American Journal of Health Promotion

To test the feasibility of introducing ‘Free Time for Wellness’ (FT4W) an intervention to increase healthy behaviours and reduce the risk of cancer.

Feasibility study; Setting: Washington Heights, New York, USA is a low socioeconomic status area.

Mothers aged 18 and above with children under 12 years of age and living in Washington Heights were recruited.

FT4W, a community-based intervention delivered through a neighbourhood-based app, offering weekly dance and yoga classes, food pantry visits and group playdates. Childcare professionals cared for participants' children during wellness activities.

A bespoke before and after survey was designed and tested for its ability to collect relevant data to assess the impact of FT4W. Outcomes included recruitment rates, participation, attrition, acceptability, and success of the community champion.

Comparisons of proportions and means

Twenty-one mothers participated in the study of which 90% attended ≥ 1 FT4W activity; 65% ≥ 2; 52% ≥ 3. The survey was completed by a 100% of participants indicating it was easy to understand and not too burdensome. All measures detected change in constructs from baseline to follow-up. Availability of childcare was the most commonly (66%) reported reason participants were able to engage in the offered wellness activities.

Conducting a larger-scale trial to assess the impact of FT4W is feasible considering 4 major lessons. (1) Recruitment, retention, and acceptability rates were high; however, moms need additional support to increase participation in wellness activities and improve tech literacy. (2) Research measures were sensitive enough to detect change, but the timing of assessments needs to be considered. (3) Participants greatly valued access to professional childcare. (4) The Community Champion is a necessary, but difficult role to fill that requires careful consideration by the Institutional Review Board (IRB).

This study examined current (past 30-day) dual- and polytobacco use patterns and COVID-19 symptomatology, testing, and diagnosis status among college student electronic cigarette (e-cigarette) users.

Cross-sectional online questionnaire administered during October–December 2020.

Four large, U.S. public universities in geographically diverse locations.

College students (N=756) ages 18–24 who reported current e-cigarette use.

Current use of e-cigarettes, combustible cigarettes, and cigars, and self-reported COVID-19 symptomatology, testing, and diagnosis status were measured.

Multivariable logistic regression models accounting for students’ demographics, university site, fraternity/sorority membership, and current residence.

Over half (53.6%) of students were exclusive e-cigarette users, 20.4% were dual e-cigarette and combustible cigarette users, 4.6% were dual e-cigarette and cigar users, and 21.4% were poly users of e-cigarettes, combustible cigarettes, and cigars. Compared to exclusive e-cigarette users, dual users of e-cigarettes and combustible cigarettes (AOR=2.12, 95%CI=1.05–4.27) and poly users of e-cigarettes, combustible cigarettes, and cigars (AOR=3.70, 95%CI=1.78–7.70) had increased odds of COVID-19 symptomatology, even when accounting for covariates. While current tobacco use groups did not differ based on COVID-19 testing, polytobacco users had significantly increased odds (AOR=2.16, 95%CI=1.11–4.20) of having received a positive COVID-19 diagnosis.

Given use of two or more tobacco products increased COVID-19-related risks, results underscore the need to prevent dual- and polytobacco use behaviors in college student e-cigarette users.

Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization.

Cross-sectional telephone survey.

All United States and Territories.

246 801 adults aged 18–64.

The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined.

Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions.

The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25–35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior.

Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.

We sought to describe leisure-time, aerobic, and muscle strengthening physical activity (PA) patterns in U.S. Asian Indians, in comparison to other races/ethnicities.

We utilized the 2011–2018 National Health Interview Surveys, a set of cross-sectional, nationally representative surveys of the U.S. noninstitutionalized population. Our study population included 257 652 adults who answered PA questions.

PA was classified per 2008 U.S. guidelines and continuously per estimated metabolic equivalents (METs). Race was classified into White, Black, Asian Indian, Other Asian, and American Indian/Alaskan Native/Multiracial.

We used survey design-adjusted, multivariable logistic regression to determine odds of sufficient and highly active physical activity levels, adjusting for predisposing, enabling, need, and health care service factors as guided by the Anderson Model. We also used linear regression to determine racial differences in average MET-minutes/week. Analysis was additionally stratified by comorbidity status.

While Asian Indians (N = 3049) demonstrated similar odds of sufficient aerobic PA as Whites (aOR [95% CI]: .97 [.88,1.07]), Asian Indians had 22% lower odds of meeting highly active aerobic PA levels (.78 [.71,0.87]) and 18% lower odds of meeting sufficient muscle strengthening PA levels (.82 [.73,0.91]). This translated to an average 172 (95% CI: 45 300) fewer MET-minutes. Furthermore, this decrease in MET-minutes/week was especially apparent in those without hypertension (β[95% CI]: −164 [-314,-15]) without diabetes (−185 [-319,-52]), and low/normal BMI (−422 [-623,-222]).

Asian Indians, especially those without comorbidities, are less likely to engage in high-intensity physical activity than Whites.

Despite having lower socioeconomic status, Latinos in the US experience fewer adverse health outcomes than non-Latinos. However, they are disproportionately affected by diet-related diseases. Among other racial/ethnic groups, high acculturation and low socioeconomic status are associated with worse dietary intake, yet, few studies have investigated these relationships among Latinos.

2013–2014 NHANES analyzed to examine pathways through which acculturation, income, nativity, and food security are associated with dietary behaviors.

U.S. population-based survey.

Survey respondents >18 years old and identified as Latino/Hispanic (N = 1197; 53.88% female; Mage = 44.61).

Primary language spoken (acculturation), total household income (income), place of birth (nativity), Food security, and the Flexible Consumer Behavior Survey (dietary behavior).

Univariate and multivariate regressions in STATA. Covariates include length of time in the US, ethnicity/Hispanic origin (i.e., “Mexican American” or “Other Hispanic”), and gender.

Nativity (β = −1.16; SE = .19; P < .001) and income (β = .39; SE = .07; P < .001) were significant predictors of dietary behavior. Foreign-born Latinos and those with lower income consumed significantly lower numbers of fast-food or pizza. Food security was not a significant predictor of dietary behavior (β = .16; SE = .1; P > .05).

Results suggest that income is not a protective factor against unhealthy dietary behavior and a renewed importance of nativity as a predictor of health behavior among Latinos.

To examine the feasibility and acceptability of a social network weight loss intervention delivered by lay health promoters (HPs) to immigrant populations.

Single-arm, non-randomized, pilot study of a social network weight loss intervention developed by a community-based participatory research partnership and delivered by HPs.

Community-based setting in Southeastern Minnesota, United States.

Somali and Hispanic immigrants to the United States: 4 social networks of adults (2 Hispanic and 2 Somali) with 39 network participants.

Twelve-week behavioral weight loss intervention delivered by HPs (4 weeks in-person and then 8 weeks virtual).

Feasibility was assessed by recruitment and retention rates. Acceptability was assessed by surveys and focus groups with HPs and participants. Behavioral measures included servings of fruits and vegetables, drinking soda, and physical activity. Physiologic measures included weight, blood pressure, glucose, cholesterol, and triglycerides.

Paired t-tests of pre- to post-intervention changes at the end of 12 weeks of treatment.

Recruitment was feasible and post-intervention was 100%. Participants highly rated the intervention on satisfaction, motivation, and confidence to eat a healthy diet, be physically active, and lose weight. Participants were motivated by group social support and cohesion of their social networks. On average, participants lost weight (91.6 ± 15.9 to 89.7 ± 16.6 kg, P < .0001), lowered their systolic blood pressure (133.9±16.9 to 127.2 ± 15.8 mm Hg; P < .001), lowered their diastolic blood pressure (81 ± 9.5 to 75.8 ± 9.6 mm Hg; P < .0001), had more servings of vegetables per day (1.9 ± 1.2 to 2.6 ± 1.4; P < .001), and increased their physical activity (2690 ± 3231 to 6595 ± 7322 MET-minutes per week; P = .02).

This pilot study of 2 immigrant communities who participated in a peer-led weight loss social network intervention delivered during the COVID-19 pandemic demonstrated high feasibility and acceptability. Participants lost weight, improved their health status, and improved their health behaviors.

The COVID-19 pandemic is correlated with decreased physical activity (PA). Transitioning to remote work may impact people’s acceptability and preferences for remotely delivered behavioral interventions, including PA. The objective was to examine perceptions of COVID-19 impacts on PA engagement and motivation, and perspectives related to remotely delivered PA interventions.

Cross-sectional small-group interview.

Harris County, Texas. Participants: Insufficiently active, overweight/obese adults (16 healthy adults [aged 25–52 years], and 7 cancer survivors [aged 50–74 years]).

Group discussion was guided by semi-structured questions. Audio-transcribed data (278 pages) was analyzed using Braun and Clarke’s process centering identification, analysis, organization, description, and reports.

Overall, participants expressed a decreased level of PA due to the pandemic. Difficulties (e.g., care-taking activities, working from home, and safety concerns) negatively affected motivation. Participants indicated high acceptability of remotely delivered PA interventions, with advantages of virtual technology features (e.g., did not have to maintain a gym membership) and even accountability in maintaining a PA routine (e.g., using virtual groups to engage in community support).

Participants described COVID-19 negatively affects access to PA opportunities yet also expressed willingness to engage in remotely delivered PA interventions instead of in-person programs because of their COVID-19 experiences. Remote interventions can greatly increase accessibility and offer opportunities to provide personalized motivation and accountability that people need to be more physically active.

This practice-based research funded by the Centers for Disease Control and Prevention (CDC) focuses on the translation of evidence-based practices and policies into real-world applications. To the best of our knowledge, this is the largest study to research the implementation process for lactation accommodations and policies for work sites.

Pre-/post-test evaluation of work-site lactation accommodations, and 6-month follow-up with business that worked on the project.

34 businesses across New Hampshire.

The team developed work-site selection criteria to award mini-grants; developed trainings and a toolkit; and worked with 34 businesses over a 3-year period. Pre-/post-implementation data were collected using the CDC work-site scorecard. A 6-month follow-up phone interview was conducted with each site.

We assessed the CDC scorecard and evaluated the challenges of implementing lactation spaces by industry. In our 6-month follow-up, we found that spaces were still being utilized and we identified specific research to inform practical evidence-based applications and lessons learned when implementing a work-site lactation space.

We successfully provided financial/technical support to develop or improve 45 lactation spaces, with policies and practices to support mothers and families for 34 businesses. We identified key takeaway lessons that can be used to guide the development of lactation spaces and policies in work sites. Sites self-report that these work-site changes were sustainable at 6-month follow-up.

This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions.

SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches.

SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington.

SRCP recipient staff, emergency food program staff, and key stakeholders.

We conducted semi-structured interviews with key stakeholders and systematic review of program documents.

Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis.

Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes.

Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources.

LIVESTRONG at the YMCA is an evidence-based 12-week physical activity (PA) program for cancer survivors. The purpose of our study was to understand the factors that motivated cancer survivors to begin the program, how the program impacted their habits, and how their experience influenced their motivation to continue with the program.

Key informant interviews

Phone interviews conducted between April 15 and June 1, 2020.

27 cancer survivors in Texas who previously participated in the LS program.

Participants completed a 30- to 60-minute interview with one of four interviewers. All interviews were recorded, transcribed, and analyzed for themes.

Most interviewees were motivated to begin the program because of a desire to feel better after treatment. The most cited motivator to continue in the program was the community of cancer survivors. During the program, interviewees enjoyed learning different exercises, the community of cancer survivors, and the supportive teachers. Nearly all interviewees adopted or changed a healthy habit as a result of the program.

These results could be used by healthcare professionals to better understand what motivates cancer survivors to participate in a PA program. Results could also be used to plan or modify other PA programs for cancer survivors.

This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination.

Cross-sectional survey data.

Online Qualtrics recruitment panel.

Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%).

Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors.

We conducted multivariate linear regressions on each outcome variable after controlling for covariates.

Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (β = .37, 95% confidence interval [CI] = .25–.48), child (β = .32, .21–.44), and HPV for child (β = .38, .27–.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (β = .46, .33–.59), child (β = .41, .28–.53), and HPV for child (β = .75, .64–.85).

Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior.

To explore the physical activity level of community environmental volunteering (CEV) participants and the differences in physical functions and daily activity patterns between the older adults who engaged in intensive CEV (≥15 hours/week) and non-intensive CEV (<15 hours/week) groups.

Cross-sectional study.

Three recycling stations in Taiwan.

In total, 113 community-dwelling older adults who regularly participated in CEV. The response rate was 53%.

The ActiGraph wGT3x-BT accelerometer for the percentage of sedentary, light, and moderate to vigorous physical activity (MVPA) of CEV time and awaken time; the Jamar hand dynamometer for grip strength; and the MicroFET3 muscle testing dynamometer for knee extension strength.

Analysis of covariance with the baseline characteristics as covariates.

Overall, MVPA, light, and sedentary activities accounted for 53.73%, 41.10%, and 5.23% of CEV time, respectively. The intensive group (n = 61) displayed greater dominant handgrip strength (P = .004) and higher MVPA percentage in daily life (P = .044) than the non-intensive group (n = 52).

CEV provides sufficient opportunities for older adults to perform physical activity. Intensive CEV is related to greater handgrip strength but not lower limb strength. Further study is needed to establish the causal relationship between CEV and health variates.

This study aims to develop and test feasibility of a colorectal cancer (CRC) education video appropriate for Somali immigrants.

One-group pretest–posttest design.

Minneapolis, MN.

Thirty-one Somali men (mean age = 60.6; SD = 13.0).

A CRC education video was developed in the Somali language with Somali community partners. Participants were invited to a workshop and watched the video.

Levels of understanding about CRC and screening were assessed before vs after the video.

Binomial tests were conducted to examine changes in level of understanding.

Analysis on pre–post, within-person changes in understanding about cancer, and CRC screening showed that proportions with a positive change in understanding risks of cancer (80%) and benefits of CRC screening (90%) were significantly higher than expected if the video had no effect (50%; P = .012, P < .001, respectively). Ninety-three percent of participants agreed that the video contained useful information.

These results provide evidence of usefulness of culturally tailored videos to facilitate CRC screening in the Somali community. Results of this study were limited by a small sample size and lack of a control group.

To conduct a scoping review to synthesize evidence on food prescription programs.

A systematic search of PubMed, CINAHL, Web of Science, Embase, and the Cochrane Library was conducted using key words related to setting, interventions, and outcomes.

Publications were eligible if they reported food prescription administered by a health care practitioner (HCP) with the explicit aim of improving healthy food access and consumption, food security (FS), or health.

A data charting form was used to extract relevant details on intervention characteristics, study methodology, and key findings.

Study and intervention characteristics were summarized. We undertook a thematic analysis to identify and report on themes. A critical appraisal of study quality was conducted using the Mixed Methods Appraisal Tool (MMAT).

A total of 6145 abstracts were screened and 23 manuscripts were included in the review. Food prescriptions may improve fruit and vegetable consumption and reduce food insecurity (FI). Evidence for impacts on diet-related health outcomes is limited and mixed. The overall quality of included studies was weak. Addressing barriers such as stigma, transportation, and poor nutrition literacy may increase utilization of food prescriptions.

Food prescriptions are a promising health care intervention. There is a need for rigorous studies that incorporate larger sample sizes, control groups, and validated assessments of dietary intake, food security, and health.

Social network analysis (SNA) can measure social connectedness and assess impact of interpersonal connections on health behaviors, including physical activity (PA). This paper aims to systematically review adult PA studies using SNA to understand important social network concepts relative to PA.

A search was performed using PsycINFO, MEDLINE, PubMed, and Web of Science.

To be included in the search, articles needed to 1) include a measure of PA, 2) conduct an SNA in which specific relationships were measured, and 3) conduct an analysis between social network measures and PA.

Key study elements including network design and results were extracted.

Data were synthesized to answer 2 questions: 1) how has adult PA been investigated using SNA approaches and 2) how is an adult’s social network associated with PA behaviors?

A final sample of 28 articles remained from an initial 11 085 articles. Network size, homophily, network composition, and network exposure to PA were all associated with individual level PA across studies. Lastly, longitudinal and intervention studies showed a more complex picture of social influence and diffusion of PA behavior.

Adults’ PA behaviors are influenced by their networks. Capitalizing on this influence, researchers should engage not just individual behavior change but also the social influences present within the person’s life.