American Journal of Health Promotion最新文献

PurposeThis research investigates the perceived benefits and challenges of participating in the Supplemental Nutrition Assistance Program (SNAP) among households with young children across urban and rural Nebraska, aiming to address the limited exploration of disparities in its reach.DesignCross-Sectional (SNAP-Ed Needs and Assets Assessment).SettingHouseholds across Nebraska.ParticipantsLow-income families with at least 1 child aged 6 or younger (n = 1040).MeasuresPerceived benefits and challenges to SNAP participation across urban-rural populations, controlling for race, income, and education.AnalysisChi-square tests and logistic regression with Benjamini-Hochberg correction.ResultsOverall, financial need was perceived as the top reported benefit, while time and efforts for recertification were the top challenge. Rural residents perceived financial need (P < 001) and ability to have enough healthy food (P < 05) as major drivers for SNAP enrollment, whereas urban residents perceived previous SNAP-Ed participation (P < 001) and positive peer influence (P < 01) as benefits. Rural respondents perceived greater challenges in SNAP application requiring more time and effort (P < 001), while urban respondents had significantly higher concerns about native language accessibility (P < 001), poor customer service (P < 05), and unwillingness to depend on government agencies (P < 05).ConclusionGeographically and culturally tailored SNAP-Ed interventions and streamlined application processes are required to address the urban-rural disparities.

PurposeTo evaluate the association between demographic characteristics and weight-loss in response to financial incentives designed using behavioral economics.DesignRetrospective analysis of randomized clinical trial (RCT).SettingFIReWoRk RCT (NCT03157713), which found that financial incentives were more effective than provision of weight-management resources only for weight-loss.Subjects668 adults with obesity (221 in resources-only group, 447 in incentive groups) living in low-income neighborhoods.MeasuresDemographic characteristics and weight-loss.AnalysisLinear mixed-effects models with interaction terms to examine effect of incentives on weight-loss in different demographic groups.ResultsMean age of participants was 47.69 years, 81.0% were women, 72.6% were Hispanic, and mean BMI was 37.95 kg/m². Financial incentives increased percent weight loss at 6 months (difference in percent weight loss between financial incentive and resources-only group = -2.41%; 95% CI -3.23% to -1.58%). In fully adjusted models, participants who were Black lost less weight than participants who were White (difference in percent weight loss = 2.12%; 95% CI 0.25% to 3.99%). Differences in percent weight loss by sex, age, education and neighborhood income were absent. Models that tested for interactions between group assignment and percent weight loss did not demonstrate evidence of a heterogenous effect of incentives in sociodemographic subgroups.ConclusionBlack participants in the FIReWoRk intervention lost less weight than White participants, but effectiveness of financial incentives generally did not vary significantly by sociodemographic characteristics. However, it remains important to evaluate potential impacts of financial incentive programs on health disparities.

PurposeTo examine if perceived harm moderates the relation between grade level and past 30-day use of electronic cigarettes for a nationally representative sample of youth in the United States.DesignSecondary data analysis of the 2022 National Youth Tobacco Survey (NYTS); a cross-sectional survey.SettingYouth in the United States.ParticipantsA nationally representative sample of the students in private and public schools, grades 6^th-12^th, collected via online questionnaire that included 341 schools and 28 291 participants.MeasuresDemographic variables and covariates (ie, sexual identity, sex, race/ethnicity), independent variables (ie, grade level 6-12, perceived harm of using electronic cigarettes) and dependent variable (ie, past 30-day use of electronic cigarettes).ResultsA binary logistic regression, including interaction F(6, 131) = 1.87, P = 0.000, indicated that perceived harm moderated the relation between grade level and electronic cigarette use in the past 30 days. As grade level increased so did the probability of using electronic cigarettes; however, the tested model extended these findings by including perceived harm as a moderator. Thus, the model allowed testing differences within and between grade levels. The highest probability of electronic cigarette use was for youth in 12^th grade with low perceived harm whereas the lowest use was in 6^th grade, regardless of perceived harm level.ConclusionWe believe our findings present novel ways to approach adolescent electronic cigarette health promotion, prevention, and education with the goal of influencing perceptions of harm for electronic cigarette use, especially with youth at lower grade levels.

PurposeTo investigate the impact of illness perception and its three measures on vaccination in patients with cardiovascular disease (CVD), and the importance of each influencing factor.DesignA cross-sectional survey.SettingThis study was conducted in two large comprehensive medical institutions in Jiangsu Province, China.Sample602 eligible patients with CVD were recruited from cardiovascular departments.MeasuresA self-administered questionnaire with feasible reliability and validity was used to investigate the demographic characteristics and illness perception.AnalysisBinary logistic regression analyses were performed using intention (total population) and behavior (willing population) as dependent variables and illness perception and its three measures as independent variables. Furthermore, the importance of the variables was ranked using a random forest model.ResultsIllness perception in patients with CVD negatively influences vaccination intention (OR = 0.560, 95%CI: 0.496.0.633, P < 0.001) and actual vaccination behavior (OR = 0.780, 95%CI: 0.675, 0.900, P < 0.001). In the order of importance of the influencing factors, illness perception was dominant. Among the specific measures of illness perception, cognitive response and emotional response were more important than illness comprehensibility.ConclusionsThis study identified a negative association between illness perception (across all three measures and both influenza vaccination intention and behavior. Assessing the level of illness perception in patients can help identify those who are reluctant to receive the vaccine. The association between illness perception and vaccine hesitancy should be considered when developing future intervention strategies for influenza vaccine hesitancy in patients with CVD.

PurposeTo investigate the trust levels in health information sources from a United States (U.S.) sample, and to examine the relationships between trust in healthcare professionals (HCPs) and perceptions of modifiability of dementia and stroke risks through maintaining or changing lifestyle habits.DesignCross-sectional.SettingA survey distributed via the vendor platform Prolific to a sample of the U.S. population.ParticipantsData included on U.S. adults (n = 1478) in 2023.MeasuresOutcome variables were perceiving that dementia and stroke risk can be modified through maintaining or changing lifestyle habits. Independent variables were trust levels in HCPs.AnalysisDescriptive analysis was performed to assess levels of trust in information sources. Subsequently, we performed multivariable regression analyses between trust in HCPs and perceptions of risk modifiability in dementia and stroke. A hierarchal cluster analysis was conducted to characterize trust patterns in this cohort.ResultsParticipants with high trust in HCPs compared to those with low trust in HCPs were more likely to perceive that maintaining (adjusted odds ratio [aOR] = 1.57, 95% confidence interval [CI]:1.15-2.12) and changing lifestyle habits (aOR = 1.72, 95% CI: 1.26-2.33) could reduce risk of dementia. Similar associations were found for perceptions of stroke risk reduction through maintaining (aOR = 1.49, 95% CI: 1.07-2.04) and changing (aOR = 2.68, 95% CI: 1.72-4.12) lifestyle habits. Cluster analyses identified three trust patterns amongst the participants: (i) a generally trusting cluster, (ii) a trusting of "official" health sources only cluster, and (iii) a generally not trusting cluster.ConclusionThis study found statistically significant associations between trusting HCPs and the perceptions that maintaining or changing lifestyle habits can modify risks of dementia and stroke, highlighting the importance of trust when developing preventive strategies.

PurposeArtificial intelligence (AI) is increasingly integrated into healthcare, including psychiatric care. This study evaluates ChatGPT-4o's reliability in answering frequently asked antidepressant-related questions by comparing its performance with psychiatrists across four key dimensions: accuracy, conciseness, readability, and clarity.DesignA comparative study analyzing ChatGPT-4o-generated responses and those of psychiatrists with at least five years of clinical experience.SettingParticipants were recruited through institutional and professional networks and provided with standardized questions derived from authoritative treatment guidelines.SubjectsTwenty-six psychiatrists participated, and ChatGPT-4o responses were generated using a standardized prompt for each question.MeasuresTwo independent psychiatrists evaluated accuracy and conciseness using a blinded rating system. Readability was assessed with the Flesch-Kincaid Grade Level test, and clarity was measured with the Writing Clarity Index Calculator.AnalysisThe Shapiro-Wilk test assessed normality. Paired t-tests were used for normally distributed data, and the Wilcoxon signed-rank test for non-normally distributed data. Statistical significance was set at P < .05.ResultsChatGPT-4o showed comparable accuracy to psychiatrists (P = .0645) but was significantly more concise (P = .0019). Readability differences were not statistically significant (P = .0892), while psychiatrists provided clearer responses (P = .0059).ConclusionChatGPT-4o delivers accurate and concise responses, highlighting its potential as a patient education tool. However, psychiatrists offer greater clarity, underscoring the indispensable role of clinical expertise in psychiatric care.

PurposeTo evaluate change in home radon testing after initiation of a public library radon detector lending program (LLP) in four rural counties; and describe the impact of LLP promotions on check-outs.DesignLongitudinal tracking of radon testing and description of LLP promotions.SettingFour rural Kentucky counties.Sample14,697 radon tests pre-LLP (charcoal-based test kits); 12,707 radon tests post-LLP (detector check-outs plus charcoal-based).InterventionLLP and promotional strategies including direct mail, radio, newsletters, social media, and in-library promotions and training.MeasuresRadon detector check-outs (03/2023-11/2024) comparing counties with and without LLP.AnalysisExamined change in radon testing pre- and post-LLP implementation using incidence rate ratios. Evaluated number of check-outs following promotions.ResultsThere was a 2.5-fold increase in the rate of radon testing in the four study counties (RR=2.5, 95% CI: 2.27-2.76; p<.001), while the testing rate fell in non-study counties. Two study counties exceeded their check-out goals multiple months in a row following direct mail campaigns. Social media, in-library signage, and billboards were reported most effective at promoting the program. The proportion of county-level renter-occupied housing fluctuated, potentially affecting differences in library check outs.ConclusionLLPs show promise in maximizing access to population-based radon testing. Mailing postcards to residents had a sustained impact on detector check-outs over 3-5 months in some counties.

Scientists are experiencing unprecedented challenges to the time honored conventions that usually guide consensus building and health communications. This editorial offers a primer on this journal's peer review process and argues that professional societies, the private sector and non-governmental organizations need to fill the void being created by disinvestments in our federal and state public health infrastructure. The process that guides our peer reviewers and composite reviewers is described. The vital importance of peer reviewers sharing their expertise with fellow scientists via narrative feedback on studies is emphasized. An interview with an exemplary composite reviewer, our Associate Editor in Chief, Dr Kerry Redican, is offered as a way to underscore the rigor needed to preserve the integrity of the scientific method at a time when science is being threatened by ideological clashes.

PurposeClinical firearm safety counseling can help prevent firearm injuries, yet many clinicians have not adopted this practice. We collected practical tips from physicians who do such counseling to help others interested in conducting such counseling while perhaps feeling insecure about how to implement it.DesignQualitative interview study.Setting/ParticipantsSixteen physicians who had made clinical firearm safety counseling part of their practice.MethodsAn interview guide included questions about how, when, and with whom participants were undertaking firearm safety counseling, motivations, experiences with the counseling, patient reactions, and barriers and facilitators. The interviews were analyzed using inductive thematic analysis.ResultsMost (11 out of 16) physicians were in primary care/family medicine or pediatrics; 54% worked in urban, 27% in rural/small town, and 20% in suburban settings. Three takeaways were reported by virtually every participant: firearm safety counseling is not difficult; almost all patients react positively, and occasional skeptical reactions are easily defused; and this counseling does not take much time. Participants kept conversations nonjudgmental and focused on safety, not on firearm ownership itself. Participants' strong convictions that it was their responsibility to address firearm safety helped them overcome barriers such as lack of time, training, and guidelines.ConclusionParticipants shared actionable ideas on how to facilitate firearm safety counseling, exemplifying ways to encourage firearm safety behaviors.