American Journal of Health Promotion

This study estimated mandated physical education (PE) and physical activity (PA) time stipulated by state laws in public schools across the 50 States and the District of Columbia, and compared these times between states with and without specified mandates across education levels.

Descriptive research.

State PE and PA regulation across 50 States and the District of Columbia.

Regulations were sourced from the School Health Policy Database developed by the National Association of State Boards of Education, Nexis Uni academic research database, Casetext, and state government websites.

Frequency analysis and two-way analysis of variance were used to compare estimated PE and PA time between states with and without specific mandates.

Across education levels, only 25.5% of the states mandated specific PA/recess time, 74.5% did not. About 51.0% mandated specific PE time, 45.1% mandated PE without specifying time, and 3.9% did not mandate PE. States with specified mandated PE and PA time averaged 76.54 and 131.41 minutes per week, respectively, showing significantly higher estimated PE and PA (P < 0.001) time compared to states without such mandates.

Many states mandate specific PA or PE times, but the average mandated time is significantly below the recommended 60 minutes of daily PA for school-aged children. This highlights the need to reassess current legislation to align with established recommendations.

Examine whether baseline participant characteristics predict engagement in a movement-based RCT for chronic low back pain (CLBP).

Longitudinal study within an RCT.

Online.

138 individuals with CLBP (18-79 years).

Participants were randomized to a 12-week intervention of twice-weekly synchronous online yoga OR stretching/strengthening classes, and received 20-min pre-recorded home videos to complete daily.

Baseline questionnaires assessed sociodemographic, psychosocial, and pain factors (100% response rate). Engagement was operationalized as minutes of class attended + minutes of home videos completed.

Bivariate correlations were computed between baseline variables and engagement. Three multivariate negative binomial generalized linear models (GLMs) were constructed to simultaneously examine predictors of engagement in the domains of sociodemographic, psychosocial, and pain-related factors. Greater engagement was significantly associated with greater baseline age, educational attainment, energy, and emotional well-being, and less emotion regulation difficulties, cannabis use problems, and pain interference (|rs| = .19-.33). In the domain specific GLMs, education (B = .491, P = .017) and cannabis use problems (B = −.048, P = .027) were the only significant predictors in the sociodemographic and psychosocial models, respectively. Neither pain interference nor pain severity were significant in the pain model.

Factors identified can inform strategies to increase engagement in movement-based CLBP interventions, potentially improving research validity and outcomes. Limitations include lack of racial diversity and not testing how engagement fluctuates throughout the intervention.

Social support, particularly from family, is crucial for physical activity (PA) among youth. This study examined the association between father support and moderate-to-vigorous physical activity (MVPA) in Latina pre-teens and explored the moderating role of body mass index (BMI).

Cross-sectional analysis.

Baseline data from a pilot randomized controlled trial in San Diego County.

Sixty Latina pre-teen girls aged 8-11 years.

Girls’ MVPA was measured via accelerometry. An exploratory factor analysis created a composite measure of father support, reported by mothers.

Hierarchical linear regression models, adjusting for covariates, assessed the relationship between father support and MVPA. Interaction models tested the moderating effect of BMI z-score (zBMI).

Father support was significantly associated with MVPA (b-range = 0.07 to 0.08, 95%CI = 0.02, 0.13) after adjusting for age, income, acculturation, and maternal support. However, this association became non-significant with the inclusion of zBMI (b = 0.06, 95%CI: −0.01, 0.11). The interaction model showed a significant positive association between father support and MVPA among girls with a healthy weight (b = 0.27, 95%CI: 0.27, 2.68) but not among those with overweight/obesity (b = 0.95, 95%CI: −0.38, 2.28).

Our findings indicate a potential association between father support and daughters’ MVPA among girls with a healthy weight. Further research is needed to understand why this association is not observed in girls with overweight/obesity.

Artificially Intelligent (AI) chatbots have the potential to produce information to support shared prostate cancer (PrCA) decision-making. Therefore, our purpose was to evaluate and compare the accuracy, completeness, readability, and credibility of responses from standard and advanced versions of popular chatbots: ChatGPT-3.5, ChatGPT-4.0, Microsoft Copilot, Microsoft Copilot Pro, Google Gemini, and Google Gemini Advanced. We also investigated whether prompting chatbots for low-literacy PrCA information would improve the readability of responses. Lastly, we determined if the responses were appropriate for African-American men, who have the worst PrCA outcomes.

The study used a cross-sectional approach to examine the quality of responses solicited from chatbots.

The study did not include human subjects.

Eleven frequently asked PrCA questions, based on resources produced by the Centers for Disease Control and Prevention (CDC) and the American Cancer Society (ACS), were posed to each chatbot twice (once for low literacy populations). A coding/rating form containing questions with key points/answers from the ACS or CDC to facilitate the rating process. Accuracy and completeness were rated dichotomously (i.e., yes/no). Credibility was determined by whether a trustworthy medical or health-related organization was cited. Readability was determined using a Flesch-Kincaid readability score calculator that enabled chatbot responses to be entered individually. Average accuracy, completeness, credibility, and readability percentages or scores were calculated using Excel.

All chatbots were accurate, but the completeness, readability, and credibility of responses varied. Soliciting low-literacy responses significantly improved readability, but sometimes at the detriment of completeness. All chatbots recognized the higher PrCA risk in African-American men and tailored screening recommendations. Microsoft Copilot Pro had the best overall performance on standard screening questions. Microsoft Copilot outperformed other chatbots on responses for low literacy populations.

AI chatbots are useful tools for learning about PrCA screening but should be combined with healthcare provider advice.

This study explored the association between diabetes education and self-management during different COVID-19 periods.

Cross-sectional study.

Korea Community Health Survey (2019, 2021, and 2022) and the data from Korea Centers for Disease Control and Prevention Agency.

78, 860 individuals with diabetes who participated in the 2019, 2021, and 2022 KCHS.

Diabetes education was categorized according to whether individuals received education on how to manage the disease. Diabetes self-management was assessed using self-checking and screening of HbA1c levels.

Multiple logistic regression analysis and a subgroup analysis examined the regional impact of COVID-19 on this association.

Participants who received education before and after COVID-19 were more likely to self-manage their diabetes than those without education (pre-COVID-19 aOR = 2.11, post-COVID-19, 2022 aOR = 2.04, and post-COVID-19, 2021 aOR = 1.94). Those in regions with lower COVID-19 incidence had slightly higher self-management rates (pre-COVID-19 aOR = 2.37; post-COVID-19 2022 aOR = 2.33; post-COVID-19 2021 aOR = 2.02) compared to participants in high-incidence regions (pre-COVID-19 aOR = 1.96; post COVID-19 2021 aOR = 1.89 and post COVID-19 2022 aOR = 1.89).

Diabetes education has a positive impact on self-management, which is especially important during public health crises such as the COVID-19 pandemic.

Targeting cardiovascular fitness (CVF), rather than weight loss, may be a more acceptable and feasible outcome among Latinos.

The purpose of this study was to test the short-term efficacy of Athletes for Life (AFL), a fitness- and lifestyle-focused behavioral intervention to improve CVF and performance among Latino families.

Latino parent-child dyads (n = 137) were randomized to either AFL program or a waitlist control condition. AFL consisted of 24 group family-based, nutrition and sport/fitness oriented 90-minute sessions (twice-weekly). Measures included 1-mile run/walk time, three-minute step test, accelerometer-measured physical activity, body mass index (BMI), waist circumference, DEXA-measured % body fat, cardiometabolic risk biomarkers, and sociodemographic characteristics. Group differences at post-intervention were tested using ANCOVA analyses adjusting for outcome values at baseline and demographic variables.

Parents were primarily female (93%), aged 38.3 ± 6.9 years, and 96% Latino and children were 8.8 ± 1.7 years old and 58% female. Intervention participants showed significantly faster adjusted post-intervention 1-mile run/walk times compared to control group participants (difference of −76.6 seconds P < 0.01 and −44 seconds P = 0.04, respectively). Parents also showed a significantly higher adjusted relative VO₂ max (ml/kg/min) compared to control group parents (43.91, SE = 0.41 vs 42.93, SE = 0.44, respectively, P < 0.01). There were no significant post-intervention group differences on physical activity, BMI, waist circumference, % body fat or cardiometabolic biomarkers P > 0.05.

The AFL program successfully improved aerobic performance among underserved Latino families with no observable changes in adiposity. These results support that fitness may be a more viable and acceptable outcome among Latino families than weight loss.

Asian and pacific region countries are considered to be high risk countries for Human Immunodeficiency Viruses (HIV). There is little literature quantifying the relationship between education of HIV/AIDS and its principal socioeconomic determinants through a spatial analysis. The purpose of this study was to assess the knowledge and awareness about HIV among the women in Thailand, and its direct and indirect association with sociodemographic factors including sexual education, level of education, area of living and wealth index through a structural equation modelling approach.

Cross-sectional analysis using data from the 2022 UNICEF Multiple Indicator Cluster Survey (MICS).

Thailand.

A total of 3671 women from the 2022 MICS dataset.

Key variables included knowledge and misconceptions about HIV, sexual education, education level, area of residence, marital status, and wealth index.

Structural equation modeling was used to assess direct and indirect effects of sociodemographic factors on HIV-related knowledge and misconceptions.

The direct effect of sexual education on knowledge, transmission and misconception about HIV/AIDS is significant (β = 0.051, P = .002). The mediation effect test found that the sexual education and education indirectly affected knowledge, transmission and misconceptions about HIV/AIDS through the mediation effect of women’s marital status (β = −0.068, P = .018) and wealth index (β = 0.007, P = <.001).

Sexual education alone is insufficient to improve health literacy on HIV/AIDS, as other mediating factors such as education level, wealth index, marital status and area of residence are also key drivers. To achieve Sustainable Development Goal (SDG) 3 by 2030, it is essential to enhance HIV/AIDS related health education for women through multifaceted intervention programs that address these mediating factors.

Examining the associations between sleep duration and lifestyle risk factors and assessed whether sex modify such associations among U.S. adolescents.

Cross-sectional study among high school students from the 2015-19 national Youth Risk Behavior Survey.

US, national.

High school students grade 9-12 (n = 31 871).

Students reported hours of sleep on an average school night categorized into “less than 6 hours”, “6 to 7 hours” and “8 hours and more”. Lifestyle risk factors including physical inactivity, insufficient breakfast consumption, current tobacco use, and current binge drinking were self-reported and dichotomized.

Multivariable logistic regression models were used to estimate associations between sleep duration and lifestyle risk factors, adjusting for confounders.

Compared to students with 8 hours and more of sleep, students with 6 to 7 hours and less than 6 hours of sleep had 79% and 228% (P < .01) increased odds of insufficient breakfast consumption; and had 22% (P = 0.0014) and 74% (P < .01) increased odds of binge drinking, respectively. There is a significant interaction between sleep duration and sex (P < .05) for physical inactivity and current tobacco use.

Insufficient sleep is common among US adolescents and is associated with increased risks of multiple lifestyle risk factors, which suggests great needs for multilevel interventions to address sleep deprivation and promote good sleep hygiene among adolescents.

To examine associations between identified factors to accessing Food and Drug Administration-approved quit medication (FDAQM) and use among a sample of tobacco users.

Cross-sectional, online survey.

County in Central California.

Current adult tobacco users (n = 76).

Demographics self-reported likelihood of quitting in the next month, contacting a healthcare provider about quitting, time since last healthcare visit, provider asking about tobacco/nicotine use, provider advice to quit, provider FDAQM prescription and FDAQM use in the past year.

Logistic regression.

Those with a higher likelihood of quitting had a lower odds of FDAQM use (OR = 0.15, 95% CI = 0.03, 0.73) while those who had contacted a healthcare provider had a higher odds (OR = 15.39, 95% CI = 2.72, 87.05).

While the sample was limited, this research provides evidence in an understudied tobacco cessation area. More work is needed to understand the generalizability of these results and develop interventions that address these factors.

To investigate how media literacy and varied media consumption influenced substance use behavior.

A cross-sectional survey was conducted.

Online survey was conducted June 22-July 18, 2020, with quality checks.

The study recruited U.S. residents aged 18 and older who were proficient in English (N = 1264). Panel sampling using quotas reflecting U.S. census was employed as an alternative to random digit dialing sampling.

Substance use behavior, media literacy for news, liberal media use, conservative media use, social media use, and demographics were assessed.

Hierarchical multiple regression analysis was conducted. Media literacy for news was negatively associated with substance use (β = −.15, SE = .08, P < 0.01, [95% CI: −.36, .06]) and interaction effect between social media use and media literacy for news on substance use behavior was significant (β = .47, SE = .05, P = 0.02, [95% CI: .02, .20]) in the final model (F(12, 1207) = 33.21, R² = 25%).

Media literacy for news has a negative association with substance use behavior. Social media use, specifically, diminishes the effect of media literacy skills on substance use behavior. The prediction is based on correlational data. Further investigations are required to examine how individuals’ specific patterns of media use impact substance use behavior as part of media literacy intervention efforts.

Food pantries have provided nutrition education to promote healthy food choices with mixed outcomes. This study assessed the impact of Guided Stars food quality rating system to promote healthy food choices among food pantry clients.

Randomized parallel-group study with balanced randomization.

A client-choice food pantry in a midwestern city.

613 food pantry clients.

Clients were randomly assigned to a one-time treatment group (n = 330) where they received a nutrition information sheet with pantry foods ranked using the Guided Starts rating system, or a control group (n = 299) that did not receive this information.

Healthy food selection; food selection quality measured by a Healthy Index.

Multiple linear regression models to estimate the effect of the intervention on the food choices of the food pantry client, accounting for potential confounders.

Results showed a decrease (−.021, P < .05) in the selection of lower nutrition-rated food items, particularly among men.

Food-labeling nutrition education strategies could help promote healthy food choices at food pantries, especially among future-biased clients. However, an information-based intervention alone may not be enough to alter food choices in low-income populations.