American Journal of Health Promotion最新文献

PurposeTo explore associations between adolescent's concern for their body weight/shape/size and engagement in unhealthy weight control behaviors (UWCBs).DesignSecondary data analysis.Setting2022 National Survey of Children's Health.SubjectsAnalyses included 23 357 (51.8% male) adolescents, ages 10-17 years (mean 13.8 ± 2.3 years).MeasuresReported concern for body weight/shape/size, and UWCBs including skipping meals/ fasting; low interest in food; picky eating; binge eating, purging; diet pills; and over-exercising.AnalysisLogistic regression models assessed the odds of engaging in UWCBs by reported concern for body weight/shape/size.ResultsEngagement in UCWBs was low with 21.1% reporting picky eating, 13.5% fasting, 11.7% low interest in food, 5.3% binge eating, and <2% purging, over-exercising, or using diet pills. Compared to adolescents who were not at all concerned about their body weight/shape/size, adolescents who were somewhat or very much concerned had significantly higher odds (P's < 0.05) of engaging in all UCWB outcomes except for using diet pills or laxatives, which was only significant for adolescents who reported being very concerned (OR = 12.74; CI: [19.16, 36.94]). Further, after stratification by gender and age, there was a significant p-for trend (P's < 0.05), in engagement in UWCBs by concern for body weight/shape/size except for using diet pills or laxatives in 10-11- and 12-14-year-olds.ConclusionExpressing concern for body weight/image/size is associated with an increased likelihood of engaging in UCWB in adolescents, regardless of gender or stage of adolescence.

PurposeStudents can serve as key advocates for healthier environments in their schools. This study employs the Youth Advocacy for Obesity Prevention Framework to investigate associations between advocacy skills for environmental and policy change and both self-efficacy and health behaviors, and explores applications of advocacy skills for health among 9-15 year-old elementary and middle schoolers.DesignConvergent, nested mixed-methods approach.SettingElementary and middle schools in a mid-Atlantic U.S. state.Subjects457 low-income elementary and middle students.MeasuresValidated questionnaires were administered to 457 students attending 33 elementary or middle schools serving low-income communities in 5 school districts, assessing self-efficacy for physical activity (PA) and healthy eating (HE), PA and HE behaviors, and advocacy skills. Semi-structured interviews with a subset of 199 students explored advocacy applications.AnalysisHierarchical linear regressions assessed associations between students' self-efficacy for PA and HE, PA and HE behaviors, and advocacy scores, accounting for school-level clustering and controlling for student factors (eg, gender, race, and BMI category). Integrated analysis of quantitative and qualitative data explored conceptualizations of advocacy skills.ResultsSelf-efficacy for PA (b = .24; P < .001), self-efficacy for HE (b = .39; P < .001), and engagement in PA (b = .10; P < .001) were associated with higher advocacy scores. Mixed methods findings further operationalized advocacy skills including leadership participation and history, self-efficacy for health promotion, and assertiveness in advocacy.ConclusionPromoting youth self-efficacy for health behaviors may enhance advocacy efforts for healthier school environments. Future research should further explore methods to foster youth advocacy and assess its impact on promoting healthier school environments.

Artificial intelligence (AI) is reshaping employer-sponsored mental health and well-being initiatives, offering new opportunities for personalized support, early detection, and scalable interventions. Yet the rapid expansion of AI tools raises critical concerns regarding clinical effectiveness, data privacy, equity, and responsible use. This editorial synthesizes insights from the Spring 2025 Health Enhancement Research Organization (HERO) Think Tank, which convened experts in mental health, AI, ethics, and workplace well-being to identify guardrails for safe and equitable implementation. Key recommendations include establishing rigorous clinical validation standards, ensuring human oversight and transparent communication, conducting regular bias and fairness audits, strengthening data privacy and consent practices, and countering AI-generated misinformation through digital literacy efforts. Employers are encouraged to adopt governance structures, pilot and evaluate AI tools, and develop ethical procurement practices. By proactively shaping policy and organizational practices, employers can harness AI's potential while protecting trust, human dignity, and workforce well-being.

PurposeGraphic warning labels (GWLs) are widely employed to communicate smoking-related health risks. Most GWLs elicit a high level of emotional reaction (ER). Our recent study showed poorer efficacy of high-ER GWLs vs low-ER ones during a month-long naturalistic exposure. Here, we aimed to examine whether GWL effects persist after discontinuing the exposure.DesignA secondary analysis investigated the delayed GWL effects on smoking severity.SettingPhiladelphia Metropolitan Area, United States.Subjects96 adult smokers who completed a month-long exposure to high-ER or low-ER GWLs.MeasuresThe number of cigarettes smoked per day (CPD) was measured immediately and 4 weeks after the end of GWL exposure. Participants also indicated their subjective feeling of being relieved from having to see the GWLs.AnalysisGeneralized estimating equations examined the change in CPD across time and its association with sense of relief.ResultsWe found a significant reduction in CPD from the immediate to the 4-week post-exposure timepoint (11.69 vs 10.30, P = 0.001). There was no difference between the high-ER and low-ER groups in CPD reduction (P = 0.74). Higher sense of relief was associated with greater CPD reduction in the high-ER group (z = -2.14, P = 0.033).ConclusionOur study suggests lasting impact of GWLs on smoking behavior. The findings may be particularly important to high-ER GWLs, which appear less effective in reducing smoking during active exposure.

PurposeThis study examines whether loneliness mediates the association between food insecurity and multiple sleep problems.DesignQuantitative, cross-sectional.SettingData were drawn from the 2021/22 wave of the UK Household Longitudinal Study, which-for the first time in the main survey-included a validated measure of food insecurity.SubjectsThe analytic sample included 21,650 individuals aged 18 and older.MeasuresSleep problems were assessed across six dimensions using items from the Pittsburgh Sleep Quality Index. Loneliness was measured using the UCLA three-Item Loneliness Scale. Food insecurity was assessed using the Food Insecurity Experience Scale. Sociodemographic variables were included as covariates.AnalysisOrdinary Least Squares and logistic regression models were used to examine associations between food insecurity and sleep outcomes. The Karlson-Holm-Breen method was employed to assess mediation by loneliness.ResultsIndividuals experiencing food insecurity reported worse outcomes across all sleep problems compared to those without food insecurity (from b = .154, P < .001 for greater daytime dysfunction to b = .470, P < .001 for longer sleep latency; OR = 2.531, P < .001 for short sleep duration). Loneliness mediated all associations, explaining between 14.75% and 27.24% of the total effect.ConclusionPublic health interventions that address both food insecurity and loneliness may help improve sleep health.

PurposeA case example describing a teen-led council convened by an integrated health system. We seek to share the approach and impact of this work with the broader health services and promotion field.Approach or DesignA stakeholder-informed formative evaluation.SettingIntegrated health system in Upper Midwest.ParticipantsProgram staff, a program alumna, external program partners, subject matter experts, and current council members.MethodThis evaluation was informed by a literature review, data previously collected by the program, key informant conversations, and a participatory data collection activity with current council members. Rapid qualitative analysis was used to describe council framework and stakeholder-identified outcomes.ResultsInformed by best practices in authentic youth engagement and youth-adult partnership, this council has had a positive impact on participants, the convening health system, and the community served by the health system, in service of adolescent health and well-being.ConclusionThis formative evaluation demonstrates how youth are able to take on a leadership role and have a positive impact on adolescent care delivery and health promotion.

PurposeScreening for chronic conditions such as diabetes, high blood pressure and high cholesterol during a voluntary wellness program visit.DesignObservational study based on secondary data collected between 2000 and 2017.Setting and sampleData included 4876 visits from 2309 unique participants, all employees of an academic institution in United States.MeasuresWe leverage clinical guidelines to define criteria for classifying a patient as susceptible, or not, to a chronic disease.AnalysisWe perform descriptive statistics and logistic regression to quantify the association between patient characteristics and their susceptibility to chronic conditions.ResultsThe prevalence of susceptibility for diabetes is 17.03% (18.29%) for one-time (frequent) participants, for high blood pressure is 44.76% (48.27%), and for high cholesterol is 8.97% (7.33%). The risks of diabetes and high blood pressure increase with age, and all three risks increase with BMI. Being female is associated with a lower risk of diabetes and high blood pressure. Race is generally not associated with a higher risk of chronic conditions, except for high blood pressure. We also find that each of the three risks is positively and strongly associated with the other two.ConclusionOur study provides evidence that wellness program checks can serve as viable screening opportunities for alerting participants when their health exhibits concerning signs associated with chronic diseases.

PurposeDescribe the Perspectives of Psychiatry approach and how it was integrated into an employer-based mental health engagement program.DesignRetrospective cohort study.SettingWorkplace-based.Sample913 employees.InterventionThe Johns Hopkins Balance program is a novel, employer-initiated mental health engagement program. The Balance program integrates the Perspectives of Psychiatry (Perspectives) ideology for mental health care and takes a population health and psychoeducational approach to screening and care connection.MeasuresUtilization and engagement rates, algorithm-based mental health symptom risk, Perspectives-based risk.AnalysisChi squared tests for risk categorization associations, odds ratio high risk categorization, frequency and percentage of referral types.Results94% (860/913) of participants who registered completed the Balance assessment and 14% (130/913) completed a care concierge visit. Referrals were placed for 69% (90/130) of employees who completed a care concierge visit. A person identified as high risk by the standardized assessments had 6.74 (4.38, 10.71) times the odds of endorsing a concern on at least one of the Perspectives. An additional 28 participants were identified as high risk based on their own concern after scoring low risk on the standardized assessment. Of the 117 referrals placed, 96.6% (113/117) were in individuals scoring high risk on the assessment.ConclusionA population health and psychoeducational approach to employer-based mental health engagement can successfully identify risk and connect employees to care.

PurposeTo identify food decision-making profiles for adults with T2DM and overweight/obesity based on nutritional health and decision process, and to explore differences in health outcomes among profiles.DesignCross-sectional.SettingPrimary healthcare settings.Subject105 adults with T2DM and overweight/obesity (90.52% retention).MeasuresNutritional health and decision process were assessed through the Food Choice Task, indicated by healthy decision rate and reaction time respectively. Health outcomes included clinical (HbA1C, fasting blood glucose, BMI) and psychological (diabetes management self-efficacy, food choice motives) measures.AnalysisHierarchical cluster analysis was used to identify profiles according to nutritional health and decision process. Welch's ANOVA were used to test their differences in health outcomes.ResultsFive profiles were identified: Cautious (healthy choice + slow reaction, 42.86%), Moderate (moderate healthy choice/reaction time, 28.57%), Well-Habit (healthy choice + fast reaction, 11.43%), Strained (unhealthy choice + slow reaction, 7.62%) and Impulsive (unhealthy choice + fast reaction, 9.52%). The Well-Habit Profile exhibited the best outcomes, including lower BMI, higher self-efficacy and healthier food choice motives. The Cautious Profile showed healthy choices but suboptimal self-efficacy. The Impulsive Profile presented a good self-efficacy, but the highest BMI and inadequate healthy choice motives.ConclusionThis study identified five food decision-making profiles for adults with T2DM and overweight/obesity, providing insights of considering both nutritional health and decision process as food choice features when conducting dietary interventions. Limitation included the small sample size and limited settings.