American Journal of Health Promotion最新文献

PurposeThis study examines community and provider perceptions of colorectal cancer (CRC) screening using the Theory of Planned Behavior (TPB) to identify barriers and interventions for improving screening rates.Approach or DesignA mixed methods research design using focus groups with community members and semi-structured interviews with health care providers in counties with the highest and lowest CRC mortality-to-incidence ratios (MIRs). Data analysis was guided by the TPB.SettingNorth Dakota counties with the highest and lowest CRC MIRs, covering urban and rural populations.ParticipantsTwenty community members aged 50+ (18 women, 2 men) participated in 5 in-person and 3 virtual focus groups. Eight health care providers, including physicians and nurse practitioners, were interviewed virtually.MethodFocus groups and interviews were conducted between summer and fall 2023. Discussions were transcribed, coded, and thematically analyzed using Dedoose, guided by the TPB.ResultsTop barriers included access to screening (total codes, n = 183), fear/stigma (n = 126), provider communication (n = 80), cost (n = 67), and travel (n = 58). Community members relied on social networks over providers for screening decisions. No significant differences emerged between high- and low-MIR counties, nor between rural and urban, indicating systemic rather than geographic barriers.ConclusionFindings suggest improving provider communication, leveraging trusted social networks, addressing stigma, and reducing barriers to screening (eg, cost, transportation). Future interventions should prioritize community-informed health promotion efforts to increase CRC screening rates and improve health equity.

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.

PurposeThis study explored the relationships between social influence, vaping behavior, and susceptibility across different grade levels.DesignThe study design was cross-sectional. Data were collected from middle and high school students who voluntarily participated between September 2022 and April 2023.SampleA convenience sample of students in 6^th to 12^th grades in Kentucky (N = 4677).MeasuresDemographic information, including age, grade level, school location, and race/ethnicity, was collected. The outcome variables included social influence, susceptibility, and vaping behavior.AnalysisLogistic regression analysis was used to explore the relationships between social influence, vaping behavior, and susceptibility.ResultsThe analysis showed significant differences in vaping behaviors and susceptibility between middle and high school students, with high school students having higher odds of vaping (OR = 1.58, 95% CI = [1.15, 2.17]). However, after adjusting for covariates, grade level differences were no longer significant (aOR = 1.01, 95% CI = [0.67, 1.51]). The adjusted model showed that youth with 1 vaping friend were 3 times more likely to try vaping (aOR = 2.83, 95% CI = [1.91, 4.22]), while those with 5 vaping friends were over 22 times more likely (aOR = 22.30, 95% CI = [13.34, 37.29]).ConclusionThe results emphasize the need for primary interventions that address social influences on youth vaping initiation and continued use among students across middle and high school grade levels.

The COVID-19 infodemic underscored the urgent need to strengthen media health literacy (MHL) as a cornerstone of public health resilience. This perspective examines MHL within the complex sociopolitical, cultural, and digital landscape of the Middle East and North Africa (MENA) region, where misinformation, inequities, and limited institutional trust amplify health vulnerabilities. It proposes an integrated framework built on 4 pillars-policy and advocacy, multi-sectoral collaboration, empowerment of vulnerable populations, and technology-driven innovation-to foster equitable access to reliable health information. Advancing MHL in MENA is essential to building trust, enhancing informed decision-making, and promoting regional health equity.

PurposeIdentify demographic, behavioral lifestyle, psychological, and clinical factors associated with suboptimal activity patterns several years after a first pregnancy and delivery.DesignCross-sectional, secondary analysis.Setting and SampleWomen (n = 2843) from eight U.S. centers assessed 2-7 years after delivery in the nuMom2b Heart Health Study.MeasuresSelf-reported leisure time moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior (SB) were used to define patterns based on meeting recommendations for MVPA (active at ≥150 minutes/week) and leisure time SB (low SB at ≤3 hours/day). Factors (demographic, behavioral lifestyle, psychological, and clinical) assessed at study visits and hypothesized to be related to MVPA-SB patterns were included.AnalysisMultinomial logistic regression with forward selection identified factors associated with MVPA-SB patterns.ResultsParticipants most frequently reported the optimal active + low SB pattern (37.8%). Modifiable factors significantly associated with suboptimal patterns included lower diet quality (odds ratios [OR] 0.18-0.62; P < 0.001), higher body mass index (BMI) (ORs 1.15-2.49; P = 0.001), less sleep (ORs 1.27-1.46; P = 0.0013), and higher perceived stress (ORs 1.20-1.52, P = 0.0015). Lower income (ORs 0.39-0.60, P = 0.0002), lower education (ORs 0.38-0.40; P = 0.0323) and working/studying full-time (ORs 1.42-1.97, P-0.0021) were also associated with suboptimal patterns.ConclusionsFuture research designing "sit less, move more" interventions following pregnancy and delivery could consider simultaneous intervention for modifiable factors and tailored strategies for low income/education and full-time working/student women who may face additional barriers.

PurposeTo evaluate the association of alcohol drinking behaviors with depression and sex differences among Brazilian adults.DesignCross-sectional study.SettingBrazilian National Health Survey of 2019.SubjectsPopulation-based sample of 88 531 Brazilian adults.MeasuresAlcohol drinking behaviors (heavy episodic drinking; alcohol-related impairment; alcohol-induced blackout), depression (Patient Health Questionnaire-9), and socioeconomic information (sex; age; education; income; geographic region; partner/spouse).AnalysisLogistic regression models for the association between alcohol drinking behaviors and depression in the total population, stratified by sex and with interaction effect between depression and sex. Models were adjusted by socioeconomic variables.ResultsHeavy episodic drinking was reported by 40.5% and associated with depression in the total population (Odds Ratio - OR1.31; 95%CI 1.14-1.51) and among women (OR1.30; 95%CI 1.10-1.54). Alcohol-related impairment was reported by 4.6% and associated with depression in the total population (OR2.47; 95%CI 1.88-3.23), among men (OR3.24; 95%CI 2.24-4.68) and women (OR1.85; 95%CI 1.27-2.70). Alcohol-induced blackout was reported by 9.7% and associated with depression in the total population (OR2.27; 95%CI 1.88-2.76), among men (OR2.39; 95%CI 1.82-3.12) and women (OR2.18; 95%CI 1.67-2.85). Men presented higher chance of alcohol-related impairment associated with depression than women (OR1.77; 95% CI 1.04-3.02).ConclusionSex differences in alcohol drinking behaviors associated with depression were observed. These results emphasize the need for gender-specific approaches to tackle issues on mental health and alcohol consumption.

This article argues that clinicians and researchers must apply the same evidence-based medicine (EBM) hierarchy to digital health interventions that they use for traditional treatments. When comparing interventions for the same clinical indication, evidentiary standards should not change based on delivery method - whether pharmacotherapy, psychotherapy, or digital therapeutics. The manuscript outlines the spectrum of digital health tools (Digital Health, Digital Medicine, and Digital Therapeutics) and examines the rigorous FDA approval process for digital therapeutics, which requires Phase III randomized controlled trials comparable to pharmaceutical standards. Using substance use disorder treatment as a concrete example, the article demonstrates the "evidence gap" between FDA-approved digital therapeutics with robust clinical trial data and unvalidated commercial apps that rely on testimonials or no published research. The framework extends to emerging artificial intelligence applications in therapeutic spaces. Finally, the article addresses systemic implementation barriers - including reimbursement uncertainty, limited provider awareness, and clinical workflow integration challenges - and practical considerations clinicians face when selecting digital tools, including cost-access trade-offs, engagement metrics, and professional liability concerns.

PurposeAssess burnout prevalence, identify the healthcare professionals experiencing burnout, and identify organizational predictors of burnout in community health centers (CHCs) nationwide.ApproachIn 2022 the Health Resources and Services Administration administered surveys to assess health center workforce well-being among the 1400+ community health centers that it oversees. Our team statistically evaluated the findings to isolate the factors likely to predict burnout among center healthcare professionals.SettingData completed by staff in 694 CHCs.ParticipantsRespondents were 52 568 healthcare professionals.MethodsChi-squared tests derived homogeneity in burnout among occupations; proportion tests evaluated differences in burnout indicators; and structural equation modeling with latent variables estimated direct and indirect effects of organizational burnout predictors and mediators.ResultsUp to 77% of direct clinical service professionals endorsed at least one symptom of burnout and reported higher burnout rates than management (P < .001). The most significant burnout predictors were engagement (-0.263***), work-life balance (0.281***), workload (0.174***) and professional growth (0.143***). For engagement, a perception of disconnection with the CHC predicted heightened burnout. Work-life balance, workload, and professional growth each had a positive effect on burnout, demonstrating that higher perceived work demands, greater work-life imbalance, and increased professional growth opportunities equated to higher burnout.ConclusionResults highlight the need to redesign healthcare delivery models to mitigate burnout, promote provider engagement and enhance workforce well-being.

PurposeThe media environment is a key structural factor that influences population knowledge, attitudes, norms, and health behaviors. This study examined changes in tobacco-related advertising for adolescents in California between 2017-18 and 2019-20, a period of significant advertising activities both promoting and discouraging tobacco use, from the tobacco industry and public health authorities, respectively.DesignRepeated cross-sectional study.SettingCalifornia Student Tobacco Survey in 2017-18 and 2019-20.SubjectsEighth, 10^th, and 12^th grade students (138 528 in 2017-18 and 160 350 in 2019-20).MeasuresSelf-report of exposure to and perception of whether advertisements mostly encouraged (pro) or discouraged (anti) vaping [or smoking].AnalysisWeighted percentages of ad exposure and ratios of anti-over-pro ads in 2017-18 and 2019-20 were compared.ResultsThe proportion of students reporting vape-related advertisement exposure increased from 42.2% in 2017-18 to 67.1% in 2019-20 (P < .001); those reporting cigarette-related advertisement exposure decreased (from 64.6% to 51.2%, P < .001). The ratio of anti-over-pro advertisement perception for vapes increased (from 1.43 to 2.28, P < .001) and the ratio for cigarettes decreased (from 3.75 to 2.55, P < .001).ConclusionsAdvertising activities from both the tobacco industry and public health authorities have reached adolescents. Adolescents' overall perception was that the tobacco-related media environment, while being generally anti-tobacco, had become more anti-vaping and less anti-smoking. The effects of these advertisements on tobacco use behaviors merit further investigation.