American Journal of Health Promotion

Owing to the reproductive health needs of the budding adolescent and young population, the present study aims to determine the factors associated with and decomposing the gap in contraceptive use among adolescents and young women in India.

Cross sectional design.

SettingThe present study is based in India using the appended datasets (IV and V rounds) of the Indian Demographic Health Survey (DHS), also known as National Family Health Survey (NFHS) conducted in 2015-16 and 2019-21.

The adequate sample size was 475,294 adolescents and young women in NFHS-4 and 229,705 in NFHS-5, totaling 704,999 adolescents (appended for NFHS-4 and 5) for the present study.

Sociodemographic, sexual and reproductive history and contraceptive measures.

Descriptive statistics, chi-square tests, and a binary logistic regression model were executed. Additionally, a decomposition technique called Fairlie decomposition was employed to identify the primary causes of the difference in the prevalence of contraceptive use between the two survey periods.

Almost 96% of young women aged 15-24 knew about contraception, but only 12% used it. Regression analysis revealed that contraceptive use was associated with higher age (AOR 1.09), higher education (AOR 1.28), married adolescents (AOR 4.08), richest wealth quantile (AOR 2.95), joint decision making (AOR 4.40), knowledge of ovulatory cycle (AOR 1.47), interaction with a health worker about any methods of family planning (AOR 3.29) and three and above children ever born (AOR 18.54). Decomposition analysis showed that factors like decision-making of contraception, age, interaction with family planning worker, the intention of last pregnancy, place of residence and age at first sex contributed to increasing the probability of contraceptive use from NFHS-4 to 5.

A target-based approach dedicated to understanding the mindset of adolescents and keeping up with their unique needs is the need of the hour.

To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity.

Cross-sectional study.

Rural Southeastern United States.

Participants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m²; 35% (n = 102) were classified with Class 3 obesity.

We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys.

Chi-Square analysis for categorical variables and analysis of variance (ANOVA) – via multiple linear regression – for continuous variables.

There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences – lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02).

For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.

Increase practitioners' Motivational Interviewing (MI) skill set to develop intrinsic motivation and behavior change competencies.

Pilot comparing intervention group with waitlist-control group.

Health Plan in northeast of U.S.

Training program including a 3 day 19 hour MI training intensive, 1.5 hour follow-up skill-building trainings, and quality assurance review using an MI assessment tool paired with strengths-based mentoring. Cohort 1 (experimental group) received the intervention for 6-months and cohort 2 for 3 months (control group).

Practitioners’ MI skill set was assessed pre- and post-intervention using Motivational Interviewing Competency Assessment (MICA). Practitioners’ MI knowledge and attitudes were assessed pre- and post-training using adapted Motivational Interviewing Knowledge and Attitudes Test (MIKAT). Active learning and confidence questionnaires were administered post-training.

A generalized linear mixed model with repeated measures to analyze difference in MICA growth rates; paired T-test for MIKAT pre/post training analysis. Descriptive statistics for active learning and confidence.

MICA scores significantly improved for both cohorts (P < .0001). Practitioners had significant increase in knowledge and attitudes for MI (P < .001) and confidence in using MI (P < .01). High levels of active learning were observed (93-100%).

With planning, adequate resources/support, and iterative processes for adjustment, practitioners can improve their MI skill set in a short period of time with modest investment of practitioner resources.

To examine trends in single, dual, and polytobacco use between 2014-2020 for US youth and to identify disparities in these trends by grade level, sex, and race/ethnicity.

A secondary analysis of the National Youth Tobacco Survey (NYTS).

A total of 122 566 students.

Past 30-day exclusive use of cigarettes, e-cigarettes, other combustibles (cigars, little cigars, cigarillos, hookah, pipe tobacco, bidis) and smokeless tobacco (snus, smokeless, dissolvable); dual use of each product with e-cigarettes; polyuse with e-cigarettes; dual/polyuse without e-cigarettes.

Multivariable modified Poisson regression.

Compared to 2014, exclusive e-cigarette use (APR = 2.51, 95% CI: 1.96, 3.21) trended upward while exclusive cigarette (APR = .34, 95% CI: .23, .50), ‘other’ combustibles (APR = .47, 95% CI: .37, .58), and smokeless tobacco (APR = .40, 95% CI: .25, .65) use trended downward in 2020. Polytobacco use with and without e-cigarettes trended downward in 2020 compared to 2014. We also saw differences in trends across sociodemographic groups. Comparing 2020 to 2014, exclusive e-cigarette use was higher for females than males, ‘other’ combustible tobacco use remained stable for Non-Hispanic Black students but decreased for other racial/ethnic groups, and dual e-cigarette/cigarette use trended upward more for middle school students than high school students.

Despite decreased trends in tobacco product use without e-cigarettes between 2014-2020, differences in tobacco product use trends by grade level, sex, and race/ethnicity were identified. Prevention efforts targeting disparities in tobacco product use are needed.

To evaluate awareness about cardiovascular (CVD) risk among a racially and ethnically diverse cohort of health system employees.

Cross-sectional study.

Voluntary survey of health system employees during an annual CVD awareness and screening event.

759 health system employees.

We performed initial CVD screening measurements (blood pressure, body mass index) and collected patient-reported answers to questions about their own CVD risk factors (hypertension, high cholesterol, diabetes, overweight, smoking, physical inactivity and family history of CVD) and whether or not they believed that CVD is preventable. Subjects were offered in-depth follow-up CVD screening (lipid panel, hs-CRP, hemoglobin A1c), if interested.

Continuous measures were compared across sex and racial/ethnic subsets using a t test and analysis of variance technique. Univariable and multivariable logistic regression models were used to estimate the employee’s willingness to undergo further comprehensive screening.

African American, Hispanic, and Asian employees were younger than white employees (P < .0001). More than one-quarter of African Americans reported a history of hypertension, a higher rate than for other subgroups (P = .001). The rate of self-reported diabetes was highest in African American and Asian employees (P = .001). African Americans had a 54% reduced odds of electing to pursue follow-up CVD screening (odds ratio: .46, 95% confidence interval = .24−.91, P = .025).

Presence of CVD risk factors and knowledge of their importance differ among racial and ethnic groups of health system employees in our cohort as does interest in pursuing follow-up screening once risk factors are identified. Development of evidence-based customization strategies by racial and ethnic group may improve understanding of and interest in CVD risk factors and advance prevention. The data from this study will inform future research and strategies for employee health promotion.

Participant engagement in an online physical activity (PA) intervention is described and baseline factors related to engagement are identified.

Longitudinal Study Within Randomized Controlled Trial.

Online/Internet.

Primary care patients (21-70 years).

ActiveGOALS was a 3-month, self-directed online PA intervention (15 total lessons, remote coaching support, and a body-worn step-counter).

Engagement was measured across six outcomes related to lesson completion (total number and time to complete), coach contact, and behavior tracking (PA, sedentary). Self-reported baseline factors were examined from seven domains (confidence, environment, health, health care, demographic, lifestyle, and quality of life).

General linear and nonlinear mixed models were used to examine relationships between baseline factors and engagement outcomes within and across all domains.

Seventy-nine participants were included in the sample (77.2% female; 74.7% white non-Hispanic). Program engagement was high (58.2% completed all lessons; PA was tracked ≥3 times/week for 11.3 ± 4.0 weeks on average). Average time between completed lessons (days) was longer than expected and participants only contacted their coach about 1 of every 3 weeks. Individual predictors related to health, health care, demographics, lifestyle, and quality of life were significantly related to engagement.

Examining multiple aspects of engagement and a large number of potential predictors of engagement is likely needed to determine facilitators and barriers for high engagement in multi-faceted online intervention programs.

In the United States (US), individuals vary widely in their readiness to get vaccinated for COVID-19. The present study developed measures based on the transtheoretical model (TTM) to better understand readiness, decisional balance (DCBL; pros and cons), self-efficacy (SE), as well as other motivators for change such as myths and barriers for COVID-19 vaccination.

Cross-sectional measurement development.

Online survey.

528 US adults ages 18-75.

Demographics, stage of change (SOC), DCBL, SE, myths, and barriers.

The sample was randomly split into halves for exploratory factor analysis using principal components analysis (EFA/PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Correlation matrices were assessed and multivariate analyses examined relationships between constructs and sub-constructs.

For DCBL, EFA/PCA revealed three correlated factors (one pros, two cons) (n ₁ = 8, α = .97; n ₂ = 5, α = .93; n ₃ = 4, α = .84). For SE, two correlated factors were revealed (n ₁ = 12, α = .96; n ₂ = 3, α = .89). Single-factor solutions for Myths (n = 13, α = .94) and Barriers (n = 6, α = .82) were revealed. CFA confirmed models from EFAs/PCAs. Follow-up analyses of variance aligned with past theoretical predictions of the relationships between SOC, pros, cons, and SE, and the predicted relationships with myths and barriers.

This study produced reliable and valid measures of TTM constructs, myths, and barriers to understand motivation to receive COVID-19 vaccination that can be used in future research.

To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice.

Analysis of mixed methods data from a large, cross-sectional survey on LM practice.

Web-based survey platform.

Members of an LM medical professional society at the time of survey administration.

Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression.

Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%).

Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.

To understand the trade-offs, defined as compromises or decisions students must make to prioritize one important need over another, as a result of economic constraints, food insecure (FI) college students experience and the perceived impact of these challenges on health, well-being, and academic achievement.

8 Semi-structured focus groups.

Seven 2- and 4-year Minnesota colleges.

53 students initially screening positive for FI.

The focus groups were audio-recorded and transcribed verbatim. Thematic analysis, a systematic approach for identifying and analyzing patterns across qualitative data, was used through four analysis phases to identify themes and categories.

We identified five themes within trade-offs: sacrificing food, missing out on relationships, sacrificing academic studies, choosing between basic needs, and maintaining physical and mental well-being. The trade-offs students described were multifaceted, caused notable stress and worry, and presented challenges to students’ well-being.

This study provides evidence on the complexities of FI among students and details on what students may be sacrificing as a result of making trade-offs. Understanding the trade-offs students are experiencing can help college staff to prioritize which issues to focus on to improve student health and academic performance.

To describe the prevalence of food insecurity among pregnant and parenting women with opioid use disorder (OUD), its association with psychosocial health, and their experience with the Special Supplemental Nutrition Program for Women Infant Child (WIC) program.

This cross-sectional study collected survey data through REDCAP.

The study was conducted at a single, urban, opioid treatment program.

A total of 91 female participants (≥18 years of age and receiving OUD treatment services) were approached about the study and all consented.

Measures included: US Household Short Form Food Security Survey, Patient Health Questionnaire 4(PHQ4), Perceived Stress Scale (PSS), and a demographics and food behavior survey.

Descriptive analyses (frequency, means) described data and Chi-Square, Fischer’s exact, t-tests were used to compare data between food security groups.

Participants were on average 34 years old, Caucasian (68%), and non-Hispanic (87%). Most reported low (32%) to very low (33%) food security. Pearson correlation analyses indicate a strong positive linear relationship between Food Security Score and PHQ4 Total (P = .0002), PHQ4 Depression (P = .0003), PHQ4 Anxiety (P = .0009), and PSS Total (P < .0001). Only 38% felt the foods available in WIC supported their breastfeeding. Limitations include a single site and recall bias.

Significant nutritional inequity in families affected by maternal substance use exists, with potential for adverse maternal and child development related implications.

The aim of this study is to scope the literature on what is currently known between physical activity and presenteeism.

A search strategy was conducting in six scientific databases.

Studies written in English about the relation between physical activity and presenteeism were considered for inclusion.

Data on definitions and measurement of presenteeism and physical activity were extracted.

The data is categorized according to the understanding of presenteeism of the studies to give a better idea of how this phenomenon is studied in relation to physical activity.

After screening 9773 titles and abstracts and 269 full-text articles, 57 unique articles fulfilled our eligibility criteria. The majority of the articles were published since 2010 and originated predominantly in the United States. Most studies (70%) define presenteeism as lost productivity due to health problems, according to the American line of research, whereas 19% of the studies define it as “working while ill” which refers to the European line of research. The studies that reflected the American school of thought tends to report more results that supported their hypothesis (i.e., that more physical activity is associated with less presenteeism).

This review has highlighted the homogeneity in how presenteeism is conceptualized and measured in studies included in our sample. Research on physical activity and presenteeism should be expanded across various disciplines in social sciences to respond to the needs that many researchers have expressed to promote healthier organizations.

This review comprehensively examines interventions which sought to improve the occupational safety and/or health of construction workers. Factors that explain the (in)effectiveness of interventions were also summarized.

This review consisted of a search using two electronic databases, PubMed and Web of Science.

Targeted workers in the construction industry; had at least one primary outcome that aimed to improve occupational safety and/or health; were published between January 01, 1990 and December 01, 2019; and were written in English.

Two researchers independently carried out the process of reviewing the titles, abstracts and full texts, and extracted all data. If there were differences, discussions were held until a consensus was reached.

A total of 1297 articles were retrieved and 24 were selected for final evaluation. Seventeen studies reported significant intervention effects, while 7 found their primary outcome not significantly improved.

Future research should place more effort on interventions aimed at improving both occupational safety and health outcomes in an integrated manner, with environmental interventions that accompany behavioral interventions at the individual level. Besides, additional effort is also needed to ensure the involvement of relevant stakeholders in designing the intervention, avoiding contamination effects (through cluster randomization), optimizing the “dosage” of intervention, and improving measurement of outcomes.