American Journal of Health Promotion

To determine whether the use of worksite health and wellness clinics reduced hemoglobin A1c (HbA1c) for prediabetic and diabetic employees.

Hemoglobin A1c values were compared between clinic users and matched non-users.

The Wonderful Company’s (TWC’s) agricultural and packaging sites in Central California.

TWC’s 2016 to 2017 employees who used clinics (n = 445, defined below) and clinic non-users (n = 217) who had HbA1c screening and worked at TWC for 3 or more months each year.

A unique worksite health and wellness clinic that offers multidisciplinary primary medical care in synergy with TWC’s overall wellness programs.

Exposure was clinic use, defined by frequency and patterns of visits. Hemoglobin A1c was the outcome of interest.

Users and non-users were propensity score matched using the 2016 employee data including HbA1c, and then 2017 HbA1c values were compared between the 2 groups.

The 2017 HbA1c of diabetic employees was lower among clinic users compared to non-users (7.42 vs 8.53, P < .001). Differences in HbA1c among prediabetics or diabetics and prediabetics aggregated were not statistically significant, despite TWC’s population-level data showing a reduction in prediabetes prevalence. The clinic impact results were robust to multivariate analyses and an alternative definition of utilization.

The implementation of TWC’s Health and Wellness clinics was associated with reductions in HbA1c among diabetics, but further research is needed on prediabetics.

We examined how socioenvironmental risk factors unique to the United States-Mexico border, defined as border community and immigration stress, normalization of drug trafficking, and perceived disordered neighborhood stress, contribute to tobacco, alcohol, and marijuana use among adolescents residing there.

Cross-sectional design.

The study was conducted at a high school on the United States-Mexico border.

A sample of 445 primarily Hispanic students (ages 14-18).

Perceived Disordered Neighborhood Stress Scale, Border Community and Immigration Stress Scale, and Normalization of Drug Trafficking Scale.

Logistic regression assessed the association between the socioenvironmental risk factors and past 30-day tobacco, alcohol, and marijuana use.

Participants with higher border community and immigration stress scores were significantly more likely to have used tobacco (adjusted odds ratio [aOR] = 1.41, P < .01) and alcohol (aOR = 1.31, P < .01) in the past 30 days. Perceived disordered neighborhood stress also was associated with past 30-day alcohol use (aOR = 1.46, P < .00). The normalization of drug trafficking was associated with past 30-day marijuana use (aOR = 1.45, P < .05).

Public health practitioners, educational institutions, and policy makers should consider the economic and normative environment of the United States-Mexico border for future substance use prevention and risk reduction efforts targeting border adolescents.

This study aims to investigate the impact of disadvantaged neighborhoods and lifestyle factors on obesity among Australian adults.

Quantitative, longitudinal research design.

Cohort.

Data for this study came from a cohort of 10 734 adults (21 468 observations) who participated in the Household, Income and Labour Dynamics in Australia survey. The participants were interviewed at baseline in 2013 and were followed up in 2017.

Generalized Estimating Equation model with logistic link function was employed to examine within-person changes in obesity due to disadvantaged neighborhoods and lifestyle factors at 2-time points over a 4-year follow-up period.

Adults living in the most disadvantaged area were 1.22 (odds ratio [OR]: 1.22, 95% CI: 1.08-1.38) and 1.30 (OR: 1.30, 95% CI: 1.20-1.42) times, respectively, more prone to be overweight and obese compared with peers living at least disadvantaged area. Study results also revealed that adults who consume fruits regularly and perform high levels of physical activity were 6% (OR: 0.94, 95% CI: 0.91-0.98) and 12% (OR: 0.88, 95% CI: 0.85-0.92) less likely to be obese, respectively, compared to their counterparts. Current alcohol drinkers were 1.07 (OR: 1.07, 95% CI: 1.01-1.13) times more likely to be obese compared to peers not consuming alcohol. Highly psychologically distressed adults were 1.08 times (OR: 1.08, 95% CI: 1.02-1.13) more likely to be obese than their peers.

This study contributes to the literature regarding disadvantaged neighborhoods and lifestyle factors, which have an influence on adult obesity rates and thus help health decision-makers to formulate effective obesity prevention strategies.

To assess how nutrition knowledge is associated with global diet quality and to investigate whether sociodemographic characteristics (ie, sex, age, education, income, marital status, and living with children or not) moderate this association.

Cross-sectional web-based study.

The PREDISE study aims at identifying correlates of adherence to healthy eating guidelines in French-speaking adults from the Province of Quebec, Canada.

A probability sample of 1092 participants (50% female).

The Nutrition Knowledge Questionnaire and 24-hour food recalls from which the Canadian Healthy Eating Index (C-HEI) was calculated.

Multiple linear regressions performed to assess how nutrition knowledge is associated with the C-HEI. Interaction terms tested to evaluate whether sociodemographic characteristics moderate the association between nutrition knowledge and the C-HEI.

Nutrition knowledge (B = 0.141 [95% CI: 0.075-0.208], P < .0001) was identified as a significant correlate of the C-HEI. Education significantly moderated the association between nutrition knowledge and the C-HEI (P interaction = .0038), with a significative association among participants with a lower education level (B = 0.295 [95% CI: 0.170-0.421], P < .0001) but not among participants with a higher education level (B = 0.077 [95% CI: −0.004 to 0.157], P = .06). Whether participants lived with or without children also significantly moderated the association (P interaction = 0.0043); nutrition knowledge was associated with the C-HEI only in participants who were not living with children (B = 0.261 [95% CI: 0.167 to 0.355], P < .0001).

This study suggests that the association between nutrition knowledge and adherence to healthy eating guidelines is not the same in different subgroups of the population. Interventions aiming at increasing nutrition knowledge may be a promising approach to improve diet quality, especially among individuals with a lower education.

Flourishing and mental health in the prediction of health behaviors such as exercise has been understudied. Positive emotions may promote, and negative emotions hinder protective health behaviors; however, the direction of these associations is unclear. The objective here was to investigate possible associations prospectively.

Longitudinal cohort study.

National

The Biopsychosocial Religion and Health Study of Seventh-day Adventists provided longitudinal data from 2006 to 2007 and 2010 to 2011 (n = 5789).

Flourishing was based on 6 measures of social functioning (positive social exchanges, negative social exchanges, religious emotional support given, received, and anticipated, and negative interactions) and 4 measures of psychological functioning (mastery, self-esteem, spiritual meaning, and perceived stress). The positivity ratio was the ratio of positive to negative emotions assessed with the Positive and Negative Affect Schedule.

Linear multiple regression and mediation.

Flourishing worked indirectly through the positivity ratio to predict a later increase in exercise over the course of 3 to 5 years. Tests of mediation suggest that the association of flourishing with later exercise was indirect through an increased ratio of positive to negative affect. Initial exercise frequency was also associated with later improved flourishing and positivity ratio scores over the same period.

The association of mental health and exercise is likely bidirectional. Exercise improves mental health, and those that have better psychosocial functioning have better mood and are more likely to increase exercise behaviors over time. Exercise is likely integral to mental health in mid to late life.

Investigate sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

Cross-sectional.

2014 and 2017 National Health Interview Survey.

54 326 participants.

Exposure measures were sexual identity (heterosexual, gay/lesbian, bisexual, “something else”) and race/ethnicity. Awareness of heart attack and stroke symptoms was assessed.

Sex-stratified logistic regression analyses to examine sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

Gay men were more likely than heterosexual men to identify calling 911 as the correct action if someone is having a heart attack (adjusted odds ratio [AOR] = 2.16, 95% CI: 1.18-3.96). The majority of racial/ethnic minority heterosexuals reported lower rates of awareness of heart attack and stroke symptoms than White heterosexuals. Hispanic sexual minority women had lower awareness of heart attack symptoms than White heterosexual women (AOR = 0.43, 95% CI: 0.25-0.74), whereas Asian sexual minority women reported lower awareness of stroke symptoms (AOR = 0.25, 95% CI: 0.08-0.80). Hispanic (AOR = 0.52, 95% CI: 0.33-0.84) and Asian (AOR = 0.35, 95% CI: 0.14-0.84) sexual minority men reported lower awareness of stroke symptoms than White heterosexual men.

Hispanic and Asian sexual minorities had lower rates of awareness of heart attack and stroke symptoms. Health information technology may be a platform for delivering health education and targeted health promotion for sexual minorities of color.

An outcomes’ evaluation of a community-based cardiovascular disease (CVD) prevention program in persons with newly diagnosed type 2 diabetes.

A prospective, observational study.

A community-setting in Ireland.

Persons with newly diagnosed type 2 diabetes, aged 40 years or older, and 2 or more cardiovascular risk factors.

A 16-week community-based, cardiovascular prevention program, with health promotion seminars, group exercise, and individual consultations, delivered by a multidisciplinary team.

Medical, lifestyle, and well-being measures.

Changes in categorical and continuous variables were analyzed using the paired exact test and the t test/Wilcoxin matched-pairs test, respectively.

In total, 218 persons (134 men) participated, mean age was 59.8 (10.2) years. Completion rate was 75.2% (n = 164). The proportion achieving target glycosylated hemoglobin (HbA_1c) increased from 53% at baseline to 75% (P < .001) at end of program. Systolic and diastolic blood pressures reduced by 8.8 mm Hg (95% CI: −11.2 to −6.4, P < .001) and 5.2 mm Hg (95% CI: −6.9 to −3.5, P < .001), respectively. Mean low-density lipoprotein cholesterol reduced from 2.45 to 2.05 mmol/L (P < .001). Significantly higher proportions met recommended targets in diet (6.9% vs 43.4%, P < .001) and physical activity (9.2% vs 56.6%, P < .001). Psychosocial measures significantly improved at end of program. The majority of improvements were sustained at 1 year.

Participation in this CVD prevention program was associated with significant improvements in glycemia and CVD risk factors in newly diagnosed patients with type 2 diabetes.

To evaluate the feasibility, utility, and limitations of a rapid community behavioral diagnosis (RCBD) for social distancing behaviors to prevent coronavirus transmission during a global coronavirus pandemic.

Using social media for recruitment, we partnered with a local community task force to administer a brief online survey.

Residential urban community.

Eighty-four community members, the majority of whom were white, female, college educated completed the survey.

Theory of planned behavior constructs: behavioral intentions, attitudes, perceived norms, and perceived behavioral control for 3 social distancing behaviors: maintaining a 6-foot distance, avoiding places people congregate, and staying home as much as possible.

Path analyses were conducted to understand significant determinants of intentions for each behavior to guide the development of locally tailored health promotion messages.

The RCBD was implemented, and results were communicated to the community within 1 week. Intentions were high across the 3 behaviors but lowest for staying home as much as possible. Younger participants had lower intentions of maintaining a 6-foot distance than older participants. For each behavior, specific recommendations for health promotion messaging emerged based on how attitudes, norms, and perceived behavioral control related to intentions.

In a situation where local community action is paramount for reducing coronavirus transmission, this RCBD process is feasible and useful for informing local health promotion.

Assessed racial disparities in health information-seeking behavior and trust of information sources from 2007 to 2017.

Pooled cross-sectional survey data.

Health Information National Trends Survey (HINTS).

Data included 6 iterations of HINTS (pooled: N = 19 496; 2007: n = 3593; 2011: n = 3959; 2013: n = 3185; Food and Drug Administration [FDA] 2015: n = 3738; 2017: n = 3285; and FDA 2017: n = 1736).

Outcome variables were health information seeking, high confidence, and high trust of health information from several sources. Independent variable was race group, controlling for other sociodemographic and socioeconomic variables.

Weighted descriptive and multivariate logistic regression for the pooled sample assessed associations by race. Fully interacted models with race–survey year interactions compared differences in outcomes between years.

Black respondents, relative to white, had greater odds of having high confidence in their ability to attain health information, trust of health information from newspapers and magazines, radio, internet, television, government, charitable organizations, and religious organizations. Hispanic respondents, relative to white, had lower odds of seeking health information and trusting health information from doctors. They had higher odds of trusting health information from the radio, the internet, television, charitable organizations, and religious organizations.

Disparities between races in trust of information sources remained across time. Understanding optimal information media, their reach, and credibility among racial groups could enable more targeted approaches to developing interventions. Our analytical approach minimized limitations present in the HINTS.

The purpose of this systematic literature review is to assess the factors associated with synergistic multisector alliances in the public health domain.

Articles in PubMed, CINAHL, Scopus, and Google Scholar between March 2009 and February 2019 were searched.

Included alliances had a public health and behavioral focus, were from the public or private sector, and were multipartner and multisector, and from high-income countries. Public health research alliances were included, but clinical research alliances were excluded.

Data extraction included alliance description, alliance domain, country, single or multiple alliances, and the sectors included in the alliance. Two theoretical frameworks were used in data extraction.

Data were coded according to 28 factors representing antecedents, management, and evaluation (Parent and Harvey model) and 3 output-specific factors (Bergen model).

A final 24 papers were included, of which 58% contained synergistic alliances. While almost all factors reportedly enabled synergy, some factors were more frequently associated with synergistic alliances, including clear purpose and positive coordination, information sharing, and evaluation of project outcomes. Complexity within some factors was also reported.

The theoretical models were supported by the data. Public health alliances would likely benefit from incorporating factors identified as beneficial for synergy and from carefully considering the management of complex factors.

Guided by the hypothesis that the arts can play a role in changing attitudes, beliefs, and health behaviors, the objectives of the study were to (1) overview artistic practices, interventions, and research being conducted at the intersection of the arts and health communication and (2) identify desired and observed outcomes and variables measured in these studies.

The search strategy was developed iteratively with 2 health science librarians and conducted using 8 databases (Applied Social Sciences Index and Abstracts, Art and Architecture Source, CINAHL, Communication and Mass Media Complete, ERIC, PsycINFO, PubMed, and Web of Science) and hand searching. Articles included were published between 2014 and 2018.

Inclusion criteria include US nonclinical setting and use of the arts (broadly defined) to change health knowledge, beliefs, behaviors, or awareness. Any articles not meeting inclusion criteria were excluded.

Covidence’s data extraction tool exported to MS Excel.

This final set of results was analyzed and synthesized by research design, population, sample size, health issue, purpose, variables measured, and findings.

In all, 78 articles met inclusion criteria. Number of participants ranged from 4 to 2140 (mean = 179); 61 (78.2%) outcome studies, including 8 experimental studies; 17 (21.79%) formative research or reports. Many different health topics were addressed and different art forms used.

The arts can help build knowledge and awareness of health issues. The authors highlight the need to build an evidence base for arts and public health.

To evaluate the effects of preconception care (PCC) consultations by change in lifestyle behaviors.

Women in deprived neighborhoods of 14 Dutch municipalities were encouraged to visit a general practitioner or midwife for PCC.

The study included women aged 18 to 41 years who had a PCC consultation.

In this community-based prospective cohort study, we assessed initiation of folic acid supplementation, cessation of smoking, alcohol consumption, and illicit drug use.

Self-reported and biomarker data on behavioral changes were obtained at baseline and 3 months later.

The changes in prevalence were assessed with the McNemar test.

Of the 259 included participants, paired analyses were available in 177 participants for self-reported outcomes and in 82 for biomarker outcomes. Baseline self-reported prevalence of no folic acid use was 36%, smoking 12%, weekly alcohol use 22%, and binge drinking 17%. Significant changes in prevalence toward better lifestyle during follow-up were seen for folic acid use (both self-reported, P < .001; and biomarker-confirmed, P = .008) and for self-reported binge drinking (P = .007).

Our study suggests that PCC contributes to initiation of folic acid supplementation and cessation of binge drinking in women who intend to become pregnant. Although based on a small sample, the study adds to the limited body of evidence regarding the benefits of PCC in improving periconception health.

To evaluate the impact of Desire2Move (D2M) implementation fidelity by Wellness Champions on program effectiveness.

Cross-sectional.

Years 1, 3, and 5 of D2M; an annual peer support health and well-being initiative for university employees.

D2M participants included 422 employees from 28 teams; however, only 144 provided survey data (34.1% response rate).

During the 8-week program, departments competed as teams to accumulate the greatest average physical activity (PA) minutes. Each team selected a Wellness Champion who delivered program information. Each team member recorded PA minutes with MapMyFitness.

An electronic survey assessed program implementation fidelity and program satisfaction.

Median split (median [Mdn] = 21.2) categorized teams into “high” (n = 14; Mdn = 24.0, range = 21.4-25.0) and “low” (n = 14; Mdn = 19.4, range = 14.3-21.0) implementation groups. Independent samples t tests evaluated differences between groups on program satisfaction and team program average PA minutes.

Groups were significantly different for program satisfaction, t(26) = −2.76, P = .011, and team program average PA minutes, t(26) = −2.40, P = .024. The “high” implementation group reported greater program satisfaction (mean [M] = 12.6, standard deviation [SD] = 1.8) and team program average PA minutes (M = 2104.4, SD = 807.4) than the “low” implementation group (program satisfaction M = 11.1, SD = 1.1; team program average minutes M = 1340.8, SD = 875.8).

Wellness Champions positively impacted employee PA participation and program satisfaction.

United States Department of Agriculture Supplemental Nutrition Assistance Program (SNAP) participants use SNAP-authorized stores for dietary purchases. Relationships between obesity prevalence and access to grocery and varied nontraditional (eg, dollar, drug, and convenience) SNAP settings are underexplored. This research aimed to determine the association of a full range of SNAP-authorized stores with obesity prevalence in Virginia.

The SNAP Retailer Locator was used to cross-sectionally identify authorized stores, and county health ranking information was applied based on store location.

Virginia, United States.

The SNAP-authorized stores, classified among store categories: grocery or supermarket; drug; mass merchandiser; supercenter; convenience; dollar; club; other; nonfood store; farmers markets; and independent grocery stores.

County-level obesity prevalence with income and rurality as potential confounders.

Multiple linear regression was used to determine associations between county-level adult obesity prevalence and available SNAP-authorized store formats (P < .05 a priori).

Store format was a predictor of obesity prevalence in Virginia in simple and adjusted models (R ² = 0.035, P < .0001 and R ² = 0.434, P < .0001, respectively). Grocery store or supermarket access was associated with obesity. The SNAP-authorized convenience, dollar, and nonfood stores were associated with a 0.3, 0.5, and 1.3 increase in county obesity prevalence, respectively (P < .05).

Research, practice, and health policy approaches to improve grocery, convenience, dollar, and restaurant or delivery service settings may favorably influence community obesity prevalence in Virginia.

Home food environment, including home food availability and parental food preparation practices, plays a significant role in child diet patterns. Recent evidence suggests that parental psychological stress is related to parental food preparation practices; however, there is limited information about the relationship between parental psychological stress and home food availability. The purpose of the study is to examine the relationships between parental stress, home food availability, child diet patterns, and body mass index (BMI) in families with young children.

A secondary data analysis from a mixed-methods design study.

The parent study was conducted in both local and online communities using a web-based survey.

Participants were 256 parents of children aged 2 to 5 years (53.4% white; 41.5% of overweight or obese children).

Parents completed well-validated self-report questionnaires.

We used latent structural equation modeling using Bayesian analysis.

There was a negative relationship between parents’ general stress and healthy food availability at home (β* = −.20, P < .001 for fruits; β* = −.23, P < .001 for vegetables; and β* = −.24, P < .001 for healthy beverage) and a positive relationship between parenting stress and healthy snack and healthy beverage availability (β = .13, P = .03; β = .14, P = .02, respectively). There was no relationship between parental stress and unhealthy food availability at home while unhealthy food availability was significantly associated with child’s unhealthy eating pattern (β* = .86, P < .01 for unhealthy snack; β* = .51, P < .01 for unhealthy beverage). There was no moderating effect of children’s health insurance on the relationships between parental stress and home food availability. Furthermore, child diet patterns were not associated with child BMI.

Parental psychological stress is a potentially important intervention target point for improving home food environment and child diet patterns.