American Journal of Health Promotion

The concept of self-efficacy is a determining factor in many behaviours related to health promotion and health education. Several pilot studies have been conducted in different parts of the world on different populations regarding the impact of training based on the Pender Health Promotion Model on self-efficacy, yielding conflicting results. Therefore, the present systematic review and meta-analysis were conducted with the aim of evaluating and summarizing the results of studies on the impact of training based on the Pender Health Promotion Model on self-efficacy.

MagIran, SID, PubMed, Embase, Web of Science (WoS), Scopus and Google Scholar.

Original scientific research articles; Interventional studies; Studies investigating the effects of education based on the Pender Health Promotion Model on self-efficacy; Studies irrelevant to the objective; Cross-sectional studies; case reports; and papers presented in conferences; letters to the editor; systematic and meta-analysis studies.

Two independent reviewers extracted data and assessed the quality of the 18 included studies using a pre-prepared checklist for the systematic review and meta-analysis process.

We conducted meta-analyses and reported the characteristics, outcomes, and risk of bias of studies.

The present study was conducted according to PRISMA guidelines until December 2022. The quality assessment of the included articles for meta-analysis was performed using the JBI checklist. Heterogeneity of the studies was calculated using the I ² statistics, and Egger's regression intercept was used to assess publication bias.

In the initial search, 13,943 studies were found, and after excluding studies irrelevant to the research objective, a total of 18 articles were included in the meta-analysis. These articles represented a sample size of 1015 individuals in the intervention group and 999 individuals in the control group. The combined results of the studies showed a significant increase in self-efficacy in the intervention group when compared to the control group (1.788 ± .267; CI: 95%, P < .001). With an increase in the year of study and the quality assessment score of the articles, the effect of the intervention decreased (P < .001).

The results of this study indicated that training based on the Pender Health Promotion Model significantly increased self-efficacy. Therefore, it seems that training based on this model can have positive effects on individuals' self-efficacy.

This study examines the pathways through which e-cigarette users’ awareness of the truth® campaign influences e-cigarette use frequency over time.

Data included four waves (2020–2023) of the Truth Longitudinal Cohort, a probability-based, nationally representative survey.

The analytic sample was 15-24-year-olds who reported current e-cigarette use at baseline (N = 718). Wave-by-wave retention rates were 64% to 69%.

Respondents’ cumulative awareness of truth® ads was calculated (Waves 1–2). Strength of agreement with campaign-targeted attitudes was measured on five-point scales (Wave 2). The outcome was change in the 4-level frequency of e-cigarette use (Waves 2–4).

Latent growth structural equation modeling examined the pathway from cumulative ad awareness to the frequency of e-cigarette use via campaign-targeted attitudes.

Model fit estimates identified a three-step pathway by which awareness of the campaign reduced e-cigarette use. Ad awareness was significantly associated with stronger campaign-targeted attitudes: perceived risk (β = .20, P < .0001); anti-vape industry (β = .13, P = .003); independence from addiction (β = .13, P = .004); and affinity with groups that reject vaping (β = .18, P < .0001). Each attitude was significantly associated with stronger perceived norms against e-cigarette use (respectively: β = .25, P < .0001; β = .15, P < .0001; β = .12, P = .018; β = .27, P < .0001). Perceived norms against e-cigarette use had a significant negative relationship with growth in e-cigarette use frequency over time (β = −.23, P < .0001).

Greater truth® anti-vaping ad awareness strengthens campaign-targeted attitudes among current users, increasing perceived norms against e-cigarette use and reducing use over time.

The Sustainable Culturally Adapted Nutrition Program (SCAN) is a novel adaptation to the National Diabetes Prevention Program (NDPP) that aims to improve attendance and effectiveness. This paper presents its feasibility and impact through the initial 6-month outcomes.

A pragmatic quasi-experimental pilot study with intervention (DPP plus SCAN) and control (DPP only) groups.

Sustainable Culturally Adapted Nutrition Program participants were recruited from federally qualified health center (FQHC) clinic patients enrolled in a NDPP in Houston, Texas. Participants needed to be (1) ≥18 years old, (2) body mass index >25, (3) no prior diagnosis of diabetes, and (4) not pregnant.

Sustainable Culturally Adapted Nutrition Program cooking classes were designed to teach skills to prepare fresh produce, and utilized Motivational Interviewing (MI) techniques to encourage participants to adapt these skills for foods that were culturally important to them.

(1) National Diabetes Prevention Program attendance, (2) BMI and (3) percent weight loss.

We used linear mixed models to test the association between weights and NDPP attendance.

22 intervention and 15 control participants completed the program to the 6-month point. Intervention participants had increased DPP attendance over controls (7.14 vs 6.87 session). Intervention participants also demonstrated on average, 1.5% weight loss for each additional SCAN class attended (P = .144).

The SCAN adaptation shows promising results for effectively increasing both NDPP attendance and weight loss.

Examine trust in sources of COVID-19 information and vaccination status.

Cross-sectional.

Chicago, Illinois.

Convenience sample of 538 Black adults surveyed between September 2021 and March 2022.

Trust in sources of COVID-19 information, COVID-19 vaccination.

Using latent class analysis, we identified classes of trust in sources of COVID-19 information. We considered predictors of class membership using multinomial logistic regression and examined unadjusted and adjusted associations between trust class membership and COVID-19 vaccination while accounting for uncertainty in class assignment.

Our analytic sample (n = 522) was predominantly aged 18-34 (52%) and female (71%). Results suggested a four-class solution: (1) low trust, (2) high trust in all sources, (3) high trust in doctor and government, and (4) high trust in doctor, faith leader, and family. Unadjusted odds of vaccination were greater in the high trust in all sources (OR 2.0, 95% CI 1.2-3.2), high trust in doctor and government (OR 2.7, 95% CI 1.4-5.3), and high trust in doctor, faith leader, and family classes (OR 2.1, 95% CI 1.2, 3.9) than the low trust class. However, these associations were not significant after adjustment for sociodemographic and health status factors.

Although COVID-19 vaccination varied across trust classes, our adjusted findings do not suggest a direct association between trust and vaccination, reflecting complexities in the vaccine decision-making process.

To describe healthcare experiences and health outcomes among rural LGBTQ + individuals.

2022 cross-sectional survey.

Southern Illinois.

85 individuals.

Demographics, sexual orientation and gender identity, healthcare experiences, health outcomes.

Experiences and outcomes were assessed vs orientation and identity. Distribution comparison was by t-test and chi-square, risk prediction by logistic regression, and significance assumed at P < .050.

By orientation, participants were: 35.3% gay, 16.5% lesbian, and 45.8% bisexual plus; and by identity they were: 49.4% cisgender, 25.9% transgender, and 24.8% other identity. Survey item responses ranged from 95%-99%. Compared to gay men, lesbians and bisexual plus individuals more frequently reported medical bill payment difficulty (58.3% and 57.9% vs 25.0%; P = .020) and more past month days of poor mental health (19.4 and 15.8 vs 10.6; P = .018). Compared to heterosexual and other identity, transgender individuals less frequently reported having a routine medical provider (72.7% vs 92.7% and 95.0%; P = .037) and more frequently reported past healthcare denial (45.5% vs 17.5% and 18.8%; P = .042). Current health was associated with medical bill payment ability (OR = .33, 95% CI = .13-.86) and respectful treatment by healthcare administrators (OR = 3.90, 95% CI = 1.34-11.35) and clinicians (OR = 3.82, 95% CI = 1.39-10.47). Significance of some findings likely limited due to sample size.

Our data describes healthcare experience and health outcome disparities among rural lesbian, gay, bisexual, transgender, queer and other sexual and gender minority individuals, and indicate that clinical experiences directly influence health outcomes.

To examine associations between time perspective and health promotion behaviors of physical activity and weight management.

Quantitative cross-sectional.

This study is part of the Betula project on aging, memory, and dementia in Northern Sweden.

417 older adults aged between 55 and 85 years.

Swedish-Zimbardo Time Perspective Inventory; Physical Activity in the past year, past week, and in comparison with others of similar age; Weight Management = Body Mass Index (BMI; kg/m²).

After controlling for age, sex, and years of education, hierarchical linear regression indicated a Balanced Time Perspective was significantly associated with more physical activity in the past year (P = .04), the past week (P < .001), and in comparison with others (P < .01). Past Negative time perspective was associated with less physical activity in the past year (P = .03), and in comparison with others (P = .03). Present Fatalistic was associated with less physical activity during the past week (P = .03), and in comparison with others (P = .01). Present Hedonistic was associated with more physical activity the past week (P = .03), and in comparison with others (P = .03). Past Negative was associated with higher BMI (P = .02), and Future Negative were associated with lower BMI (P = .01). Taken collectively, greater positivity and flexibility across time perspectives was associated with more physical activity, whereas negative oriented time perspectives related with less physical activity and poorer weight management.

Time perspective can be associated with health behaviors in older adults and have implications for health across the lifespan. Health promotion interventions may target older adults’ enjoyment of exercise and weight management in the present, rather than highlight potential negative health outcomes in the future.

To examine whether local blue and green space access was associated with weekly physical activity frequency during the COVID-19 pandemic.

Cross-sectional.

Population-based, nationally representative sample of U.S. adults (May and June 2021).

Adults, ages 18-94 (N = 1,771).

Self-reported data included the presence of blue spaces (e.g., lakes, outdoor swimming pools, riverside trails) and green spaces (e.g., parks, forests, or natural trails) in their neighborhoods, and days of physical activity per week (e.g., running, swimming, bicycling, lifting weights, playing sports, or doing yoga).

Multiple Poisson regression assessed relationships between blue and green spaces and physical activity, with coefficients transformed into incidence risk ratios (IRR).

Among participants, 67.2% reported living near a blue space and 86.1% reported living near a green space. Racial/ethnic and socioeconomic disparities in access to blue and green spaces were observed, with less access among non-Hispanic Black participants and those with lower income and educational attainment. Living near blue (IRR = 1.23, 95% CI = 1.10, 1.39) or green space (IRR = 1.25, 95% CI = 1.02, 1.54) was significantly associated with more frequent weekly physical activity.

Proximity to blue or green spaces is associated with more frequent physical activity during the COVID-19 pandemic. Health promotion efforts should include equitable strategies to improve accessibility to blue and green spaces.

Hypertension-related knowledge, attitude and practice (KAP) of hypertensive patients can affect the awareness, treatment and control of hypertension. However, little attention has been paid to the association between the change of hypertension preventive KAP and blood pressure (BP) control in occupational population using longitudinal data. We assess the effectiveness of a workplace-based multicomponent hypertension intervention program on improving the level of KAP of hypertension prevention, and the association between improvement in KAP and BP control during intervention.

From January 2013 to December 2014, workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20) using a cluster randomized control method. All employees in each workplace were asked to complete a cross-sectional survey to screen for hypertension patients. Hypertension patients in the intervention group were given a 2-year workplace-based multicomponent hypertension intervention for BP control. The level of hypertension prevention KAP and BP were assessed before and after intervention in the two groups.

Overall, 3331 participants (2658 in the intervention group and 673 in the control group) were included (mean [standard deviation] age, 46.2 [7.7] years; 2723 men [81.7%]). After 2-year intervention, the KAP qualified rate was 63.2% in the intervention groups and 50.1% in the control groups (odds ratio = 1.65, 95% CI, 1.36∼2.00, P < .001). Compared with the control group decreased in the qualified rate of each item of hypertension preventive KAP questionnaire, all the items in the intervention group increased to different degrees. The increase of KAP score was associated with the decrease of BP level after intervention. For 1 point increase in KAP score, systolic blood pressure (SBP) decreased by .28 mmHg and diastolic blood pressure (DBP) decreased by .14 mmHg [SBP: β = -.28, 95%CI: −.48∼-.09, P = .004; DBP: β = −.14, 95%CI: −.26∼-.02, P = .024]. SBP and DBP was significantly in manual labor workers (SBP: β = −.34, 95%CI: −.59∼-.09, P = .008; DBP: β = −.23, 95%CI: −.38∼−.08, P = .003), workers from private enterprise, state-owned enterprise (SOE) (SBP: β = −.40, 95%CI: −.64∼−.16, P = .001; DBP: β = −.21, 95%CI: −.36∼−.06, P = .005) and a workplace with an affiliated hospital (SBP: β = −.31, 95%CI: −.52∼−.11, P = .003; DBP: β = −.16, 95%CI: −.28∼−.03, P = .016). The improvement of knowledge (SBP: β = −.29, 95%CI: −.56∼−.02, P = .038; DBP: β = −.12, 95%CI: −.29∼.05, P = .160), as well as attitude (SBP: β = −.71, 95%CI: −1.25∼−.18, P = .009; DBP: β = .18, 95%CI: −.23∼.59, P = .385) and behavior (SBP: β = −.73, 95%CI: −1.22∼−.23, P = .004; DBP: β = −.65, 95%CI: −.97∼−.33, P < .001) was gradually strengthened in relation to BP control.

This study found that workplace-based multicomponent hypertension intervention can effectively improve the level of hypertension preventive KAP among employees, and the improvement of KAP levels were significantly associated with BP control.

Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

The purpose of this study was to evaluate the effectiveness of the WISE (Women in the South-East) Telehealth Network.

A follow-up survey design was used to determine the impact of the program on access to healthcare.

WISE provided preventive care to women and gender expansive people at local libraries and the Mobile Library in the rural South Carolina Lowcountry.

In 1 year (February 2021-2022), WISE reached 523 individuals with 151 agreeing to participate in the study. Most participants identified as white (66%) or Black (22%).

A Community Health Worker provided health education, connection to telehealth services, referrals, and connected individuals with community and social services.

The Telehealth Usability Questionnaire (TUQ), changes in knowledge, satisfaction with WISE, Acceptability of Intervention measure (AIM), and sociodemographic characteristics.

Participants with a high telehealth usability score were significantly more likely to be under the age of 35 (OR 4.60 [95% CI 1.21-17.52]), married (OR 10.00 [95% CI 2.19-45.64]), or white (OR 4.00 [95% CI 1.06-15.08]). The intervention earned a high acceptability score 4.46 (± .61)/5.0 by helping participants obtain necessary medical care and resources, as well as meeting their educational needs.

This study offers practical suggestions to expand the use of telehealth initiatives to improve health outcomes by engaging libraries in rural communities.

Examine possible message topics to promote rural vaccination using psychosocial antecedents of vaccination.

Cross-sectional survey administered by Research America, Inc.

West Virginia (WV).

756 WV adults via convenience sample (n = 370; ∼2% response rate from online panel of ∼20 000 WV residents), and random digit dial of landlines (n = 174; ∼1% response rate from 18 432 numbers) and cellphones (n = 212; ∼1% response rate from 20 486 numbers).

Outcome measures included self-reported vaccination intention and behavior. Predictor measures, rooted in theories of social and behavioral science that have been found to be predictive of vaccination outcomes (i.e., Reasoned Action Approach, Extended Parallel Process Model), included perceived severity and susceptibility, negative affect, instrumental and affective attitudes, social norms, self-efficacy, response efficacy, and perceived control.

Multivariate linear regression for intention and logistic regression for behavior.

Intention was positively predicted by affective attitude, β = .30, P < .05, instrumental attitude, β = .19, P < .05, response efficacy, β = .19, P < .05, negative affect, β = .16, P < .05, self-efficacy, β = .13, P < .05, and subjective norm, β = .13, P < .05, F(10, 267) = 30.12, Adj. R² = .53. Vaccination status was predicted by instrumental attitude, exp(B) = 2.09, and subjective norm, exp(B) = 2.00, Pseudo R² = .29, log likelihood = 125.11, χ²(10) = 38.34, P < .05. Promising message targets were instrumental attitude, M = 3.21, SD = 1.46, and subjective norms, M = 3.76, SD = 1.71.

COVID-19 vaccine confidence messages should address (1) positive feelings and safety perceptions, (2) vaccination’s effectiveness in preventing serious COVID-19, and (3) subjective vaccination norms.

Evidence suggests that sedentary behavior is increased among those with mobility impairment, but the evidence examining the impact of social support networks (SSN) on this relationship remains limited. This study examines the relationship between SSN and sedentary behavior among adults with and without mobility impairment.

Cross-sectional.

National Health and Nutrition Examination Survey (NHANES) 2007-2008.

U.S. adults (≥40 years of age) with (n = 962) and without (n = 1393) mobility impairment.

The Social Support Network (SSN) score was created using self-reported emotional, financial, church, friends, and marital support/status. The dependent variable in this study was the upper quartile of sedentary time in minutes.

Both higher SSN score (AOR .43; 95% CI 0.25-.76, P = .045) and poverty to income ratio (PIR) (AOR 2.60; 95% CI 1.40-4.82, P = .01) were significant predictors of increased sedentary time among adults with mobility impairment. Among adults without mobility impairment, higher PIR was the only significant predictor of increased sedentary time (OR 3.59; 95% Cl 1.80-7.15, P < .0001).

Higher SSN score was associated with significantly lower odds of increased sedentary time among adults with mobility impairment. A similar relationship was not revealed among adults without mobility impairment. Higher PIR was associated with significantly higher odds of increased sedentary time among adults with and without mobility impairment.

To examine the effect of e-cigarette warning labels (EWLs) prior to the August 2018 FDA-warning label mandate to establish a baseline for future research.

Cross-sectional survey.

United States.

A cohort of adult participants in the Population Assessment of Tobacco and Health (PATH) study (n = 30,004) at Wave 4 (Dec 2016-Jan 2018).

Correlates (e.g., sociodemographics, substance use, social influence, cigarette warnings, and mental health) of noticing EWLs in the past 30-days (noticed vs did not notice), perceived harm of e-cigarettes/nicotine (from 1 = not at all harmful to 5 = extremely harmful), relative harm of e-cigarettes (from 1 = less harmful to 3 = more harmful than cigarettes), intention to quit (yes/no) and intention to try e-cigarettes (from 1 = definitely not to 4 = definitely yes).

The prevalence of noticing EWLs was 22.1%. Those who currently use electronic nicotine products, established and experimentally, were more likely to notice EWLs relative to never users (aOR = 3.55; 95% CI: 2.96-4.25; P < .001 and aOR = 2.42; 95% CI: 1.88-3.10; P < .001, respectively). Those with past 30-day alcohol and cigarette use were less likely to notice EWLs (aOR = .27; 95% CI: .24-.31 and aOR = .91; 95% CI: .83-.99; respectively). Those who noticed cigarette warnings were more likely to notice EWLs (aOR = 12.00; 95% CI: 10.46-13.77; P < .001). Among those who noticed EWLs, there were higher odds of perceiving e-cigarettes to be equally or more harmful than cigarettes (aOR = 1.15; 95% CI: 1.02-1.30), but no association was found between noticing EWLs and perceived harm of e-cigarettes/nicotine or use intentions.

Noticing voluntary EWLs was not associated with increased perceived harm of e-cigarettes and nicotine harm, or e-cigarette use intentions. Future research is warranted to examine the effect of the FDA mandated EWLs.

This study evaluated the impact of obesity on cardiometabolic risk factors (CRF) interrelationships and predictive efficiency of CVD development in older African (AA) and European Americans (EA).

A comparative research design evaluated CRF risk profile differences between participant groups.

Seven neighborhoods in a southern US city.

A sample of 179 older AA (n = 128) and EA (n = 51) adults.

Non-fasting blood samples were evaluated for lipids and lipoproteins, glycosylated hemoglobin, systolic –(SBP) and diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF%) and physical function.

Data were analysis with descriptive statistics, t-tests, and correlations.

AA were heavier than EA although all had above average age-appropriate fitness. Means and relationships between CRF and other variables were different (P < .05) based on race. Both AA (41.3 + 5.8) and EA (38.6 + 6.4) BF% were CRF risks. Holding BMI constant, CRF were generally not related, and the relationships were different for AA and EA. AA had a range of 13.0 to 27.2% more favorable values for cholesterol, HDL-C, and triglyceride. EA had favorable A1c (EA 5.8 vs AA 6.2%) values.

A limitation of this report is the small sample size. Although further research is warranted, these findings suggest population specific CRF selections would improve CVD prediction in AA.

To conduct a systematic review and meta-analysis to verify the association between smartphone/tablet exposure and physical activity and sleep in children from 5 to 10 years old. Data Source: This study followed the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and included studies that met eligibility criteria based on the “PECO” strategy: participants (children from 5 to 10 years old), exposure (smartphone and tablet use), and outcome (physical activity and sleep).

The inclusion criteria were observational studies published in indexed scientific journals and written in Portuguese, English, and Spanish that verified the association of exposure to smartphones/tablets with physical activity and sleep in children aged 5 to 10 years of both sexes. Studies were considered eligible only if they met the previous criteria. Data Extraction: The search was conducted in January 2023 on databases from electronic journals without the restriction of the period. To meta-analyze were extracted and grouped using models of fixed and random effects, the coefficients Odds Ratio (OR), Beta (β), Standard Error (SE), and Confidence Intervals of 95% (95%CI). Data Synthesis: 2396 potentially relevant papers were identified, and 17 met the inclusion criteria.

It can be verified that there was an inverse association between smartphones with physical activity and sleep. Studies indicate that for every additional hour of smartphone and tablet use, sleep can be expected to decrease by an average of 11 minutes (β = − 0.11; 95%CI = −0.13; −0.09). Children using smartphones and tablets were 1.79 times (OR = 1.79; 95%CI = 1.72-1.86) more likely to have shorter sleep duration and 1.53 times (OR = 1.53; 95%CI = 1.41-1.65) more likely to have worse sleep quality. Children with shorter smartphone and tablet usage were 1.19 times more likely to be active (OR = 1.19; 95% CI = 1.03-1.37).

Children of 5 to 10 years who are more often exposed to smartphones and tablets are prone to have worse quality and quantity of sleep, as well as less practice of physical activity. Health promotion actions can be encouraged based on the results, aiming to reduce the use time of these devices and improve children’s health and quality of life.

To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs).

An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco).

Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English.

The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc).

Due to heterogeneity across studies, studies were synthesized qualitatively (narratively).

Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention.

Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.