American Journal of Health Promotion最新文献

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.

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.