PurposeTo visualize Triple Aim healthcare system performance according to cultural geography by mapping performance scores at the US county level.DesignCross-sectional, observational mapping of Triple Aim healthcare system performance for 2019.SettingUnited States of America at the county level.SampleData sources include healthcare system performance indicators of 3110 US counties for 2019. Data were mapped by aggregating county level Triple Aim performance scores according to the American Nations model. Regions with individualistic cultural ideologies and communitarian ones were grouped. Descriptive data for each were collated.MeasuresTriple Aim healthcare systems performance scores across US counties and aggregated across the American Nations.AnalysisDescriptive frequencies of adjusted performance scores are presented according to culturally distinct regional geographies.ResultsLarge heterogeneity in adjusted healthcare system performance scores was observed across the US and at the county level. For the American Nations (range = -1.43 to 0.16), population-weighted performance scores were highest for Greater Polynesia whereas First Nation scored the lowest. The 2019 mean (±SD) population-weighted performance scores for individualistic and communitarian American Nation region counties were -0.50 ± 0.83 and -0.36 ± 1.01, respectively.ConclusionVariation of healthcare system performance is large across US regions with distinct cultural phenotypes. Cultural geographies should be included as covariates in population-based analyses of healthcare system performance. Observed heterogeneity holds potential for identification of population-based health promotion opportunities at the county-level.
PurposeTo assess changes in publications of health behavior research in leading journals across a 20-years period.DesignSystematic comparative descriptive snapshot analysis of all primary research-based articles published in the 2003 and 2023 issues of five leading health behavior journals.SettingDocument review.SampleArticles (n = 1207) published in the following journals in 2003 and 2023: American Journal of Health Promotion, American Journal of Preventive Medicine, Annals of Behavioral Medicine, Health Education & Behavior, and Health Psychology.AnalysisT-tests and chi-squared tests were used to assess differences in publication characteristics between the 2 years.ResultsThe number of published studies more than doubled between the two time points. Significant changes were seen between the health behavior of interest, methodology, setting, and the use of large data sets.ConclusionsCompared to 2003, there were twice as many articles published in 2023. Sample sizes were larger, but cross-sectional studies still predominated. Theoretical frameworks have greatly expanded, and there were no clear preferred theories.Critical LimitationsPapers were only abstracted from five journals across 2 years. Comparisons of other journals and other volumes may yield different results.
PurposeTo compare employee and leadership perceptions of workplace culture of health (CoH) and health equity in a healthcare system.ApproachA qualitative approach was utilized to collect insights through interviews with leaders and focus group discussions with low-wage employees.SettingA mid-Atlantic healthcare system.ParticipantsThis study includes interview participation from 19 leaders ranging from mid-level managers to executive leadership, and focus group participation by 61 low-wage employees from departments including environmental services, security, clinical services, and administrative support.MethodData were collected through semi-structured interviews and focus group discussions. Thematic analysis was used to identify themes regarding perceptions of Culture of Health (CoH), health equity, and barriers to health and well-being (HWB).ResultsLeaders emphasized a holistic approach to HWB and generally focused on health equity in patient services vs employee HWB. Low-wage employees were largely unaware of the terms CoH and health equity, and described "not feeling valued" and a lack of connection with organizational values. Leadership noted barriers to operationalizing equitable HWB, including siloed organizational structures and limited data. Communication challenges between leaders and employees were a significant contributor to the apparent disconnect.ConclusionHealth equity should be a foundational consideration for organizational CoH activities. Organizational efforts to address communication barriers can help to ensure that organizational vision and goals are effectively conveyed and demonstrated to low-wage employees.
PurposeHealth & Wellness Coaching is a promising health promotion intervention for patients with complex clinical needs. This study aimed to explore patterns and predictors of coaching use among patients with chronic obstructive pulmonary disease (COPD) receiving care from the U.S. Veterans Health Administration (VA).DesignRetrospective cohort study using VA's electronic health records (EHR).Sample400 829 patients with COPD receiving VA care during 2021-2023.MeasuresGeographic, demographic, and clinical characteristics associated with coaching use.AnalysisMixed effects logistic regression models to examine predictors of coaching use.ResultsNationally, 4.4% of VA patients with COPD used coaching at least once during the study period. Use of coaching was highly concentrated at select sites, with half of all coaching users receiving care at only 13 VA Medical Centers. Intensive coaching use was limited, with less than 6% of users receiving the recommended 8+ sessions (median = 4.4 sessions). The demographic characteristic most strongly associated with coaching use was being female (OR = 1.64; 95% CI:1.54-1.74). Other demographics significantly associated with coaching use were being Black, Hispanic/Latino, and not married. Being older and living in a rural area were inversely associated with coaching use. Polypharmacy was the clinical characteristic most strongly associated with coaching use (OR = 1.73, 95% CI: 1.62-1.84). Other statistically significant associations with coaching use were obesity, chronic pain, mental health diagnoses, substance use disorders, and smoking were. Prior COPD-related hospitalizations were not significantly associated with using Coaching.ConclusionAn array of geographic, socio-demographic, and clinical characteristics and patterns associated with coaching use among VA patients with COPD may indicate opportunities for improving coaching implementation. VA and other health systems may consider identifying, strengthening, and diversifying pathways through which patients with complex chronic conditions get connected to coaching.
PurposeThis study investigates the relationship between urban green spaces (UGS) and residents' mental health in Dhaka, Bangladesh, with a focus on the mediating roles of social cohesion and physical activity.DesignMultilevel regression and mediation analysis with cross-sectional data were constructed.Setting10 UGS in Dhaka were selected based on spatial variation.SampleA total of 276 adult residents (response rate: 85.2%) were surveyed using quota sampling to ensure demographic diversity.MeasuresThe Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) was used for mental health assessment, validity scales for social cohesion and IPAQ-SF for physical activity. UGS accessibility and quality were evaluated using NDVI, GIS buffers, and on-site audits.AnalysisMultilevel linear regression and Sobel tests were employed to examine direct and mediated effects of UGS on mental health.ResultsUGS-level factors explained 18% of the variance in mental health. UGS accessibility (β = 0.285***), safety (β = 0.212***), and amenities (β = 0.220***) were positively associated with mental health. Social cohesion (Z = 2.82***) and physical activity (Z = 2.15**) partially mediated these relationships.ConclusionUGS enhances mental health in dense urban environments through both direct and mediated pathways. Subgroup analysis reveals that high and medium-quality UGS have more substantial positive effects through physical activity and social cohesion on mental health. In contrast, the impact of low-quality UGS's is minor and insignificant. Respondents with higher education and income benefit more from UGS on their mental health. Future research using longitudinal data or experimental designs could enhance the robustness of causation.
PurposeMental health stigma and social isolation remain major barriers to well-being in low-resource settings. This study examined the effectiveness of a 6-week community-based storytelling intervention in improving emotional relief, perceived social support, and interpersonal trust among adults in Northern Ghana.DesignMixed-methods evaluation.SettingFive community centres across the Northern Region and virtual sessions on conferenced phone call.ParticipantsFive hundred (500) adults (18+ years) selected through stratified random sampling completed pre and post-intervention surveys. A subsample of 32 participants, 6 community elders and 4 individuals with lived experience of mental health challenges participated in focus group discussions and in-depth interviews. In total, 42 informants participated in the qualitative phase of the study.InterventionStructured storytelling sessions delivered twice per week for 6 weeks (12 sessions total). Each session lasted 60-90 minutes and was facilitated by trained community mental health officers and local storytellers.MeasuresEmotional relief, perceived social support, and trust were measured using adapted items from the Kessler Psychological Distress Scale (K6) and the Social Connectedness Scale. Socioeconomic status was assessed using education, occupation and household assets. All scales demonstrated acceptable validity and reliability (Cronbach's alpha = 0.78 - 0.86).AnalysisNormality was assessed using the Shapiro-Wilk test, supporting the use of paired-sample t-test. Thematic analysis was applied to qualitative narratives.ResultsReports of emotional relief increased from 20% to 70% (t = 6.89, P < 0.001), perceived social support rose from 30% to 80% (t = 5.72, P < 0.001), and trust in sharing personal experiences increased from 25% to 65% (t = 5.21, P < .001). Qualitative findings reinforced these results, revealing themes of reduced stigma, strengthened belonging, and renewed resilience.ConclusionStorytelling is a low-cost, culturally grounded, community-driven intervention for promoting mental health. Integration into public health campaigns, digital platforms, and community leadership structures may expand impact. Future research should incorporate a control group and assess long-term outcomes.
PurposeThis study aimed to explore the association of total multidimensional activity participation and different types of activity on sleep health.DesignCohort study.SettingThe study used Chinese Longitudinal Healthy Longevity Survey (CLHLS) sleep data collected from 2005 onward (2005-2018).SampleA total of 1038 older adults aged 60 and older.MeasuresMultidimensional activity participation was assessed across ten items. Sleep quality and sleep duration were assessed using a single item each. Sociodemographic variables were included as covariates.AnalysisWe used a generalized linear mixed effects model to analyze the relationship between total multidimensional activity participation, activity types, and sleep health.ResultsPhysical activities were positively correlated with sleep quality (β = .010, P < .01). Moreover, cognitive activities were negatively correlated with short sleep duration (OR = .973, P < .05). In sleep quality, males (β = .224, P < .001), urban/town areas (β = .126, P < .01), high quality of life (β = .081, P < .01), health (β = .100, P < .001), and mental health (β = .014, P < .01) protected factors, while having heart disease (β = -.248, P < .001) was a risk factor. Regarding short sleep duration, urban/town areas (OR = .761, P < .01) and high health (OR = .808, P < .001) were negatively correlated with it. Heart disease (OR = 1.589, P < .01) was positively correlated with short sleep duration.ConclusionIt is necessary to consider the role of multidimensional characteristics in promoting sleep health and active aging.
PurposePrior research examining place of service and geographic accessibility during the COVID-19 pandemic has largely focused on the operational management of mass vaccination efforts, emphasizing aspects such as vaccine distribution, dose allocation, and user experience and satisfaction, but has paid less attention to the potential impact on mental health outcomes of vaccine seekers. This study examined the effects of different types of vaccination site and driving distance to vaccination sites on anxiety and depression among COVID-19 vaccine seekers.DesignCross-sectional analysis using data from PHQ-4 Covid-19, 2021.SettingSouthern California.SubjectsA total of 13 360 respondents from the dataset.MeasuresKey variables include anxiety, depression, place of service, travel distance, and individual-level and tract-level control variables.AnalysisMultilevel mixed-effect logistic regression models.ResultsThere is a significant positive association between receiving vaccinations at pop-up clinics and anxiety levels (OR = 1.251). Individuals vaccinated at pop-up clinics had a 25% higher likelihood of experiencing anxiety compared to those vaccinated at conventional outpatient clinics. A positive relationship was also observed between driving distance to vaccination sites and anxiety (OR = 1.088).ConclusionThe findings highlight the importance of considering the psychological impact of vaccination site selection and accessibility. To minimize anxiety, public health strategies should prioritize familiar and easily accessible vaccination locations.
PurposeThis study aimed to explore the role of bilingual provider preferences in mediating healthcare anxiety and cross-border healthcare access.DesignA multi-channel sampling was employed to recruit participants from Brownsville, Texas from March to September 2024.SettingThe research team distributed bilingual (English/Spanish) survey links through partners and community events and promoted the survey via city broadcasts and social media.SampleThe final analytic sample comprised 144 adult residents of Brownsville.MeasuresThe survey items included measures of healthcare anxiety related to providers, preference for bilingual providers, and access to cross-border healthcare, with socio demographics included as covariates.AnalysisStructural equation modeling examined the relationships between provider-related healthcare anxiety, bilingual provider preferences, and cross-border healthcare access, using path analysis to assess direct and indirect effects.ResultsThe analysis revealed a significant positive relationship between provider-related healthcare anxiety and bilingual provider preferences (β = 0.20, P = 0.018). Additionally, bilingual provider preferences were strongly associated with cross-border healthcare access (β = 0.47, P < 0.001). A mediation effect was observed, where bilingual provider preferences mediated the relationship between healthcare anxiety and cross-border healthcare access (β = 0.10, P = 0.04).ConclusionBilingual provider preferences significantly mediate the relationship between provider-related healthcare anxiety and cross-border healthcare access in U.S.-Mexico border communities. These findings emphasize the importance of language concordance in reducing healthcare anxiety and enhancing access to care.
PurposeTo examine the individual and combined effects of modifiable health behaviors-physical activity, healthy diet, smoking, and alcohol consumption-on obesity among U.S. college students.DesignCross-sectional.SettingData from the 2018 American College Health Association-National College Health Assessment surveys.SampleData included 91,535 undergraduate students.MeasuresModifiable health behaviors included self-reported physical activity, diet, smoking, and alcohol use. Weight-related measures included perceived weight status, weight control intentions, weight loss behaviors, and BMI (obesity defined as BMI ≥30).AnalysisWeighted and adjusted logistic regression models estimated associations between individual behaviors, the number of guidelines met, and obesity.ResultsNon-adherence to guidelines for moderate-intensity physical activity, vigorous-intensity physical activity, muscle-strengthening activities, and healthy diet significantly increased obesity odds (OR = 1.14, 1.53, 1.45, and 1.46, respectively). Non-adherence to alcohol guidelines was associated with lower obesity odds (OR = 0.78). Cigarette smoking was not significantly associated with obesity after covariate adjustments. Meeting more guidelines was linked to healthier BMI and weight perceptions. Males were more likely to meet physical activity and alcohol guidelines, whereas females adhered more to dietary and smoking guidelines.ConclusionsInterventions targeting multiple health behaviors are needed to reduce obesity among college students.
PurposeTo estimate the effect of the culturally-adapted Greenlight intervention on parent activation and locus of control (LOC) among Chinese-American immigrant parents.DesignProspective, quasi-experimental study.SettingA New York City-based federally-qualified health center with a large patient population of low-income, ethnically Chinese immigrant individuals and families.Sample444 Immigrant Chinese-American parents of infants (267 cross-sectionally enrolled historical controls and 177 Greenlight recipients followed prospectively).InterventionA culturally-adapted version of Greenlight, a health literacy- and communication-informed early childhood obesity prevention intervention in primary care which promotes certain healthy infant feeding practices at 12 months in the present sample.MeasuresParent activation and LOC were measured at 6, 12, 24, and 36 month well child visits.AnalysisGeneralized estimating equations were used to examine the effects of the Greenlight intervention on the outcome measures.ResultsCompared to historical controls, parents receiving Greenlight were more likely to strongly agree with the activation statements: "I know how to prevent my child from becoming overweight" (adjusted odds ratio (aOR): 9.62 [4.70, 19.73]); "I have been able to help my child maintain recommended changes like eating right or exercising" (aOR: 6.42 [4.14, 9.97]); and "I am confident I can keep my child eating and exercising right, even when I am busy or stressed" (aOR: 8.44 [5.35, 13.31]). Greenlight recipients also demonstrated increased internal LOC (aOR: 2.02 [1.35, 3.03]) and decreased powerful others external LOC (aOR: 1.76 [1.23, 2.51]).ConclusionTo reduce disparities in child obesity, especially among immigrant families, interventions must also prioritize parent factors like parent activation and LOC to build upon their inherent assets and promote long-term change.
PurposeMicro-influencers (10,000 -100,000 followers) promote e-cigarettes in various contexts on social media. We assessed how e-cigarette promotion alongside fitness-oriented, healthy-lifestyle activities affects adolescent perceptions of e-cigarettes and micro-influencers.DesignRandomized experiment.SettingOnline survey.SampleCalifornia adolescents (N = 664, Mean age = 15) recruited in 2024.MeasuresAfter viewing each of 10 influencer videos, participants rated perceived influencer credibility (eg, honesty). After all videos, participants reported perceived harm, appeal, and susceptibility to use e-cigarettes.AnalysisParticipants were randomized to view 10 Instagram/TikTok posts of micro-influencers promoting e-cigarettes alongside fitness-oriented activities (treatment condition) vs micro-influencers promoting e-cigarettes without fitness-oriented imagery (control). Outcomes were compared between groups (treatment vs control) and between participants who perceived influencers as credible vs non-credible, using Cumulative Link Mixed Models.ResultsParticipants in the treatment condition were more likely to report lower e-cigarette harm perceptions (AOR = 1.15; 95% CI = 1.03-1.27), higher social appeal (AOR = 1.13; 95% CI = 1.02-1.25) and attractiveness (AOR = 1.21; 95% CI = 1.09-1.34) of e-cigarette use. Among those who perceived influencers as credible, participants in the treatment condition were more likely to report lower harm perceptions and higher social appeal, attractiveness, and fun of e-cigarette use.ConclusionMicro-influencer e-cigarette promotion alongside fitness-oriented activities, and perceptions of micro-influencers as credible, contributes to lower harm perceptions and higher appeal of e-cigarettes among adolescents.
PurposeYoung individuals are increasingly turning to platforms like TikTok for health-related information, driven by its popularity and widespread acceptance. This study aimed to investigate the key contributors behind sexual assault education on TikTok.DesignExploratory content analysis.SettingVideos tagged #sexualassaultawareness or #sexualharassmentawareness published via public accounts before February 2024 were collected from the platform using Apify.SubjectsAmong 1042 videos collected in our metadata, we examined 203 TikTok posts focused on sexual assault education to determine the types of creators behind the content.MeasuresEducational videos were categorized into non-professionals, small businesses, organizations, and professionals.Analysis100 random videos were coded to identify themes and categories, leading to the development of a codebook with distinct definitions and examples. Using Microsoft Excel, two independent reviewers coded the educational videos, and inter-rater reliability was tested using SPSS.Results203 (30.4%) were classified as educational content. 166 (81.8%) videos were posted by non-professionals/lay TikTok users, 12 (5.9%) by small businesses, 5 (2.5%) by organizations, and 22 (10.8%) by professionals, such as therapists.ConclusionsNone of the users who shared this information self-identified as health education professionals, such as those holding a health education certification. This presents an opportunity for health professionals to share science-based, timely health education online, thus meeting the needs of users seeking reliable information.
ObjectiveTo review literature on Community Health Workers' (CHW) role in providing tobacco cessation programming and offer recommendations for future research and programming based on findings.Data SourcesPubMed, Scopus, and Academic Search Complete.Study Inclusion and Exclusion CriteriaThe first author screened and selected articles that (1) were published after 2000; (2) used CHWs; (3) included tobacco cessation as a primary objective; and (4) were conducted in the United States. Twenty articles met the criteria and were analyzed.Data ExtractionData were extracted and organized in a table that included: author, title, publication year, study design, intervention characteristics (type, length, setting, and description), primary outcome, summary of outcomes, and strengths/limitations.Data SynthesisData were analyzed based on study characteristics and grouped thematically.ResultsTwenty studies demonstrated positive associations between CHW engagement and improved cessation outcomes across populations, including public housing residents and racial/ethnic minorities. CHWs contribute to successful cessation through four mechanisms: repetitive/consistent interactions, provision of medical therapies, wraparound services addressing the social determinants of health (SDOH), and psychosocial support to improve mental health and well-being.ConclusionThis study highlights the ability of CHWs to reach diverse populations and establish trust through shared experiences and understanding of barriers to cessation. Key recommendations include expanding research to engage underrepresented populations such as sexual and gender minorities, veterans, and unhoused people; prioritizing sustained CHW-patient engagement; incorporating medical therapies and culturally tailored cessation aids; and developing comprehensive programming that addresses the SDOH along with cessation.
PurposeTo identify primary sociodemographic factors contributing to cancer health literacy disparities in cancer and non-cancer samples.DesignCross-sectional study.SettingCancer and primary care clinics, healthcare events, community centers, and churches in the Mid-Atlantic region.SubjectsWe recruited U.S. adults with confirmed cancer diagnosis (n = 1306) and adults without cancer (n = 512).MeasuresThe Cancer Health Literacy Test-30 and a demographic questionnaire were administered using touchscreen tablets.AnalysisOne-factor model and measurement invariance were tested. Structural equation modeling was used in univariate and multivariable prediction models.ResultsOne-factor and scalar invariance models were uniformly supported. Race/ethnicity, education, and income were the strongest predictors of cancer health literacy. Age effect was non-significant in univariate analysis, but it was significant with a small effect size in multivariable analysis. A significant but small marital status effect in univariate analysis became non-significant after adjustment, similar to sex effect in non-cancer sample. A significant but small sex effect in cancer sample became non-significant after adjustment. Multivariable models explained 57%-59% variability in cancer health literacy.ConclusionsRace/ethnicity, educational attainment, and income are the primary drivers of disparities in cancer health literacy. Health promotion activities should target cancer health literacy in subpopulations self-identified as Non-Hispanic Black, low income, and low education, and adopt practical health promotion strategies to improve the health outcomes and wellbeing targeting these patients.
PurposeTo understand variables involved in COVID-19 vaccine hesitancy in women, including sociodemographics and concerns regarding the vaccine's effects on reproductive health.DesignCross-sectional survey.Subjects617 adult females.MeasuresDemographics; adult Vaccine Hesitancy Scale (VHS); time between COVID-19 vaccination eligibility and vaccination; medical conditions; gynecologic history; menstrual cycle changes related to COVID-19 vaccination, infection, and stress; levels of worry regarding effects of the vaccine on reproductive health.AnalysisWilcoxon rank-sum, Kruskal-Wallis, Chi-square or Fisher's exact tests, linear regression.ResultsWomen without a college degree had higher VHS scores (P < 0.002) and waited longer to get vaccinated once becoming eligible (P < 0.001). There were no significant differences in vaccine hesitancy between women of reproductive age and older women. VHS scores were significantly higher for women worried about adverse effects of the vaccine on reproductive health (P < 0.001). Women not using hormonal contraception were more likely to report late onset of their cycle after receiving the vaccine compared to those using hormonal contraception (P = 0.018).ConclusionGreater vaccine hesitancy was associated with concerns around the vaccine's effects on reproductive health and lower levels of total education achieved. This study highlights specific concerns women have related to COVID-19 vaccination, emphasizing the importance of prioritizing reproductive health information in the development and dissemination of novel vaccines.
The purpose of this analysis was to quantify hypertension (HTN) prevalence, awareness, treatment, and control in low-resource neighborhoods of Chicago, Illinois. Data were collected among a convenience sample of 11,167 adults screened between 2013 and 2019 at community events conducted through Keep Your Heart Healthy, a student-led community health program at a large academic medical center. HTN was defined as average systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or self-reported BP medication use. Awareness was defined as self-reported history of HTN; treatment was defined as self-reported BP medication use among those aware; and control was defined as SBP <140 mmHg and DBP <90 mmHg among those aware and treated. Descriptive statistics were used to estimate HTN prevalence, awareness, treatment, and control rates. HTN prevalence was 45.3% (95% CI: 44.3%-46.2%). Among those with HTN, 66.7% were aware, 65.3% of those aware were treated, and 48.3% of those treated achieved control. Overall, 21.0% (95% CI: 19.9%-22.2%) of adults with HTN were aware, treated, and controlled. Additionally, 29.6% of all participants met criteria for prehypertension (SBP 120-139 mmHg or DBP 80-89 mmHg). In conclusion, in low-resource communities of Chicago, only 21.0% of participants with HTN were aware, treated, and controlled, indicating significant gaps in HTN management. Findings are limited by convenience sampling, single-visit BP measurement, and missing data on medication use, which may lead to underestimation of treatment and control rates.
PurposeTo investigate the frequency of physical activity behavior among adolescents between the ages of 14-18 and to explain their physical activity behavior within a mixed theory of planned behavior and social cognitive theory model (TPB/SCT) with structural equation modeling.DesignWe investigated the causality of physical activity behavior in adolescents with classical epidemiological regressions models and structural equation models.SettingThe data were stratified by student grade, school type (public/private), and education type (vocational/other).SubjectsThe analyses included data from 1003 students from 31 high schools.Measures & AnalysisFor the "classical epidemiological approach" descriptive, univariate, and multivariate (logistic regression) analyses were presented. For the "structural approach", based on the mixed model of TPB/SCT, 10 structural equation models were established, with stratum of gender and socioeconomic status of the participants.ResultsOur results confirm the hypothesis that attitudes of adolescents - except in poor male adolescents - (β min-max: 0.39-0.46) and perceived behavioral control (β min-max: 0.27-0.39) predicts "intention," while intention (β min-max: 0.39-0.46) predicts physical activity "behavior." The barriers significantly reduce physical activity, especially in wealthy male adolescents (β: -0.12), and peer support significantly increases physical activity in all models (β min-max: 0.21-0.28) except for poor female adolescents. Our models explained approximately 60.0% of physical activity intention variance and approximately 45.0% of physical activity behavior variance. In addition, the lowest values of these two variance percentages were calculated (54.0% and 28.0%) among poor female adolescents.ConclusionOur model could be applied to understand physical activity behavior in adolescents, and still three out of every four adolescents are not physically active at recommended levels. Psychological theories have not yet been able to adequately explain the physical activity behavior of poor female students. According to structural equation modeling, peer social support was found to be twice as effective as parental social support.
PurposeTo assess U.S. parents' perceptions of the healthfulness and safety of non-sugar sweeteners (NSS) and examine their views of NSS front-of-package labels (FOPLs).DesignCross-sectional online survey conducted in August 2024.SettingNational online survey distributed to U.S. parents through a research panel platform.ParticipantsA total of 1047 parents of children aged 2-12 years.MethodsThe questionnaire assessed perceptions of NSS compared with added sugars, confidence in identifying NSS, and evaluations of proposed FOPL formats. Descriptive statistics and were used to summarize all responses. Stratified analyses were conducted by demographic and health characteristics to examine differences in views across five hypothetical NSS FOPL formats.ResultsMost parents viewed NSS as helpful for reducing sugar intake for themselves (82%) and their child (58%), with 52% preferring NSS-containing products over those high in added sugars. While 79.8% and 61.4% considered occasional NSS use safe for adults and children, respectively, only 21.9% viewed daily use as safe for children. Natural NSS were perceived as safer than artificial (60.5% vs 26.6%). Nearly all parents (92.6%) indicated that an NSS FOPL would facilitate product identification, and 76.3% supported mandatory labeling, particularly a yellow triangle stating "Not recommended for children." The preference for this FOPL was consistent among participants of different demographic and health characteristics.ConclusionParents acknowledged potential benefits of NSS for sugar reduction but expressed caution about children's intake, showing strong support for mandatory, child-focused FOPL.
PurposeAdaptive eating refers to internally regulated eating that is enjoyable and gently guided by the nutritional quality of foods. Despite growing interest in this construct, there is currently no validated scale to measure adaptive eating among US college students aged ≥18 years. This study aimed to develop and evaluate the psychometric properties of the Adaptive Eating Scale (AES) in a diverse sample of US college students.DesignThirty-seven items were developed to comprise the AES. Students completed AES and measures of intuitive eating, mental health, diet, and anthropometrics.SampleEight hundred and forty-nine university students aged ≥18 years, from racially and ethnically diverse backgrounds.AnalysisThe sample was divided randomly into two. Exploratory Factor Analysis (EFA) was completed on subsample A (n = 424). Confirmatory Factor Analysis (CFA) was conducted on subsample B (n = 425) to confirm factor structure from subsample A.ResultsEFA showed 17 items representing gentle nutrition (GN), unpreoccupied by food cravings (UBFC), enjoyment of food (EOF), and honoring hunger (HH) explained 63.1% of the variance. CFA showed a bifactor model comprising one global factor and four orthogonal factors (GN, UBFC, EOF, and HH) had excellent fit [CFI = 0.972, RMSEA = 0.051, SRMR = 0.048]. GN, EOF, and HH were reliable, and significantly associated with each other, intuitive eating, emotional eating, weight status, and mental health.ConclusionResults showed that AES is best conceptualized as a multidimensional measure with one general factor and specific factors representing GN, EOF, and HH.