Health Promotion Practice

This project examined health behaviors of newly arrived immigrant and refugee youth through digital photography as part of a health promotion intervention. Students (n = 23) aged 12 to 17 years at a school for newcomer youth in North Carolina used digital cameras to record dietary and physical activity behaviors, barriers, and promoters in their home environment. Eighteen participants completed individual photography projects that revealed consumption of soda, processed foods, limited calcium-rich foods, and limited evidence of physical activity. Photography project results and topics from nutrition education provided during the program were used to tailor health promotion resources. Students used digital cameras and props to create visual health-promoting materials (e.g., large posters for school hallways) that included and represented the wide range of cultures and ethnicities at the school. Facilitated discussion analysis revealed students preferred positive health promotion messages (health benefits of fruits and vegetables) versus negative (sugar or salt content of foods). Students reported they enjoyed using the cameras and developing materials and that as result of their experience they want to increase fruit and vegetable consumption, reduce sugar sweetened beverages, and increase physical activity. Digital photography shows promise as a tool to identify health behaviors and environmental barriers and to tailor health messages, especially with populations experiencing language, literacy, and/or cultural barriers.

Web- and application-based prescription services have been heralded as “Uber for birth control,” offering patients the convenience of obtaining hormonal contraceptives at the touch of a smartphone screen. This innovation stands poised to disrupt a system that currently fails to meet the contraceptive needs of many women, particularly adolescents and those who are rural or low-income. The creation of online contraceptive prescribers provides a new and promising avenue for increased access to hormonal birth control. However, the reach and coverage of these services, as well as their implications for public health goals, including unintended pregnancy and various health screenings, remains unclear. In this article, we describe the current landscape of online contraceptive services and identify the potential impacts on unplanned pregnancy and other health outcomes. We find these services may reduce geographic and logistical barriers for rural and low-income populations. However, their impact on access for adolescents is likely to be minimal, as more than half the services do not prescribe to minors. Furthermore, increasing use of telemedicine may reduce rates of screening for public health concerns, including interpartner violence, sexually transmitted infections, and cervical cancer. We offer specific recommendations for future research to evaluate the impact of these services on unplanned pregnancy and other public health outcomes.

The authors met during a career development experience where they discussed the commonalities of their successes and challenges conducting creative strengths-based health promotion research with underserved communities during their graduate and postgraduate training. They identified changes to health promotion pedagogy that they would like to see in the future. These include understanding both the strengths and the challenges of creative strengths-based health promotion research conducted with underserved communities, ensuring that reflexivity and flexibility is a component of the process, developing support networks for trainees, understanding personal limitations to effect change, and supporting self-care. They hope that trainees and health education programs will learn from their experiences.

Objective. College peer health education groups have grown in popularity to provide information about health and wellness topics. The purpose of this systematic review was to evaluate the effectiveness of peer education groups on reducing sexual health risks and increasing sexual health knowledge on a college campus. Method. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed in searching, extracting, appraising, and synthesizing the evidence. A quality assessment was also conducted. The review was conducted in April 2017. Results. The initial search yielded 2,503 records. After critical appraisal, eight articles remained. Peer education was beneficial for increasing knowledge of sexual health topics and creating some behavior change such as increased condom use and HIV testing. Additionally, interventions developed specifically for women were effective. Conclusions. Peer education is an effective way to disseminate sexual health information and can be a reliable resource for college students.

Introduction. While school-based kitchen garden programs are shown to improve fruit and vegetable consumption and knowledge among children, there has been little research on participant perceptions of these programs, specifically among minority populations that are disproportionately affected by and at high risk for overweight and obesity. This qualitative study examined the perceptions of and values associated with participation in school-based kitchen garden programs implemented through Edible Schoolyard New Orleans in low-income, predominantly African American schools in New Orleans, Louisiana. Method. Qualitative data were collected through semistructured focus group discussions with key stakeholder groups at schools offering Edible Schoolyard New Orleans. Results. A total of 10 focus groups were conducted across 4 middle schools with students (n = 27), parents (n = 17), and teachers (n = 17). Four primary themes emerged during data analysis: development of life skills, food and health, family and community, and experiential and participatory learning. Conclusions. To strengthen the sustainability and potential impact of school-based kitchen garden programs, future intervention strategies should place specific emphasis on the themes that emerged from this study. School-based kitchen garden programs may be a promising strategy to positively influence the individual, social, and physical environmental factors that contribute to overweight and obesity in low-income, African American communities.

School-based interventions can play an important role in improving childhood and adolescent nutrition and preventing obesity. Schools offer a unique opportunity to implement policy, systems, and environmental interventions targeting healthy eating behaviors. An intervention was piloted in six middle schools featuring behavioral economics–based changes to the lunchroom, communication training, and communicate cues for food service staff. The pilot study employed a multicomponent evaluation with students and food service directors and staff including a lunchroom assessment, online surveys, production records, and interviews. Five schools increased their scores on the lunchroom assessment tool, and four schools increased the number of servings produced of healthy food items. Interviews with food service directors indicated the interventions was feasible and well received. School-based policy, systems, and environmental interventions targeting healthy eating behaviors may play a role in preventing obesity in children and adolescents.

Aim. To test the efficiency and acceptance of school-based dental education for improving oral self-care in Mexican elementary school–aged children. Method. A total of 408 students from 4 schools were examined at the baseline, 3 months (follow-up rate was 94%) and 6 months observations (follow-up rate 91%). Group 1 served as a control, Group 2 received a lecture-based education, and Group 3 consisted of trained peer-leaders who educated their peers. Oral self-care practice and oral self-care skills were assessed at the baseline and both follow-ups. A number of sociodemographic and oral health behavior/knowledge characteristics were tested as predictors of oral self-care outcomes at different observation periods. Results. Oral self-care outcomes improved in Groups 2 and 3, but not in the control group. The selected child population, their caregivers and teachers perceived the school-based educational strategy as important and necessary. There was no consistent pattern of predictors explaining variations in oral self-care outcomes at any of the observation periods. Oral self-care improvement observed at the 6 months observation was mainly predicted by the baseline oral self-care levels, dental education, and age. Conclusions. The school-based dental education was easy to implement, and it was effective for improving children’s oral self-care practice and skills.

Background. Colorado passed House Bill 11-1069 in 2011 requiring all public elementary schools to provide students with a minimum of 30 minutes of physical activity (PA) per school day (Physical Activity Expectation in Schools, 2011). The purpose of this article is to describe the results of a 3-year initiative to increase opportunities for PA and to provide recommendations for school health practitioners implementing similar programming. Intervention. In 2014, 13 school districts were funded to increase student PA during school hours and before and after school hours. Intervention activities spanned all components of the Comprehensive School Physical Activity Program framework. An evaluation was conducted to estimate the number of schools providing at least 30 minutes of PA a day. A mixed methods evaluation design was implemented that included tracking the number of minutes of PA provided before, during, and after school and semistructured interviews with school health coordinators. Results. In Year 1, an average of 48 minutes of PA were provided per day. By the end of year 3, the average minutes of PA doubled to 90 minutes per day. Teachers and staff identified professional development and administrator support as key components to incorporating more PA throughout the school day. Conclusions. Health promotion interventions in schools can increase access to PA opportunities for students. Sustainability of PA efforts in schools is dependent on funding to support professional development for teachers and staff and building administrative support for school-based PA.

Objectives. Distracted driving is a major public health issue in the United States. In response to requests from high school students participating in a university-based initiative, the authors describe the collaborative development and implementation of a curriculum designed to address distracted driving behaviors among students in four high-needs school districts in the northeastern United States. Method. The curriculum integrates current statistics on distracted and drowsy driving and three interactive learning stations: driving while distracted, walking while distracted, and driving while drowsy. Pre- and postsurveys were conducted to collect student driving data, assess student satisfaction with the program, and assess their likelihood of speaking up as a passenger in a high-risk situation. Results. The majority of students reported that they learned new information and would recommend the program to others. A Wilcoxon signed-rank test showed that students were more likely to speak up as a passenger with a distracted or drowsy driver (p < .001) after the program. Conclusion. This experience demonstrates a voluntary, multidisciplinary, university-based collaboration in the development of a novel public health education initiative. Based on the success of this phase, school districts elected to participate in Train the Trainer sessions to continue the program within their local high-needs school district.

Bystander intervention is a prevention strategy commonly used to address campus sexual violence. Increasingly, there are calls for prevention efforts to be multilevel and ongoing. The current study investigated the impact of receiving varied prevention messages throughout adolescence and into early adulthood to determine whether it influences college students’ awareness of sexual violence, willingness to intervene as a helpful bystander, and actual prosocial bystander behavior. These questions were tested through administration of an online survey to a racially and ethnically diverse sample of 1,047 undergraduate students at a large, urban university in the mid-Atlantic. Results found that most students received information about sexual violence prior to coming to campus from a variety of sources, and that the sources varied significantly by gender and race. Regression analysis found that greater exposure to prevention messages prior to coming to college was significantly associated with greater bystander intentions and behavior even after accounting for gender and race and exposure since coming to college. The findings provide initial support to expand the scope of prevention efforts and to begin them prior to college.

Social media are advocated as a prime channel through which to reach college students with health-related information. However, how well are colleges and universities utilizing social media as it was intended—a means to be truly social and not just promotional? Social media can only be effective if students actually follow, interact, and share the content being produced. The following study completed a census of student health center Facebook accounts in the United States as well as investigated students’ motivations to follow, interact with, and share health-related content. Facebook pages were found for about 20% of student health centers, and about two thirds posted content within the past 14 days. However, their median number of “likes” was between 191 and 496 despite being in existence for an average of 6 years. Additionally, the majority of these centers’ most recent posts were promotional, instead of trying to socially engage with their followers. Students indicated that they would be likely to follow, interact, or share social media content from college health accounts if they were incentivized to do so, if they thought the content could be relevant to them, or if they simply knew that the account existed. Unless more attention is given to growing their followings, resources used by student health organizations to consistently post content might be better placed elsewhere. Recommendations for increasing engagement with students are discussed.

Understanding the advocacy and public policy training needs of our future health promotion workforce is crucial if we are to prepare them to meet their professional responsibilities. The purpose of this study was to examine health promotion students’ advocacy/public policy involvement, training, and perceptions. Electronic surveys were disseminated nationwide to college students in health education and closely related programs. Of 477 student respondents, the most frequently indicated advocacy/public policy activity engaged in was voting (56%). The greatest benefit to advocacy was indicated as creating public awareness, while the most prevalent barrier reported was lack of familiarity with the legislation process. Less than one third of students reported receiving any training; however, training and the number of training sources were associated with greater involvement (p < .05). Comparisons by academic classification indicated that graduate students participated in more advocacy activities and reported significantly more benefits, barriers, knowledge, and self-efficacy compared with undergraduates. Regression analysis indicated that knowledge, self-efficacy, perceived benefits, and total number of training sources were significant predictors of advocacy involvement in both graduate and undergraduate student models, with age also contributing significantly to the graduate student model. Findings emphasize the need for increased training at earlier education levels to increase knowledge, self-efficacy, and advocacy/public policy involvement.

Hispanic young adults in the United States are disproportionately affected by HIV and should be considered a priority for prevention efforts. The purpose of this study was to explore perceptions and beliefs of English-speaking students (aged 18-24 years) at a Hispanic-serving university about HIV/sexually transmitted infection (STI) testing and prevention to increase acceptance and adoption of services. Four major themes emerged from four qualitative focus groups (n = 30 students) and were corroborated by an optional anonymous survey (n = 24 surveys): (a) preferences for HIV/STI testing services, (b) essential HIV/STI testing information, (c) preferred delivery method of HIV/STI testing information, and (d) culturally appropriate message design with Hispanic young adults. Findings suggest that Hispanic young adults perceive accessible testing to be important to their community and view normalization of these services as a necessary component of successful adoption and adherence. Although flyers were reported as a practical means for distributing on-campus testing and service information, social media was endorsed as one of the most effective ways to reach young adults. Among participants, there was less consensus regarding the need for cultural tailoring. Results provide practical insights into the development and application of health promotion strategies with an ethnic minority group and demonstrate how a mixed-methods approach can be employed to inform health promotional efforts.

The Exercise is Medicine Canada on Campus (EIMC-OC) program was established in 2013 to provide opportunities for students to promote physical activity in their campus communities. Currently, 38 EIMC-OC groups are in operation, and each has encountered challenges and enablers that have yet to be formally documented. This project aimed to (1) identify barriers and facilitators when implementing an EIMC-OC group and (2) investigate levels of implementation at which the barriers and facilitators operate. Throughout winter 2016, 22 EIMC-OC group leaders representing 12 groups contributed data. Participants completed a survey and a semistructured interview developed using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and underwent thematic analysis. Eighteen barriers and 24 facilitators were identified, with four influencers cited as both a barrier and a facilitator. Common barriers included group member time constraints and communicating with health care professionals. Common facilitators included collaborating with other groups and advertising. Most influencers corresponded to the inner setting and process CFIR domains. Findings from this study suggest that EIMC-OC groups face similar barriers and facilitators despite varying local contexts. The influencers identified highlight recommendations to enhance the success of the EIMC-OC program and other multisite health initiatives at academic institutions.

Heart disease is the leading cause of death in the United States. African Americans and people of low socioeconomic status suffer disproportionately from heart disease–related morbidity and mortality. In Detroit, Michigan, a primarily African American and low-income urban area, heart disease mortality is at twice the national rate. Despite evidence for the effectiveness of self-management support interventions in reducing chronic disease burden for older adults, few are adapted for communities most in need. This article describes the process of adapting Take PRIDE, an evidence-based heart disease self-management intervention, for older adults in Detroit via the Replicating Effective Programs (REP) framework. Working within a community–academic partnership, we found REP useful in facilitating the identification of diverse stakeholders, core versus adaptable elements of the intervention and barriers to implementation. We also made several modifications to the REP framework in order to better fit our project needs. Overall, we found REP to be an effective, flexible tool that allowed us to successfully adapt a disease-management intervention for this setting. Processes, lessons learned, and recommendations offered in this article may help researchers and practitioners working to expand access to self-management support for populations most affected by chronic disease.

Historically, African Americans (AAs) have been underrepresented as blood donors. Having a lack of racially diverse blood donors contributes to transfusion complications, particularly in patients with sickle cell disease, who are both disproportionately AA and the recipients of frequent transfusions. Increasing AA blood donation is a complex public health issue. This review article serves to fill a gap in translating research regarding known hindrances and facilitators of AA blood donation to improve real-world donation practice and ultimately, patient outcomes. We incorporate findings from a literature review to develop a tool that blood centers, provider organizations, and patient advocacy groups can use to aid strategic planning efforts aimed at increasing AA blood donation.

With the increased use of multisite evaluation and implementation studies in health care, our team of evaluators reflects on our evaluation of a large-scale multiyear geriatric and extended care program implementation. We share lessons from conducting multiple rounds of data collection, analyses, and reporting. We also identify some key factors that can facilitate or hinder multisite evaluation efforts involving programs with different models of implementation. This article strives to improve the quality of large-scale evaluations of health programs implementation. Knowledge gained from this complex evaluation will inform public health programs funders, implementers, and key program staff to better plan for, engage in, and benefit from effective complex evaluations to promote health in diverse settings.