American Journal of Health Promotion

To examine how health care providers’ knowledge, attitudes, and practices affect their referrals to the National Diabetes Prevention Program.

Cross-sectional, self-report data from DocStyles—a web-based survey

USA

Practicing family practitioners, nurse practitioners, pharmacists, and internists, n = 1,503.

Questions regarding health care providers’ knowledge, attitudes, and practices and their referrals to the National Diabetes Prevention Program.

Bivariate and multivariate analyses were used to calculate predictive margins and the average marginal effect.

Overall, 15.2% of health care providers (n = 1,503) reported making a referral to the National Diabetes Prevention Program. Health care providers were more likely to make referrals if they were familiar with the program (average marginal effect = 36.0%, 95% CI: 29.1%, 42.8%), reported knowledge of its availability (average marginal effect=49.1%, 95% CI: 40.2%, 57.9%), believed it was important to make referrals to the program (average marginal effect = 20.7%, 95% CI: 14.4%, 27.0%), and used electronic health records to manage patients with prediabetes (average marginal effect = 9.1%, 95% CI: 5.4%, 12.7%). Health care providers’ demographic characteristics had little to no association with making referrals.

Making referrals to the National Diabetes Prevention Program was associated with health care providers’ knowledge of the program and its reported availability, their attitudes, and their use of the electronic health record system to manage patients with prediabetes.

To identify mammography screening prevalence and predictors in Asian American women, focusing on the potential disparities in race and its influence on screening behaviors.

A secondary analysis utilized the California Health Interview Survey (CHIS) 2015–2016.

California, U.S.

Cisgender women who were non-Hispanic (NH) White, Chinese, Filipino, Vietnamese, Japanese, Korean, or “other Asian”, aged 40 or above (unweighted N=13 451).

Socioeconomics, chronic health conditions, and preventive care utilization were mesuared as potential risk factors, where up-to-date mammography screening as the outcome variable.

Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening behaviors in relation to potential factors, stratified by race and ethnicity.

The prevalence for up-to-date mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. In NH-White women, receiving an up-to-date mammogram was associated with age, birthplace, smoking status, diabetes, hypertension, health insurance coverage, and a preventive care visit in the past 12 months, whereas only age and a preventive care visit were significant predictors in Asian women.

The findings indicate that utilization disparities exist in mammogram in relation to socioeconomics, chronic health conditions, preventive care utilization, when comparing between race and ethnicity. Asian American women with borderline hypertension and no preventive care visits may require more public health outreach and cancer education.

To determine whether Hispanic residents receiving the Healthy Fit intervention enhanced with Motivational Interviewing (MI) experienced greater improvements in body composition, relative to participants receiving the initial intervention.

Quasi-experimental evaluation.

El Paso, Texas.

Among 656 baseline participants, 374 (54%) completed the 12-month assessment.

In Healthy Fit, community health workers (CHWs) promote nutrition and exercise. To strengthen intrinsic motivation and help participants overcome barriers to change, we incorporated a 30-minute motivational interview into the baseline assessment. Follow-up phone calls at 1, 3, and 6 months were identical across conditions.

CHWs assessed body mass index (BMI) and body fat percentage (BFP) using a bioelectrical impedance scale.

Regression models estimated differences between intervention conditions on change in BMI and BFP from baseline to the 12-month assessment.

Participants receiving MI had 2.13 times higher odds of losing weight (OR = 2.14, 95% CI [1.30, 3.53], P = .003) and 2.59 times higher odds of reduced BFP (OR = 2.59, 95% CI [1.51, 4.41], P < .001), relative to initial intervention participants. MI participants lost an average of 1.23 kg (2.71 lbs.) and their BFP declined 2% over 12 months.

Findings suggest CHW use of MI is a promising approach for promoting incremental changes in diet and exercise, which Healthy Fit integrates into a low-cost intervention.

Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes.

Cross-sectional study.

Two primary care clinics in southeastern US.

615 adults aged 18 years and older.

Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record.

Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control.

In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = −.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = −.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c.

Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.

To assess the role of physical activity and healthcare access in mediating the association of acculturation with cardiometabolic health in Asian American adults with diabetes.

Cross-sectional study.

National Health and Nutrition Examination Survey (NHANES) 2011–2018.

Non-pregnant Asian American adults with doctor diagnosed diabetes.

Participants were classified into low, moderate, and high acculturation status. Self-reported leisure-time, work, and transportation-based physical activity were summed for overall physical activity. Health insurance, frequency of healthcare receipt, and glycohemoglobin (HbA1c) check in the past year indicated healthcare access. Cardiometabolic health indicators included HbA1c, total and high density lipoprotein-cholesterol, and systolic and diastolic blood pressure.

Linear and logistic regression estimates, standardized using y-standardization, and assessed mediation of acculturation with cardiometabolic health.

Low acculturation was significantly related to greater leisure-time inactivity odds [OR (95% CI) = 2.25 (1.05, 4.82)], overall insufficient activity [OR (95% CI) = 2.30 (1.12, 4.74)], and uninsured status [OR (95% CI) = 5.62 (1.55, 20.41)]. Asian Americans with low acculturation had significantly higher log HbA1c than those with high acculturation (β ± SE = .078 ± .038); however, this association was not significant after adjusting for leisure-time activity. Leisure-time activity mediated 48.9% of acculturation and HbA1c association, and the indirect effect was statistically significant [estimate (95% CI) = .021 (.002, 0.047)].

Results suggest that promoting sufficient leisure-time activity could improve glycemic control in least acculturated Asian Americans with diabetes.

The purpose of this study was to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest intervention strategies.

Ninety minute virtual focus groups (N = 8), segmented by county, race and ethnicity were conducted with stakeholders from 3 vulnerable Alabama counties.

Participants (N = 67) were primarily African American and Latinx, at least 19 years, and residents or stakeholders in Jefferson, Mobile, and Dallas counties.

Focus groups took place virtually over Zoom.

The semi-structured guide explored perceptions of COVID-19, with an emphasis on barriers and facilitators to vaccine uptake. Focus groups lasted approximately 90 minutes and were audio recorded, transcribed, and analyzed by a team of 3 investigators, according to the guidelines of Thematic Analysis using NVivo 12. To provide guidance in the development of interventions to decrease vaccine hesitancy, we examined how themes fit with the constructs of the Health Belief Model.

We found that primary themes driving COVID-19 vaccine hesitancy, ordered from most to least discussed, are mistrust, fear, and lack of information. Additionally, interventions to decrease vaccine hesitancy should be multi-modal, community engaged, and provide consistent, comprehensive messages delivered by trusted sources.

To evaluate using Facebook ads to promote hepatitis A vaccination to at-risk groups.

This descriptive research study used Facebook ads and posts to deliver a social media health campaign.

The social networking site Facebook was used to target audiences in the United States.

Adults in the United States with Facebook accounts were the general audience with at-risk audiences having interests or profile attributes in either LGBTQ or food service groups.

Facebook Ads Manager was used to determine impressions, engagement rates, link clicks, and cost per result of the ads. These metrics were measured to examine the use of Facebook ads and targeting audiences.

Quantitative data were analyzed using descriptive statistics, and the Pearson correlation coefficient analysis was used to determine if the amount spent on each ad had any correlation with reach, results, cost per result, or impressions.

The campaign resulted in a reach of 53 422 users, 70 542 impressions, 457 unique link clicks (483 link clicks), an average cost per results of $0.92 USD, and the total amount spent of $445.68 USD. The amount spent was positively correlated with reach (r = .969), results (r = .994), cost per result (r = .841), and impressions (r =.957).

The social media health campaign was effective in reaching an audience about hepatitis A vaccination. Using interest groups was not more cost-effective than a using a general audience for link clicks.

This study aims to assess the relationship between social determinants of health (SDoH) burden and overall health.

Three years of Behavioral Risk Factor Surveillance System (BRFSS) data (2017–2019) were combined for this cross-sectional study.

Massachusetts.

Out of a possible 21,312 respondents, 16,929 (79%) were eligible for inclusion.

To create the SDoH summary measure, items assessing social risk experiences including financial instability (1 item), housing instability (2 items), perceptions of neighborhood crime (1 item), and food insecurity (2 items) were summed to create a count of risk experiences. Outcome measures included self-rated general health, days of poor physical health, and days of poor mental health.

Multivariable logistic regression was used to evaluate the association between each outcome and the SDoH summary measure, adjusting for demographic confounders.

In adjusted analyses, respondents who reported experiencing 1, 2, 3, or 4+ SDoH had a 1.6 (95% CI: 1.3–2.0), 2.9 (95% CI: 2.3–3.7), 3.2 (95% CI: 2.4–4.3), or 5.3 (95% CI: 4.0–7.0) increased odds (respectively) of self-rated fair/poor health, compared to those who reported zero SDoH. The adjusted relationship between the SDoH summary measure and physical health and mental health was similar in magnitude and statistically significant.

These results demonstrate that the overall burden of risk due to SDoH is an important predictor of health.

This study aims to test the effect of an information and support intervention on physical activity (PA) in women aged 50+ years.

Randomized wait-list controlled trial.

Sydney, Australia.

126 female university and health service employees, aged 50+.

Information session, activity tracker, regular motivational emails.

Proportion achieving ≥ 10,000 steps/day (primary outcome), daily step count, proportion meeting 150 mins/week of moderate to vigorous PA (MVPA), self-reported PA.

Odds-ratios and general linear regression models.

At 3 months, the intervention group reported significantly more vigorous PA (1.04 hours, 95% CI 0.24 to 1.85, P = .01, measured by IPAQ), were more likely to achieve 300 mins/week of MVPA (OR = 1.98, 95% CI 0.89 to 4.36, P = .09, measured by Actigraph) than the control wait-list group, and reported adopting PA promotion strategies (technology = 31/58% or goal-setting = 39/74%). No significant between-group differences in the primary outcome were detected (1.39, 95% CI 0.61 to 3.18, P = .44).

This low-dose intervention significantly increased self-reported vigorous PA time and non-significantly increased the proportion of people achieving 300 mins/week of MVPA but did not significantly increase the proportion of participants achieving 10,000 steps/day. Relatively small effects may be important at a population level given the minimal resources needed to deliver this intervention.

This study aims to examine the relationship between cash value benefit (CVB) redemption outcomes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) across food processing types and socio-demographics.

Cross-sectional and panel analyses.

Virginia.

98,067 Virginia WIC households.

CVB redemption rate.

The predominant share of CVB redemption was for fresh produce (77.3%). Non-Hispanic whites and blacks redeemed a smaller share of fresh produce than Hispanic participants (P < .001). Non-Hispanic black WIC households have a significantly lower CVB redemption rate than non-Hispanic white WIC households (β = −.008, P < .001). Households with a child participant tend to have a higher redemption rate (β = .01, P < .001). The redemption rates of fruits and of vegetables were positively correlated with household size.

Minority status and household size were significantly related to CVB redemptions among Virginia WIC participants.

This study aims to evaluate the interaction between veteran status and race/ethnicity on obesity status.

Cross-sectional survey

The 2013–2017 National Health Interview Survey

A total of 151,765 adults (8.62% veterans and 91.38 nonveterans) with 69.30% identifying as White, 13.05% identifying as Hispanic, 12.57% identifying as Black, and 5.08% identifying as Asian

Obesity status (measured using self-reported body mass index), race/ethnicity, survey year, age, marital status, educational attainment, federal poverty level, health insurance, type of insurance, self-reported health status, and whether participant had a usual care source.

Weighted logistic regression analysis

In a fully adjusted model, there was no evidence that veterans overall had higher odds of obesity compared to nonveterans (adjusted odd ratio (aOR): 1.05, 95% CI: .99, 1.11). White veterans had lower odds of obesity compared to White nonveterans (OR: .93, 95% CI: .87, .98). Hispanic veterans had higher odds of obesity compared to Hispanic nonveterans (aOR: 1.53, 95% CI: 1.23, 1.90). There was no evidence of an association between veteran status and obesity status for Black and Asian adults.

Effectual prevention strategies are needed to decrease obesity risks among active and retired Hispanic veterans.

Identify the scope of the literature which reports use of social network analysis to inform, support, or evaluate health promotion–focused community network/partnership development.

A comprehensive search (not date-limited) of PubMed, CINAHL, Web of Science Core Collection, PsycInfo, and the Cochrane Library Database for Systematic Reviews.

Criteria for inclusion included published in the English language and used social network analysis to inform, support, or evaluate development of community networks/partnerships aiding health promotion efforts. Studies were excluded if they did not use social network analysis or were not focused upon health promotion.

Three of the four authors extracted data using a summary chart to document information regarding study aims, target issue/population, methods, and key outcomes of the social network analysis.

The extracted data were qualitatively analyzed by 3 authors to categorize key social network analysis outcomes into categories.

Ninety-seven studies representing 9 geographical regions were included, with the majority (69) published after 2010. Key outcomes included the effectiveness of social network analysis to identify network characteristics, track network change over time, compare similar networks across locations, and correlate network attributes with outcomes.

Findings support the utility of social network analysis to inform, support, and evaluate development of sustainable health promotion–focused networks/partnerships.

To evaluate the effects of walking, independent of diet and weight-loss, on lipids and lipoproteins in women with overweight and obesity.

Academic Search Complete, Alternative Health Watch, Global Health, Health Source, CINAHL, MEDLINE, EMBASE, SportDiscus, and ProQuest.

(1) experiment-control design; (2) women with overweight or obesity; (3) walking as the experiment’s independent variable; (4) four or more weeks; and (5) pre- to post-assessment of lipids and/or lipoproteins. Excluded studies reported use of lipid-lowering medication, diet or other modes of physical activity, and alternative interventions as the control.

Data extraction and study quality were completed by the first 2 authors using the Cochrane review protocol and risk of bias assessment.

Raw mean difference between the experiment and control groups using a random effects model.

Meta-analyses of 21 interventions (N = 1129) demonstrated exclusive walking improves total cholesterol (raw mean difference = 6.67 mg/dL, P = .04) and low-density lipoproteins (raw mean difference = 7.38 mg/dL, P = .04). Greater improvement in total cholesterol, triglycerides, high-density lipoproteins, and low-density lipoproteins existed in women with obesity.

Exclusive walking aids in normalizing total cholesterol and LDLs in women with overweight and obesity. Exclusive walking can be used as a non-pharmacologic therapy, which may have positive clinical outcomes for individuals who especially struggle with diet and weight-reduction.

Robust program evaluations can identify effective promotion strategies. This scoping review aimed to analyze review articles (including systematic reviews, meta-analysis, meta-synthesis, scoping review, narrative review, rapid review, critical review, and integrative reviews) to systematically map and describe physical activity program evaluations published between January 2014 and July 2020 to summarize key characteristics of the published literature and suggest opportunities to strengthen current evaluations.

We conducted a systematic search of the following databases: Medline, Scopus, Sportdiscus, Eric, PsycInfo, and CINAHL.

Abstracts were screened for inclusion based on the following criteria: review article, English language, human subjects, primary prevention focus, physical activity evaluation, and evaluations conducted in North America.

Our initial search yielded 3193 articles; 211 review articles met the inclusion criteria.

We describe review characteristics, evaluation measures, and “good practice characteristics” to inform evaluation strategies.

Many reviews (72%) did not assess or describe the use of an evaluation framework or theory in the primary articles that they reviewed. Among those that did, there was significant variability in terminology making comparisons difficult. Process indicators were more common than outcome indicators (63.5% vs 46.0%). There is a lack of attention to participant characteristics with 29.4% capturing participant characteristics such as race, income, and neighborhood. Negative consequences from program participation and program efficiency were infrequently considered (9.3% and 13.7%).

Contextual factors, negative outcomes, the use of evaluation frameworks, and measures of program sustainability would strengthen evaluations and provide an evidence-base for physical activity programming, policy, and funding.