American Journal of Health Promotion

Determine the association between incremental increases in the number of social risk factors and the prevalence of any disability and disability type.

The cross-sectional analysis was conducted using 2017 Behavioral Risk Factor Surveillance System data from states whose surveys included items about social risk factors.

Respondents from 17 US states.

Respondents included 136 432 adults.

Dichotomized social risk factors included food, housing, and financial insecurity, unsafe neighborhood, and healthcare access hardship.

Weighted χ² and logistic regression analyses adjusted for demographic characteristics, measures of socioeconomic position, and comorbid health conditions were used to examine differences in the prevalence of disability by social risk factor and via a social risk index created by summing the social risk factors.

Compared to those reporting 0 social risk factors, respondents reporting ≥4 had more than thrice the odds of reporting a cognition ((adjusted odds ratio [AOR]=3.37; 95%CI [2.75-4.13]), independent living (AOR=3.24 [2.52-4.15]), self-care (AOR=3.33 [2.55-4.34]), or any disability (AOR=3.90 [3.24-4.70]); more than twice the odds of reporting a vision (AOR=2.61 [1.93-3.52]) or mobility (AOR=2.72 [2.16-3.41]) disability; and more than 1.5 times the odds of reporting a hearing disability (AOR=1.59 [1.22-2.07]).

Incremental increases in the number of social risk factors were independently associated with higher odds of disability. Intervention efforts should address the social context of US adults with disabilities to improve health outcomes.

To assess how previous experiences and new information contributed to COVID-19 vaccine intentions.

Online survey (N = 1264) with quality checks.

Cross-sectional U.S. survey fielded June 22-July 18, 2020.

U.S. residents 18+; quotas reflecting U.S. Census, limited to English speakers participating in internet panels.

Media literacy for news content and sources, COVID-19 knowledge; perceived usefulness of health experts; if received flu vaccine in past 12 months; vaccine willingness scale; demographics.

Structural equation modelling.

Perceived usefulness of health experts (b = .422, P < .001) and media literacy (b = .162, P < .003) predicted most variance in vaccine intentions (R-squared=31.5%). A significant interaction (b = .163, P < .001) between knowledge (b = −.132, P = .052) and getting flu shot (b = .185, P < .001) predicted additional 3.5% of the variance in future vaccine intentions. An increase in knowledge of COVID-19 associated with a decrease in vaccine intention among those declining the flu shot.

The interaction result suggests COVID-19 knowledge had a positive association with vaccine intention for flu shot recipients but a counter-productive association for those declining it. Media literacy and trust in health experts provided strong counterbalancing influences. Survey-based findings are correlational; thus, predictions are based on theory. Future research should study these relationships with panel data or experimental designs.

To evaluate the trend of harm perception for e-cigarettes and the trend of the association between harm perception for e-cigarettes and for cigarettes among US youth from 2014 to 2019.

The National Youth Tobacco Survey is an annual, cross-sectional, school-based survey done among youth selected using three-stage probability sampling.

Data were drawn from the 2014 to 2019 Surveys. A Multinomial logistic regression model was used to assess the association between harm perception for e-cigarettes and harm perception for cigarettes for each year.

The percentage of youth who perceived e-cigarettes as harmless decreased from 2014 to 2019 (17.2% to 5.8%). From 2015 to 2018, the percentage of smokers who perceived e-cigarettes as a little harmful increased (33.6% to 41.2%). The positive association between harm perception for e-cigarettes and harm perception for cigarettes became stronger with time. In 2014, the odds of perceiving e-cigarettes as harmless relative to very harmful were 19.55 times greater for youth who perceived cigarettes as harmless, compared to those who perceived cigarettes as very harmful (OR = 19.55; 95% CI: 14.19–26.94). These odds increased to 77.65 times in 2019 (OR = 77.65; 95% CI: 41.48–107.85).

This study suggests a stronger relationship between perceived harm of cigarettes and e-cigarettes with time. Interventions to prevent smoking have the potential to change e-cigarette use.

This study examined dietary behaviors of rural youth at school and at home and sociodemographic differences.

A cross-sectional design was used.

The study took place in five rural schools in the Southwestern US.

Student participants (N = 751) were in 3^rd-8^th grades.

Consumption of fruits, vegetables, dairy, and soda/pop, at school and at home, were measured using a modified 7-day recall Youth Risk Behavior survey for nutrition instrument (CDC, 2011); Sociodemographic data.

Descriptive statistics, frequency tables and MANCOVA were used.

Following a natural log transformation of the dependent variables, there were significant multivariate effects in dietary behaviors across schools (Wilks’ λ = 0.962, F_{(16, 2539.4)} = 2.05, P = 0.0082) and location (school v. home; Wilks’ λ = 0.849, F_{(4, 831)} = 36.94, P < 0.0001). Follow-up tests showed students in some schools reported higher consumption of fruit, vegetable, and soda at home than school, although most reported consuming less than one serving per day of fruit, vegetables, and dairy across settings. There were no significant main effects for gender/grade/ethnicity across behaviors.

Findings highlight poor dietary behaviors of rural youth as well as school/home differences that can help inform efforts to support optimal dietary behaviors of this population. Results should be interpreted considering limitations of the self-report nature of collected data and missing data.

Drawing from the Health Belief Model, we explored how disadvantaged groups in the U.S., including Black, Hispanic, less educated and wealthy individuals, experienced perceived barriers and cues to action in the context of the COVID-19 vaccination.

A cross-sectional survey administered in March 2021.

USA

A national sample of U.S. residents (n = 795) recruited from Prolific.

Perceived barriers (clinical, access, trust, religion/spiritual), cues to action (authorities, social circles), attitudes toward COVID-19 vaccination.

Factor analysis and Structural Equation Model (SEM) were performed in STATA 16.

Black and less educated individuals experienced higher clinical barriers (CI [.012, .33]; CI [.027, .10]), trust barriers (CI [.49, .92]; CI [.057, .16]), and religious/spiritual barriers (CI [.28, .66]; CI [.026, .11]). Hispanics experienced lower levels of clinical barriers (CI [-.42, .0001]). Clinical, trust, and religious/spiritual barriers were negatively related to attitudes toward vaccination (CI [-.45, −.15]; CI [-.79, −.51]; CI [-.43, −.13]). Black and less educated individuals experienced fewer cues to action by authority (CI [-.47, −.083]; CI [-.093, −.002]) and social ties (CI [-.75, −.33]; CI [-.18, −.080]). Lower-income individuals experienced fewer cues to action by social ties (CI [-.097, −.032]). Cues from social ties were positively associated with vaccination attitudes (CI [.065, .26]).

Communication should be personalized to address perceived barriers disadvantaged groups differentially experience and use sources who exert influences on these groups.

To estimate the percentage of United States adults who accurately assessed their diet quality (DQ).

Observational, cross-sectional, nationally representative.

National Health and Nutrition Examination Survey, 2015-2018.

9757 (86%) of 11 288 adults aged ≥20 years.

Perceived DQ was assessed by asking participants, how healthy is your diet? The five responses included excellent, very good, good, fair, and poor. Measured DQ was assessed using 24-hours dietary recalls scored with 2015 Healthy Eating Index; scores were categorized using a 10-point grading scale.

Matches between perceived and measured DQ that were classified as accurate included: excellent = A, very good = A or B, good = B or C, fair = C or D, and poor = D or F. All others were classified as inaccurate. Analyses included descriptive statistics and multivariable logistic regression for complex survey designs.

63% of adults perceived their DQ as very good or good while 70% scored DQ grades of F. Overall, 15% of adults accurately assessed their DQ with 96% accuracy in the poor perception group and <23% in the other 4 groups. Overall, 75% of adults overrated their DQ. Females, adults with lower educational attainment, and those with low food security were more likely to accurately assess their DQ.

Adults cannot accurately assess their DQ except for those perceiving their DQ as poor, and the majority overrate their DQ.

The current study (1) examines how disparities in quitting cigarette and other tobacco product use have changed by race and socioeconomic status and (2) utilizes an expanded measure, any tobacco quit ratio (aQR), that extends previous work on cigarette quit ratios and captures use and cessation in a growing tobacco marketplace.

Repeated cross-sectional representative survey; Setting: Minnesota

Adult Minnesotans from the 2007 and 2018 Minnesota Adult Tobacco Survey (combined N=9,258)

Cigarette QR (cQR), aQR (cigarette, cigar, smokeless, pipe, e-cigarette, hookah), past year quit attempts, and recent cessation.

Weights ensured statewide representativeness. Regression analyses tested for differences by race (Black vs White), income (low vs medium/high), and education (low vs medium/high) across survey years.

cQRs and aQRs were relatively high among White respondents and those with medium-high education and income. The disparity in aQR between White and Black respondents decreased from 2007 to 2018. Black respondents were more likely to try to quit than White respondents but were less likely to report recent cessation.

Cessation disparities by race and socioeconomic status have changed little between 2007 and 2018, and the magnitude of the disparity for several cessation indicators remains large. Public health professionals and medical practitioners can play a key role in reducing disparities by supporting public policies and cessation interventions that target social determinants of health and associated barriers to quitting.

We investigated associations of intrapersonal and environmental factors with objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes, and their interactions in rural adults.

Cross-sectional.

14 rural towns participating in a multilevel intervention to promote physical activity.

Baseline data from 241 rural community members (19% losses due to missing data).

Self-reported demographics, behavioral factors, and neighborhood environment perceptions. Weekly MVPA minutes were assessed using accelerometry data.

Generalized linear models using a negative binomial distribution examined associations of and interactions between intrapersonal and environmental correlates with weekly MVPA.

Older age (β = −1.37; P= .025) and identifying as a woman (β = −.71; p= <.001) were inversely associated with MVPA. Self-efficacy (β = .34; p = <.001) and trail use (β = .44; P-value = .003) were directly associated with MVPA. Further, among women, perceived safety from traffic was inversely associated with MVPA (β = −.37; P = .003), while indoor recreational facility access was directly associated with MVPA (β = .24; P = .045).

Rural residents, especially women, face disproportionately lower MVPA levels. Improving recreational access and self-efficacy may be effective strategies for increasing MVPA.

To examine fish consumption patterns and fish advisory awareness among Wisconsin adults.

Cross-sectional data from population-based survey. Setting: 2017-2019 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS), supplemental fish module.

15,757 Wisconsinites aged ≥18 years. Annual response rates ranged 46.1-53.3%.

Fish consumption, advisory awareness, background and demographic characteristics.

Weighted binary and multinomial logistic regression.

Most Wisconsinites reported eating fish in the past 30 days, with approximately half (49.8%) consuming less than one fish meal per week. One-fifth of adults reported consuming sportfish. Women were less likely to eat any fish (POR_adj = .6, 95% CI: .5-.7) and sportfish than men (POR_adj = .7, 95% CI: .6-.8). The majority (76.7%) of sportfish consumers were aware of fish advisories. However, women (POR_adj = .7, 95% CI: .5-.9) and black, Indigenous, and people of color (BIPOC) (POR_adj = .4, 95% CI: .2-.7) sportfish consumers were less likely to be aware of fish advisories. Compared to adults aged 18-34 years, adults ≥55 years were twice as likely to eat 1-2 fish meals (vs. less than 1 fish meal) per week (POR_adj = 2.3, 95% CI: 1.8-2.9).

Findings indicate that half of all Wisconsinites consumed less fish than recommended by Wisconsin fish advisories, and women and BIPOC respondents were less likely to be aware of advisories. Educational efforts are needed to improve fish consumption habits.

Although workplaces are prime settings for health promotion, little is known about the implementation of policy, systems, and environmental (PSE) changes focused on chronic disease. PSEs have broader reach and are more sustainable than individual level strategies.

non-experimental, one group design with no control.

Setting: West Virginia, a state with significant chronic disease-related health disparities

Convenience sample of 27 workplaces, representing 6 industry types.

$1000 in micro funding awarded to workplaces to participate in Centers for Disease Control and Prevention (CDC) Work@Health®/ScoreCard, and implement PSEs.

ScoreCard baseline results; post project survey results

Descriptive analysis of ScoreCard; survey responses coded into PSE and I (individual level strategies) categories; frequencies were calculated.

63% of the workplaces were very small (1-100 employees). Chronic disease-related organizational practices (ScoreCard) were minimal: nutrition (5/24), physical activity (7/22), diabetes (5/15), cholesterol (4/13), and high blood pressure (6/16). Workplaces reported a total of 95 PSEs: P-8, S-55, and E−32.

Policy change was the least frequently attempted and reported PSE strategy. More research with a stronger study design is needed to determine if (1) baseline organizational practices (Scorecard scores) improve, (2) PSEs (especially P) can be implemented without micro funding/TA, (3) workplace-type is related to use of the funds/TA, and (4) enacting PSE changes leads to healthier employees.

Assess family-level factors associated with childhood immunization schedule adherence.

Prospective cohort; Setting; The Healthy Start study enrolled 1,410 pregnant women in Denver, Colorado 2009-2014

Children with available vaccination data in medical records (0-6 years old)

Vaccine schedule completion and compliance

Logistic regression comparing family-level factors that differ based on vaccine schedule adherence

Most immunizations required in Colorado for school entry were below national completion goals with 61.8% of participants (n = 532/861) completing the full vaccination series. Most participants received the first dose of individual vaccines on time (73.5% - 90.7%), but fewer received all doses on time (21.0% - 39.5%). Factors associated with not completing the vaccination series (OR [95% CI]) included: in-utero exposure to cigarette smoke (1.97 [1.41, 2.75]), single parent household (1.70 [1.21, 2.38]), children identified as non-White (Hispanic 1.40 [1.01, 1.94]; Black 1.88 [1.24, 2.85]; Other 2.17 [1.34, 3.49]), mothers not working outside the home (1.98 [1.46, 2.67]), and household income <$70,000 per year (<$40,000 1.93 [1.35, 2.75]; $40,000-$70,000 1.64 [1.09, 2.46]). Conversely, families with more educated mothers (0.47 [0.29, 0.76]) and older parents (0.97 [0.94, 0.99]) were significantly more likely to complete the series.

These findings may help identify groups at risk of immunization schedule non-adherence and may be used to target education/advocacy campaigns to reduce hesitancy and increase access in these populations.

The purpose of this study was to evaluate a weekly school-based fruit and vegetable delivery via a mobile market on urban middle schoolers’ nutrition behaviors.

One-group, pretest-posttest design, quasi-experimental intervention in middle schoolers (6th-8th graders, N = 158) in Kansas City, MO

Weekly delivery of free produce via a mobile market over 12 weeks.

A self-administered survey to assess self-report consumption of fruits, vegetables, soda, and sports drinks.

Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were conducted to compare youth at baseline and 12 weeks.

More youth reported consuming fresh fruit (73.8% to 83.3%; χ² = 7.76, P = .005) and vegetables (66.4% to 71.3%; χ² = 13.55, P = <.001) from baseline to follow-up. Less youth reported soda (49.0% to 52.8%; χ²= 6.33, P = .012) and sports drinks (41.8% to 38.2%; χ²= 12.32, P < .001) from baseline to follow-up.

A mobile produce delivery intervention, like the Healthy Harvest Mobile Market, may be an effective strategy to increase fruit and vegetable consumption for adolescents.

Perceived Social Support (PSS) can impact breastfeeding behaviors, and a lack of PSS potentially contributes to disparities in breastfeeding rates for African American women (AA). Objectives were to describe PSS at two timepoints and test associations between PSS and breastfeeding intensity for AA.

Data are from a feasibility trial of breastfeeding support among AA. The Hughes Breastfeeding Support Scale was used to measure PSS (Emotional, Informational, Tangible; total range = 30–120) in pregnancy (T1, n = 32) and early postpartum (T2, n = 31). Scale means were compared with t-tests. Associations between PSS at T1 and breastfeeding intensity (ie, quantitative measure of breastfeeding) were assessed with linear regression.

Total PSS (mean ± SE) was high at both time points (T1 = 90.5 ± 4.8; T2 = 92.8 ± 3.1). At T2, older participants or those living with a partner had higher total PSS scores compared to those younger or living alone. Emotional PSS was significantly higher at T2 than T1 with no differences in tangible or informational PSS over time. Mixed-feeding, exclusive breastfeeding, and exclusive formula feeding was distributed at 39%, 32%, and 29%, respectively. Total PSS was not associated with breastfeeding intensity.

Women reported high levels of social support, and emotional PSS increased over time in this small sample of AA. PSS and sources of PSS are understudied, especially among AA, and future studies should explore quantitative methods to assess PSS. The results of such assessments can then be used to design breastfeeding support interventions.

Physical activity interventions are potential strategies to enhance psychosocial health of children and adolescents. Interventions are performed at diverse settings (e.g., school, home, community), but little research has addressed whether and how the effectiveness of these programs vary by setting type. The aim of this review is to summarize the psychosocial effects of physical activity programs for preschoolers, children, and adolescents at various intervention settings.

A systematic search of five electronic databases, MEDLINE-PubMed, CINAHL, PsycINFO, CENTRAL, and Scopus was performed.

Included studies had participants between 3-18 years, physical activity intervention duration of at least four weeks, experimental design, and at least one psychosocial health outcome.

Data on participants, intervention, comparison, outcomes, and findings were extracted.

Data were synthesized by the intervention setting; school, home, and community.

Of the thirty-five included studies, 74% were performed at schools. Although fewer studies used community (17%)- and home-based (9%) interventions, these were similarly effective in improving psychosocial health as school-based interventions.

Community- and home-based intervention settings may be underutilized despite being similarly effective as school-based settings. A large proportion of time is spent out of school during weekends and summer-break. Community- and home-based physical activity programs may be pragmatic strategies to deliver improvements in psychosocial health of preschoolers, children, and adolescents.

To appraise and synthesize evidence on the effects of health coaching as the primary intervention on cardiometabolic health among middle-aged adults.

Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, PubMed, and the Cochrane library) were searched from inception until July 2021.

Randomized controlled trials and controlled clinical trials published in English, reporting health coaching aimed to promote behavioral changes for improving cardiometabolic health among middle-aged adults were included. Studies on health coaching as secondary intervention were excluded.

Two reviewers selected the articles, appraised the study quality, and extracted data independently. All kinds of outcomes related to cardiometabolic health, including health behaviors, psychological and physiological outcomes, were included.

Meta-analysis was performed if three or more studies reported the same outcomes. Narrative synthesis was performed if pooling of data for meta-analysis was not feasible.

Eight studies were reviewed. Most studies involved substantial risk of bias. The majority of the participants were women (99.1%). Meta-analysis showed a small but significant effect of health coaching on increasing physical activity (SMD = .34, 95% CI = .08–.60, p = .01, I² = 0%); however, its effect on perceived barriers to physical activity and depressive symptoms was nonsignificant. Narrative synthesis yielded inconsistent results on diet, smoking, anxiety, goal achievement and self-efficacy for behavioral change, physiological outcomes, and metabolic syndrome severity, and nonsignificant effects on alcohol consumption, sleep quality, perceived benefits of physical activities, and cardiovascular symptoms.

Health coaching has significant effects on increasing physical activity among middle-aged adults; however, its effects on health behaviors and risk factors related to cardiometabolic health are inconclusive. Further efforts are warranted to examine how health coaching can improve cardiometabolic health among middle-aged adults.