incorporation of financial health into undergraduate health courses.

To test the effectiveness of an intervention delivered by health professionals outside the school environment to girls identified with issues such as poor body image, low self-esteem, low self-confidence, nonparticipation in sports, or being overweight or underweight.

The study’s design was a stepped-wedge randomized controlled trial to test the efficacy of an intervention on self-esteem, impairment induced by eating disorders, self-efficacy, body satisfaction, and dieting behaviors.

The study took place at the community health center located in a culturally diverse area of Melbourne, Victoria, Australia.

Participants were 122 primary and secondary school girls between 10 and 16 years of age.

Girls on the Go! is a 10-week program designed to improve self-esteem, body image, and confidence, using an empowerment model that involved interactive and experiential learning approaches. Weekly themes included body image and self-esteem, safety and assertiveness, a healthy mind, physical activity, healthy eating, trust and confidence, and connections.

Measurements were made using Rosenberg Self-Esteem Scale, clinical interview assessment, health self-efficacy (included mental health and physical health self-efficacy scales), body esteem scale, and the Dutch Eating Behavior Questionnaire for Children.

A linear mixed model was used.

The intervention led to a significant increase (p < .05) in self-esteem and self-efficacy (mental and physical health self-efficacy subscales), for both primary and secondary school-aged participants and reduced dieting behaviors (secondary school participants). These gains were retained after 6 months of follow-up.

This group-based, low-dose intervention, which, although targeting girls with a range of psychological issues and including both overweight and underweight participants, is a successful means of improving self-esteem among girls from diverse cultural backgrounds.

This study reports correlates in reported use and helpfulness of calorie information, when available, in restaurants on a national scale in the United States for demographic behavioral and health-related conditions.

This study is a secondary data analysis of the 2013 National Cancer Institute’s Health Information National Trends Survey data.

United States.

Adults (n = 3407).

Menu labeling use and helpfulness; behavior change attempts; reported fruit, vegetable, and soda consumption; weight status; and chronic health conditions.

Trends were identified in weighted logistic and linear regression models.

U.S. adults who intended to lose weight (odds ratio [OR] = 5.01 [95% confidence interval 2.96, 8.46]), increase fruit (OR = 1.10 [.66, 1.84]) or vegetable consumption (OR = 2.25 [1.32, 3.83]), or reduce soda consumption (OR = 1.67 [1.11, 2.51]) were more likely to report using menu-labeling information when available. More women reported calorie information was helpful when ordering (p < .05). Racial/ethnic and socioeconomic status disparities were identified in use (non-Hispanic [NH] blacks vs. NH whites OR = .43 [.25, .74]) and helpfulness (NH blacks vs. NH whites β = –.06 [–.44, .32]).

Findings highlight potential subgroups to target for communication and education efforts regarding use of calorie information in restaurants. Following publication of final rules for federal menu-labeling legislation and implementation, further surveillance of public response to this information may inform message framing and educational interventions to promote use of calorie information on menu boards.

To investigate how breastfeeding initiation and duration affect the likelihood of being overweight and obese in children aged 2 to 5.

Cross-sectional data from the 2003 National Survey of Children’s Health.

Rural and urban areas of the United States.

Households where at least one member was between the ages of 2 and 5 (sample size 8207).

Parent-reported body mass index, breastfeeding initiation and duration, covariates (gender, family income and education, ethnicity, child care attendance, maternal health and physical activity, residential area).

Partial proportional odds models.

In early childhood, breastfed children had 5.3% higher probability of being normal weight (p = .002) and 8.9% (p < .001) lower probability of being obese compared to children who had never been breastfed. Children who had been breastfed for less than 3 months had 3.1% lower probability of being normal weight (p = .013) and 4.7% higher probability of being obese (p = .013) with respect to children who had been breastfed for 3 months and above.

Study findings suggest that length of breastfeeding, whether exclusive or not, may be associated with lower risk of obesity in early childhood. However, caution is needed in generalizing results because of the limitations of the analysis. Based on findings from this study and others, breastfeeding promotion policies can cite the potential protective effect that breastfeeding has on weight in early childhood.

To evaluate the impact of a meditative singing program on the health outcomes of Aboriginal and Torres Strait Islander people.

The study used a prospective intervention design.

The study took place in six Aboriginal and Torres Strait Islander communities and Community Controlled Health Services in Queensland, Australia.

Study participants were 210 Australian Aboriginal and Torres Strait Islander adults aged 18 to 71 years, of which 108 were in a singing intervention group and 102 in a comparison group.

A participative community-based community singing program involving weekly singing rehearsals was conducted over an 18-month period.

Standardized measures in depression, resilience, sense of connectedness, social support, and singing related quality of life were used.

The general linear model was used to compare differences pre- and postintervention on outcome variables, and structural equation modeling was used to examine the pathway of the intervention effect.

Results revealed a significant reduction in the proportion of adults in the singing group classified as depressed and a concomitant significant increase in resilience levels, quality of life, sense of connectedness, and social support among this group. There were no significant changes for these variables in the comparison group.

The participatory community singing approach linked to preventative health services was associated with improved health, resilience, sense of connectedness, social support, and mental health status among Aboriginal and Torres Strait Islander adults.

To determine smoking abstinence rates and predictors of abstinence among college students enrolled in a campus-based Quit & Win contest.

Pre-post measure with no comparison group.

Contests conducted on seven college campuses in 2007.

Subjects (N = 484) were 23.7 ± 6.8 years of age, 61% female, 16.3% nonwhite, and smoked 12.5 ± 7.8 cigarettes per day on 28.0 ± 4.8 days in the past month.

Participants abstinent for the 30-day contest were eligible for a lottery-based prize. Assessments were completed at baseline, end of contest, and 6 months after enrollment.

The 6-month survey assessed retrospective abstinence during the contest period and the prior 6 months and 7- and 30-day point prevalence abstinence at the time of the survey.

Chi-square test was used to compare baseline characteristics among participants from 2-versus 4-year schools. Smoking abstinence was assessed by participant self-report. Both a simple imputation method (i.e., missing = smoking) and completers-only analyses were conducted. Stepwise logistic regression was used to determine baseline predictors of abstinence.

Thirty-day abstinence rate was 52.5% during the contest month and 20.5% at the 6-month follow-up. Baseline intention to stay quit (odds ratio [OR] = 1.56, p = .01), cigarettes smoked per day (OR = .67, p = .04), and 2-year (vs. 4-year) college (OR = 1.65, p = .05) predicted abstinence at 6 months.

Intention to stay quit even without winning a prize, a measure of intrinsic motivation, predicted both short- and long-term abstinence.

This study aimed to test three factorial structures conceptualizing the processes of change (POC) from the transtheoretical model and to examine the relationships between the POC and stages of change (SOC) among overweight and obese adults.

Cross-sectional study.

This study was conducted at the University Hospital of Montpellier, France.

A sample of 289 overweight or obese participants (199 women) was enrolled in the study.

Participants completed the POC and SOC questionnaires during a 5-day hospitalization for weight management.

Structural equation modeling was used to compare the different factorial structures.

The unweighted least-squares method was used to identify the best-fit indices for the five fully correlated model (goodness-of-fit statistic = .96; adjusted goodness-of-fit statistic = .95; standardized root mean residual = .062; normed-fit index = .95; parsimonious normed-fit index = .83; parsimonious goodness-of-fit statistic = .78). The multivariate analysis of variance was significant (p < .001). A post hoc test showed that individuals in advanced SOC used more of both experiential and behavioral POC than those in preaction stages, with effect sizes ranging from .06 to .29.

This study supports the validity of the factorial structure of POC concerning physical activity and confirms the assumption that, in this context, people with excess weight use both experiential and behavioral processes. These preliminary results should be confirmed in a longitudinal study.

To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program.

The study was a two-group cluster randomized controlled weight loss trial.

The study was conducted in 28 worksites.

Subjects comprised 1460 employees with a body mass index >25 kg/m².

Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin’ My Weigh (LMW; less-intense quarterly newsletters).

A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up.

The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects.

Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] (p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects (beta = .66; SE = 027; p = .014) and losing >5% weight (beta = −1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up.

HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.

Design, implement, and evaluate a 6-week social marketing campaign (SMC) to raise awareness of obesity and increase involvement in type 2 diabetes prevention, nutrition, and fitness programs offered by the Brooklyn Partnership to Drive Down Diabetes (BP3D) in two low-income, urban communities.

This was a nonexperimental, formative research, mixed-methods study.

The study took place in Central Brooklyn and East New York, two of the most impoverished, high-need communities in New York City.

Participants were black and Hispanic adults, who were 18+ years of age and residing in the priority communities.

Advertisements in English and Spanish encouraging healthier eating habits and advocating for better food options were displayed on New York City bus shelters, buses, and subway cars operating in the priority communities. Social media, Web sites, and print material were used to promote the campaign message.

Social media metrics and a street intercept postsurvey informed the campaign’s success.

Quantitative data were analyzed using descriptive statistics.

One hundred advertisements in English and Spanish were posted. After an 18-month followup, there were over 11,000 visits to the Facebook page. Results from the postsurvey (n = 171) suggest the SMC motivated participants who recognized the advertisements to improve their health behaviors.

A multifaceted SMC that coincides with prevention programs can effectively raise attention to health issues and activities in a high-risk population at a relatively low cost.

To investigate individual- and city-level factors associated with municipal officials’ participation in a local land use policy that supports active living.

Cross-sectional study.

Eighty-three cities in eight states.

Four hundred thirteen elected and appointed officials with various job functions including mayors, city councilors, aldermen, selectmen, city or town managers, and heads of departments of planning, community development, public works, transportation, engineering, parks and recreation, neighborhood services, and public health.

A Web-based survey assessed perceived importance of physical activity and livability issues to job responsibilities; perceived resident support of local government action to address physical activity and livability issues; and residence. City-level factors obtained from Census data included percentage of commuters by walking, bicycling, and public transit. The dependent variable was self-reported participation in developing, adopting, or implementing a local land use policy supportive of active living.

Hierarchical (two-level: municipal official–city) logistic regression model, using R.

Municipal officials living in the city where they worked were significantly more likely to be involved in a land use policy. Higher perceived importance of livability issues was associated with participation. Perceived importance of physical activity was inversely associated with land use policy involvement. Higher city-level bicycling rates resulted in increased odds of participation in a land use policy. City-level walking rates were inversely associated with land use policy participation.

Municipal officials who worked in cities with a higher proportion of bicycle commuters, who prioritized livability issues, and who resided in the city where they worked were more likely to engage in land use policies supportive of active living.

Create a screening measure of health literacy for use with the Health Information National Trends Survey (HINTS).

Participants completed a paper-based survey. Items from the survey were used to construct a health literacy screening measure.

A population-based survey conducted in geographic areas of high and low minority frequency and in Central Appalachia.

Two thousand nine hundred four English-speaking participants were included in this study: 66% white, 93% completed high school, mean age = 52.53 years (SD = 16.24).

A health literacy screening measure was created using four items included in the HINTS survey. Scores could range from 0 (no questions affirmative/correct) to 4 (all questions answered affirmatively/correctly).

Multiple regression analysis was used to determine whether demographic variables known to predict health literacy were indeed associated with the constructed health literacy screening measure.

The weighted average health literacy score was 2.63 (SD = 1.00). Those who were nonwhite (p = .0005), were older (p < .0005), or had not completed high school (p < .0001) tended to have lower health literacy screening measure scores.

This study highlights the need to assess health literacy in national surveys, but also serves as evidence that screening measures can be created within existing datasets to give researchers the ability to consider the impact of health literacy.