American Journal of Health Promotion

To examine the role of sleep in a school-based resiliency intervention.

Single group feasibility study.

Urban middle school

Sixth grade students.

A total of 285, 11–12-year-old students (70% White, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth (n = 248) completed electronic surveys at pre–post the 6-week study assessing mental health parameters and self-reported bed and wake time.

Students were categorized as having insufficient sleep opportunity if they reported time in bed of <9 hours per night.

General linear models examined differences between groups for each mental health parameters pre–post-study.

A third of participants (28%) were classified as having insufficient sleep opportunity. Youth with insufficient sleep were more often Hispanic (27% vs 16%; P < .001) and were more often classified with both mild to severe depression and anxiety symptoms (55% vs 35%; P = .004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep.

Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency interventions.

Sleep is critical for employee health, well-being, and productivity. Our purpose is to evaluate a sleep-focused interactive workplace health promotion program.

We evaluate sleep and mental health before and after exposure to the program using a pre/post quasi-experimental pilot study design with surveys administered at baseline and 1-, 6-, and 12 months post-exposure (Phase 1). We design program evaluation surveys for dissemination when the program is offered broadly to hospital employees (Phase 2).

The study was conducted at a large teaching hospital in the Southeast U.S. in 2016.

Subjects were full-time hospital employees.

The program was presented to subjects in one four-hour interactive session.

In Phase 1 (n = 55), surveys included the validated Apnea Risk Evaluation System, Dysfunctional Beliefs About Sleep, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index and Patient Health Questionnaire. Phase 2 (n = 3935) utilized program evaluation surveys.

We compare survey responses between pre- and post-program using a repeated measures analysis of variance with post-hoc tests.

Statistically significant improvement in all sleep and mental health domains was demonstrated. In Phase 2, 81.9% reported “strongly agree” to willingness to recommend the program to co-workers.

We demonstrate improvement in employee sleep and mental health after exposure to a novel workplace health promotion program to improve sleep.

To determine the association between exposure to FDA’s Fresh Empire tobacco public education campaign and tobacco-related beliefs.

Repeated cross-sectional data collection design with embedded longitudinal cohort over six data collection waves.

30 US evaluation markets.

Hip Hop peer crowd-identified US youth aged 12–18 (N = 5,378).

Self-reported brand and video ad awareness (saw any ad at least sometimes) and perceived effectiveness (1–5 scale) to describe campaign awareness and receptivity. Exogenous exposure was measured using population-adjusted broadcast and digital video impressions. Tobacco-related beliefs included beliefs about smoking risks, attitudes towards tobacco-free people and lifestyles, and normative beliefs about smoking.

Descriptive analyses of awareness, receptivity, and agreement with tobacco-related beliefs. Logistic regression models to determine the relationship between broadcast and digital video impressions and beliefs.

Fresh Empire campaign.

The campaign generated a high level of reach (71% brand and 66% video ad awareness at final wave) and messages were well-received (across waves 3.5–4.1 mean perceived effectiveness scores). Higher broadcast television exposure was associated with increased agreement with five beliefs related to addiction/control, being a bad influence on family/friends, and cosmetic effects of smoking (breath and attractiveness) (ORs = 1.16–1.27, (Ps < .05)).

Fresh Empire successfully reached and resonated with Hip Hop-identified youth. The campaign was associated with a limited number of targeted beliefs.

The purpose is to compare the predictive utility of alternate measures of diet and physical activity for overweight and obesity among low-income minority women.

Cross-sectional analysis of baseline data from a cohort study.

Three public housing developments in South Los Angeles.

Subjects: Adult women (N = 425).

Primary outcome—weight status (normal BMI, overweight, or obese). Primary predictors— diet: 24-hour dietary recalls (Healthy Eating Index), dietary screener (intake of specific food groups), and single-item survey question (diet quality); physical activity: accelerometry (minutes/day of moderate-to-vigorous activity), short recall questionnaire (minutes/week of moderate and vigorous activity), and single-item questions (days per week did exercise; self-assessment of overall activity level).

Multinomial logistic regression models, controlling for socio-demographic covariates. Models are built up starting with least resource-intensive measures of diet and physical activity (single items) and sequentially adding more resource-intensive measures. Model performance is assessed via information-based model selection indices.

Adjusted relative risk for obesity for single-item measures ranged from .61 to .64 for diet (P < .01) and from .80 to .81 for physical activity (P <.05). The added value of resource-intensive measures was negligible for physical activity and at best small for diet.

Single-item questions for diet and physical activity can provide valuable information about risk for overweight and obesity in low-income minority women when more resource-intensive assessments are infeasible.

To examine factors associated with water filter use (WFU) for drinking tap water at home and its association with consuming plain water and sugar-sweetened beverages (SSBs).

Quantitative, cross-sectional study.

The 2018 SummerStyles survey data.

U.S. adults (≥18 years; N=4042).

Outcomes were intake of plain water (tap/bottled water) and SSBs. Exposure was WFU (yes, no, not drinking tap water at home). Covariates included sociodemographics, weight status, Census regions, and home ownership status.

We used multivariable logistic regressions to estimate adjusted odds ratios (AOR) and 95% confidence interval (CI) for consuming tap water, bottled water, or total plain water >3 cups/day (vs. ≤3 cups) and SSBs ≥1 time/day (vs. <1 time) by WFU.

Overall, 36% of adults reported using a filter for drinking tap water at home; 14% did not drink tap water at home. Hispanics had significantly higher odds of using a water filter (AOR=1.50, 95% CI=1.14-1.98) vs non-Hispanic White. Factors significantly associated with lower odds of WFU were lower education (AOR=.69, 95% CI=.55-.86 for ≤high school; AOR=.78, 95% CI=.64-.95 for some college, vs college graduate), not being married (AOR=.81, 95% CI=.66-.98, vs married/domestic partnership), and lower household income (AOR=.68, 95% CI=.68-.90 for <$35,000, vs ≥$100,000). Using a water filter was associated with higher odds of drinking >3 cups/day of tap water (AOR=1.33, 95% CI=1.13-1.56) and lower odds of SSBs ≥1 time/day (AOR=.76, 95% CI=.62-.92). Not drinking tap water at home was associated with higher odds of drinking >3 cups/day bottled water (AOR=3.46, 95% CI=2.70-4.44).

WFU was associated with higher tap water intake and lower SSB intake among U.S. adults. WFU was higher among Hispanics, but lower among those with lower education and income and not married adults. Although WFU was associated with healthful beverage habits, additional considerations for WFU may include source water quality, oral health, cost, and proper use.

Research suggests that food’s nutritional content and the feelings and behaviors associated with eating contribute to overall health, yet these constructs are rarely considered simultaneously. The current cross-sectional study investigated healthy eating profiles in college women that included both nutritional quality and intuitive eating (IE), with IE being an eating style that prioritizes physiological hunger/satiety cues and minimizes dieting and emotional eating.

Undergraduate women (n = 352) completed an online assessment and daily diaries (80% retention).

Nutritionally healthy eating, IE, dieting, body dissatisfaction, disordered eating, and psychological health were examined.

Latent profile analysis explored patterns of nutritionally healthy eating and IE, and determined how these patterns related to psychological and disordered eating outcomes.

A four-profile solution emerged: 1) Dieting (high nutritionally healthy eating + intermediate IE), 2) Unhealthy Eating (low nutritionally healthy eating + low IE), 3) Intuitive Eating (moderately high nutritionally healthy eating + high IE), and 4) Non-Dieting (low nutritionally healthy eating + intermediate IE). These profiles significantly differed from one another, such that the Intuitive Eating and Non-Dieting profiles reported lower psychological distress, body mass index, and disordered eating compared to other profiles, while the Dieting and Unhealthy Eating profiles showed the healthiest and poorest nutritional eating, respectively.

These findings suggest that IE and nutritionally healthy eating are distinct factors in conceptualizing the eating patterns of college women, and both should be considered when developing interventions. Future research should replicate these findings in larger/more diverse samples and examine eating profiles longitudinally.

The purpose is to describe how local quantitative and qualitative data were used to assess the progress of the Supplemental Nutrition Assistance Program Education (SNAP-Ed) interventions in Los Angeles County, California.

Data from the California Health Interview Survey informed the geographical concentration of program resources during the planning phase. At the end of the program, semi-structured interviews with stakeholders were conducted to assess factors that facilitated SNAP-Ed implementation.

Los Angeles County, California.

Twenty-four project coordinators were interviewed.

From 2016 to 2020, 24 organizations across Los Angeles County delivered nutrition education, reaching an estimated 2 million people. Two-hundred policy, systems, and environmental change interventions reached an estimated 1.2 million people.

Semi-structured interview data were analyzed using a form of both inductive and deductive content analysis. A codebook was developed based on themes identified in these interviews. Each interview was coded by 2 team members; discrepancies (if they arose) were resolved by a 5-member group.

Two facilitators—support for capacity building from a local health department and presence of community partnerships—were identified as critical factors that contributed to the success of SNAP-Ed implementation.

A local health department can increase SNAP-Ed intervention reach and uptake by assisting funded partners with further capacity building, helping them to develop feasible work plans, foster evaluation skills, and engage in sustainability planning.

To understand barriers around accessing or using workplace health promotion (WHP) programs among workers in different wage categories.

We conducted qualitative analysis of responses to three open-ended questions about WHP program participation, collected as part of an existing WHP program evaluation. Setting: A large mid-western university.

Of the 20,000 employees emailed an online survey, 3,212 responded (16.1%). The sample was mostly female (75%), white (79%), and comprised of staff members (84%). The average age was 44 years and 67% had annual incomes <$75,001.

We used NVivo-12 Plus and two coders to apply Grounded Theory on the open-ended questions and identify emergent themes.

Although most respondents were happy with the program, differences across wage categories emerged around time, financial incentives, commute, workload, and organizational policies/support. Employees at all wage levels were enthusiastic about creating a culture of health but needed different cultural supports to do so. For instance, higher-wage workers needed to overcome self-made time constraints, while lower-wage workers needed supervisor support to overcome coverage constraints that prevented participation.

The unique participation challenges experienced by employees in different wage categories provide justification for WHP programs that can better accommodate the participation barriers of all employees. While some programs may simply require more flexible offerings, supervisors may need to be trained to support and foster healthy environments.

Parents play a critical decision-making role in vaccinating their children against human papillomavirus (HPV), and mothers, in particular, are key stakeholders as they are often the parent taking their children to healthcare visits. Given the importance of the HPV vaccination as a cancer prevention strategy, this study was designed to explore Latinx mothers’ suggested strategies to promote vaccine uptake among Latinx parents.

Community-based in Massachusetts, United States, and Latinx mothers.

Descriptive qualitative research employing individual semi-structured interviews. Data were analyzed using a hybrid method of thematic analysis incorporating deductive and inductive approaches.

Twenty-two, majority foreign-born (91%) Latinx mothers of adolescent girls (∼60%) and boys (∼40%) aged 11–19 years participated. Mothers suggested several strategies to promote uptake of the HPV vaccine among Latinx families including healthcare providers’ increased communication and anticipatory guidance addressing factors influencing parents’ HPV vaccination hesitancy, and improved community-wide dissemination of culturally and linguistically relevant information targeting not only parents of age-eligible participants but the broader community. Finally, mothers suggested the use of social media using personal narratives and an enhanced active role of schools in providing accurate information to raise awareness and educate adolescents and parents about the importance of HPV vaccination.

Findings are relevant to the development of tailored interventions to meet the needs of Latinx populations, and ultimately increase Latinx children’s HPV vaccination rates.

The purpose is to examine predictors of intervention non-compliance and develop a risk stratification score.

Prospective cohort.

Early care and education (ECE).

Early care and education programs (n = 3883) randomly allocated (3:1) to a development (n = 2909) or validation (n = 974) sample.

Go NAPSACC provides a structured, web-based process to help improve the health of children around 7 modules (nutrition, physical activity, oral health, breast/infant feeding, farm to ECE, outdoor play, and screen time).

Program characteristics and participation data are collected via Go NAPSACC tool.

Multivariable Lasso logistic regression was used to identify predictors. Discriminative ability was based on area under the ROC curve (AUC).

Overall, ECE program non-compliance (lack of valid pre-/post self-assessment) was 65.5%. Six predictors were retained in the final development model: type of program (P = .002), Child and Adult Care Food Program (CACFP) participation (P = .065), acceptance of subsidies (P < .001), past modules attempted (P < .001), past modules completed (P < .001), and action plans created (P < .001). These factors generated a non-compliance risk score which showed good discrimination in the validation sample (AUC: .922, 95% CI: .903–.940).

Lack of qualitative data limits the ability to fully understand the context of non-compliance; however, this study demonstrates readily available data captured by Go NAPSACC are strong predictors of future success. Early identification of high-risk programs will inform targets for future implementation strategies geared toward improving program success.

Smoke- and tobacco-free policy (SFP) is an effective strategy that can reduce tobacco-related health disparities among young adults.

Longitudinal design using administrative, survey, policy data sources, and geocoded tobacco outlet and American Community Survey data

California community colleges (CC) and cities/communities where colleges are located, 2003-2019.

114 California CCs

School-level (i.e., student population and demographics) and community-level data (socio-demographics, local tobacco control policy, tobacco-related norms and availability, and health resources) from 2003 to 2019.

Key outcome is the year CC adopted a 100% SFP.

Bivariate and multivariate Cox survival models were used to analyze timing of SFP adoption.

By 2019, 61 out of 114 (53.5%) CCs were 100% SFP. While community smoking prevalence and tobacco availability were not significant, CCs in rural areas were less likely to be smoke-free. CCs located in cities with stronger tobacco policies (hazard ratio (HR) = 1.08, P < .05), which reported higher student health fees (HR = 2.00, P < .05) and received technical assistance for SFP (HR = 4.59, P < .01) were significantly associated with having 100% SFP.

Findings suggest that key community factors (strong city tobacco policies) and school and community resources (student health fees, SFP technical assistance) are associated with the presence of 100% SFP at CCs. Resources from the community or within a college might support remaining CCs in becoming 100% smoke-free.

Evaluation findings from Comprando Rico y Sano (CRS), a culturally relevant, community-based intervention addressing nutrition knowledge and food access are presented.

No-control quasi-experimental intervention with pre, post, and follow-up assessments.

CRS was promotores-led through UnidosUS's Affiliate Network of community–based partners.

Low-income Latino adults (N = 966) receiving services at 25 partner sites.

CRS was a six-hour intervention focused on nutrition knowledge and consumption of fruits, vegetables, and home-prepared meals. It also provided guidance for health-conscious grocery shopping, Supplemental Nutrition Assistance Program (SNAP) information, and enrollment assistance.

Self-report surveys assessed nutrition knowledge; intention to change; and frequency of fruit, vegetable, and home-prepared meal consumption. Sites reported monthly SNAP enrollment data.

Paired-samples t-tests and repeated-measures ANOVAs assessed changes in knowledge, intentions, and behavior from pre-to-post (n = 960) and pre-to-follow-up (n = 115).

Pre-to-follow-up increases in nutrition knowledge (P < .001) were observed. Intention to consume more vegetables (P = .027) and home-prepared meals (P < .001) also improved between pre- and follow-up. Increases from pre-to-follow-up were observed for frequency of consuming fruits (P = .007), vegetables (P = .001), and home-prepared meals (P < .001). Across 16 months, 24,359 Latinos enrolled for SNAP.

Large-scale community collaborations to deliver culturally relevant nutrition education and SNAP enrollment assistance can increase food access, health literacy, and promote healthful diets for Latinos.

To determine 1) the indexes/indicators used for evaluating the “strengthening community actions” mechanism of the Ottawa Charter for Health Promotion and 2) to extract the characteristics and key components of the indexes/indicators using a scoping review.

Data Source: In May 2020, the search was conducted across three databases: Medline (via PubMed), Embase, and Scopus.

Inclusion and Exclusion Criteria: All primary studies relating to development, identification, and measurement of health promotion indices/indicators associated to the “strengthening community actions” were included. The review articles were excluded.

The data were extracted to a data-charting form that was developed by the research team. Two authors reviewed the extracted data.

To summarize and report the data, a descriptive numerical analysis and a narrative descriptive synthesizing approach were used.

In total, 93 study articles were included. A majority of studies (82%) were conducted in developed countries. Different types of recognized indices were categorized into seven groups: social cohesion (n = 3), community capacity (n = 1), community participation (n = 7), social capital (n = 6), social network (n = 3), social support (n = 1), and others (n = 5).

Having a collection of “strengthening community actions” indices/indicators in hand, health policymakers and health promotion specialists might be able to do their best in considering, selecting, and applying the most appropriate indices/indicators while evaluating community health promotion interventions in different settings.