American Journal of Health Promotion最新文献

PurposeGrowing evidence suggests a bidirectional relationship between depression and obesity. This study examined the association between A Body Shape Index (ABSI) and depressive symptoms among U.S. adults and explored the mediating role of the triglyceride-glucose (TyG) index.DesignCross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES, 2005-2018).SettingUnited States, utilizing NHANES data collected between 2005 and 2018.Participants15200 non-institutionalized U.S. adults aged >=20 years with complete data on ABSI, depression (assessed by PHQ-9), and TyG index.MethodsMultivariate logistic regression, smooth curve fitting, subgroup/interaction analysis, and sensitivity analyses assessed the ABSI-depression link. Mediation analysis quantified the TyG index's role.ResultsAfter adjusting for potential confounders, a significant positive association was observed between ABSI and depressive symptoms. Participants in the highest ABSI quartile (Q4) had higher odds of depression compared to those in the lowest quartile (Q1). Subgroup and sensitivity analyses confirmed the robustness and independence of this association. Mediation analysis revealed that the TyG index partially mediated the relationship between ABSI and depression, with a mediation effect accounting for 5.31% of the total association.ConclusionThis large cross-sectional study highlights a significant association between higher ABSI and depressive symptoms among U.S. adults. These findings highlight the need for further research to explore underlying mechanisms and potential clinical implications.

ObjectiveTo provide a comprehensive overview of the global prevalence of Advance Care Planning (ACP) and its moderating factors through a systematic review and meta-analysis.Data SourcePubMed, Scopus, and Cochrane Library databases were searched for studies reporting ACP prevalence up to December 31, 2023.Study Inclusion and Exclusion CriteriaEligible studies included prospective and retrospective cohort studies, cross-sectional surveys, and randomized controlled trials (RCTs). Only English-language studies were considered. RCTs reporting prevalence in control or pre-intervention arms were included.Data ExtractionTwo reviewers independently evaluated studies using Rayyan software. Data extracted included article characteristics, population characteristics, ACP prevalence, and potential moderating factors.Data SynthesisA random-effects meta-analysis model estimated ACP prevalence. Univariate meta-regressions and multimodel inference explored potential moderators. Subgroup analyses were conducted based on populations and settings.Results92 studies involving 7 839 271 individuals were included. The overall meta-analytic estimate of ACP prevalence was 0.39 (95% CI: 0.32-0.46), adjusted to 0.09 after accounting for publication bias. Significant moderators included the proportion of oncologic patients and white ethnicity. ACP prevalence was lower in acute disease populations compared to chronic disease and general populations.ConclusionACP prevalence is low and stationary over time, potentially overestimated in chronic disease contexts. Facilitators such as supportive policies, public and professional education, and adaptive ACPs should be investigated to enhance ACP adoption.

PurposeTo examine the association between sociodemographic determinants and parent-reported up-to-date childhood vaccination status in Tennessee.DesignCross-sectional statewide survey.SettingAll 95 Tennessee counties, July 2022 to May 2024. Surveys were distributed at community outreach events (health fairs, Head Start programs, community baby showers), and community organizations (schools, daycares, and preschools).SampleParents or caregivers of children aged 18 years and younger (N = 8954).MeasuresThe primary outcome was parent-reported up-to-date childhood vaccination status. Covariates included child's age, health insurance status, parental race/ethnicity and education, household income, and rural/urban residency.AnalysisDescriptive statistics and log-binomial regression models were used to assess associations between sociodemographic factors and vaccination status. Stratified analyses were conducted by rural and urban status. Adjusted prevalence (aP) and 95% confidence intervals (CIs) with robust estimates were reported.ResultsOverall, 96.5% reported that their children were up-to-date on vaccinations. The lowest vaccination rates were observed among children of multiracial (86.4%), and Asian/Native Hawaiian/Pacific Islander (90.3%) parents. Children without health insurance had a significantly higher prevalence of under-vaccination (aP = 0.104; 95% CI, 0.079-0.137) compared to insured children (aP = 0.029; 95% CI, 0.025-0.033). Across both rural and urban areas, under-vaccination was significantly associated with insurance, race, and child age, while parental education was significant only in urban areas and household income only in rural areas.ConclusionsFindings highlight critical gaps in vaccine coverage tied to insurance, race, and age. Targeted outreach to underserved and low-education communities is needed to promote equity in childhood vaccination.

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.

ObjectiveReview studies targeting obesity/overweight among older rural adults to: (1) summarize obesity prevalence and identify high-risk groups in epidemiological studies, and (2) describe the types of obesity interventions and outcomes examined in this population.Data SourceCINAHL Ultimate, PubMed, Google Scholar, MEDLINE.Study Inclusion/Exclusion CriteriaInclusion criteria: peer-reviewed intervention/epidemiological studies in English, adults aged 50+ with overweight/obesity who were rural dwellers. Exclusion criteria: review/meta-analysis articles, child/adolescent obesity, youth or adults aged <50, examining obesity with other chronic conditions, published before the year 2000.Data ExtractionStudy population/design/methodology/results, publication year (2000-2024), type of intervention, methodology of epidemiological studies.Data SynthesisStudy characteristics and outcomes were summarized in the assessment/intervention matrix tables.ResultsSeventeen articles met the inclusion criteria: 6 epidemiological studies (US = 3, overseas = 3), 7 community-based interventions, 3 remote interventions, and 1 hybrid intervention. Epidemiological studies showed that the obesity/overweight prevalence ranged from 11.2%-64.6%. Women were consistently more likely to be obese/overweight than men. While one US study found significant associations between lower educational attainment and higher obesity rates, one non-US study reported no association between educational attainment and obesity. Community-based interventions with nutrition/exercise sessions and remote/hybrid interventions were reported to support weight and/or insulin resistance management.ConclusionFuture interventions should prioritize high-risk subgroups, such as American Indians/Alaska Natives, older women, and individuals with lower educational attainment.

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.

PurposeTo determine whether baseline body mass index (BMI) moderates BMI changes following completion of an exercise referral scheme (ERS).DesignRetrospective analysis.SettingData from the National ReferAll Database.Sample634 adults out of 39,283 (64% female; mean age 54 ± 15 years).InterventionParticipants completed a community-based ERS involving physical activity counseling and supervised exercise.MeasuresBMI was calculated as weight (kg) divided by height (m²) and participants were categorized by BMI: normal weight (<25.0 kg/m²), overweight (25.0-29.9 kg/m²), and obesity classes I (30.0-34.9 kg/m²), II (35.0-39.9 kg/m²), and III (≥40.0 kg/m²).AnalysisA 5 × 2 mixed methods analysis of covariance, adjusted for age, sex, ERS type, and follow-up duration examined BMI changes over time by group. Linear regression assessed the relation between baseline BMI and BMI change.ResultsBaseline BMI predicted BMI reduction (β = -0.07 ± 0.01, 95% CI: -0.09 to -0.04, P < .001). Compared to the normal weight group, individuals with obesity classes I-III had significantly greater reductions in BMI (mean difference range: 0.83-1.01 kg/m², all P < .001). No significant difference was observed between normal weight and overweight participants (P = .207).ConclusionThis study provides evidence that ERS can be effective in improving BMI outcomes among individuals who have an elevated initial BMI. These findings support the continued development and refinement of ERS as a scalable public health strategy to promote weight-related improvements.

Healthcare is among the fastest growing sectors utilizing artificial intelligence to improve efficiency, quality and accessibility to services. In particular, the role bots can play in creating greater access and scalability in mental health services is attracting growing investment along with greater scrutiny. This editorial explores the promises and pitfalls of using artificial intelligence to train chatbots to conduct health coaching services. Although bots can use relevant psychological principles to help with mental health issues, they do not have lived experience. Can age-old philosophical debates help to inform the way health coaching bots are trained and prompted?

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.