Perceived Parental Knowledge Reduces Risk for Initiation of Nicotine and Cannabis Vaping: A Longitudinal Study of Adolescents

Purpose This study examines the role of perceived parental knowledge on initiation of nicotine and cannabis vaping among youth. Design Longitudinal study from a self-administered online survey. Three waves of data collected in 6-month intervals. Setting 79 public and private schools in Texas. Participants Adolescents who self-reported never using e-cigarette to vape nicotine (n=1907; weighted sample [N] = 304371) or vape cannabis (n=2212; N=351955) at baseline. Participants were in 8th, 10th, and 12th grade at baseline. Measures Self-reported measures of nicotine and cannabis vaping. Analyses Weighted multivariate logistic regression models examined role of perceived parental knowledge at baseline (Spring 2016) as a predictor of nicotine and cannabis vaping initiation at 6-month (Fall 2016) and 12 month (Spring 2017) follow-up. Covariates were age, sex, race/ethnicity, and other tobacco use. Results Initiation rates were 5.9% for nicotine vaping and 8.6% for cannabis vaping, at 12-month follow-up overall. Higher perceived parental knowledge was associated with lower odds of nicotine vaping initiation at 6 months (adj OR: .69; 95% CI: .50-.93) and 12 months (adj OR: .68; 95% CI: .50-.92). Similarly, higher perceived parental knowledge was associated with lower odds of cannabis vaping initiation at 6 months (adj OR: .58; 95% CI: .38-.87) and 12 months (adj OR: .53; 95% CI: .38-.74). Conclusion E-cigarette prevention efforts directed at adolescents should incorporate parent engagement strategies as a method of increasing actual and perceived parental knowledge of their child’s location, activities and peer groups.

An Email Coaching Option Increases Participant Program Utilization and Coach Productivity

Purpose To assess impact of adding an email option to phone-based coaching on the number of coaching sessions completed. Design Retrospective analysis of a change in program design. Setting A health plan health and wellness coaching service. Subjects Six thousand six hundred twenty four individuals who scheduled at least one coaching session. Intervention Adding an email option to phone coaching May 1 to August 31, 2020. Measures Association of a participant using an email coaching option with completing 3 coaching sessions; overall number of participants completing 3 coaching sessions when email is offered; participant satisfaction rates; and, average number of participants coached per coach by month. Analysis χ2; linear and logistic regression with gender, age, and education as covariates. Results When we offered email coaching, 29.6% of eligible participants used the option, and compared with the same months the prior year, the proportion of participants completing 3 sessions during those months was higher (73% vs 67%). ( P < .0001) 96.5% of participants who used email, vs 92.0% who did not, completed 3 sessions before their employer’s benefit qualifying deadline. ( P < .0001) More than 85% who responded to the email coaching survey expressed satisfaction. On average, each coach served 43% (486 vs 340) more participants per month when we offered email coaching. ( P < .0001). Conclusion Adding email coaching to phone coaching can increase program utilization by individuals who use email, increase overall program utilization, generate high levels of participant satisfaction, and increase the number of participants served per coach.

Pathways to Employee Outcomes in a Workplace Health Promotion Program

Purpose This study examined the relationship between employee outcomes and employer implementation of evidence-based interventions (EBIs) for chronic disease prevention. Design Cross-sectional samples collected at 3 time points in a cluster-randomized, controlled trial of a workplace health promotion program to promote 12 EBIs. Setting King County, WA. Sample Employees of 63 small, low-wage workplaces. Measures Employer EBI implementation; 3 types of employee outcomes: perceived implementation of EBIs; perceived employer support for health; and health-related behaviors, perceived stress, depression risk, and presenteeism. Analysis Intent-to-treat and correlation analyses using generalized estimating equations. We tested bivariate associations along potential paths from EBI implementation, through perceived EBI implementation and perceived support for health, to several employee health-related outcomes. Results The intent-to-treat analysis found similar employee health-related behaviors in intervention and control workplaces at 15 and 24 months. Workplaces implemented varying combinations of EBIs, however, and bivariate associations were significant for 4 of the 6 indicators of physical activity and healthy eating, as well as perceived stress, depression risk, and presenteeism. We did not find significant positive associations for cancer screening and tobacco cessation. Conclusion Our findings support broader dissemination of EBIs for physical activity and healthy eating, as well as more focus on improving employer support for employee health. They also suggest we need better interventions for cancer screening and tobacco cessation.

Are Gross Motor Skill Interventions an Equitable Replacement for Outdoor Free Play Regarding Children’s Physical Activity?

Purpose The purpose of this study was to determine if children engaged in equal amounts of physical activity during an established gross motor skill intervention (the Children’s Health Activity Motor Program (CHAMP)) and outdoor free play. Design Cross-sectional study; sample: Ninety-nine children (Mage = 4.21, 51% boys) were randomly divided into two movement environments: CHAMP (n = 55) or control/outdoor free play (n = 44). Measures Physical activity was assessed using GT3X+ Actigraph accelerometers worn on the waist across four mornings. Average physical activity across the four days during either CHAMP or outdoor free play was extracted and categorized as light, moderate, vigorous, or MVPA. Physical activity data were reduced in the Actilife software using the cutpoints from Evenson et al. Analysis A 2 (treatment) x 2 (sex) mixed measures ANOVA was used to compare the amount of time children spent in light, moderate, vigorous, and MVPA. Results There was a significant main effect for treatment for light PA (F(3,95) =13.60, P<.001, partial η2=.125), and post hoc t-tests support that children in the control/outdoor free play group engaged in more light PA compared with children in CHAMP (t95 = −3.75, P<.001). Conclusions Results show that children in CHAMP engaged in less light PA but equal amounts of all other physical activity behaviors than their peers in outdoor free play.

A Shot of Faith—Analyzing Vaccine Hesitancy in Certain Religious Communities in the United States

Vaccine hesitancy in the United States continues to hamper ongoing coronavirus vaccination efforts. One set of populations with higher-than-average initial rates of vaccine hesitancy are certain religious groups, such as white evangelicals, African-American Protestants, and Hispanic Catholics. This article discusses the reasons underlying vaccine hesitancy in these populations, focusing on new trends in religious, political, and ideological beliefs that may influence vaccine acceptance. By using recent data and empirical case studies, this article describes how these trends could hinder the effectiveness of certain vaccine promotion strategies while also improving the potential efficacy of other forms of vaccine promotion, such as faith-based outreach. (100)

Persistent Barriers to Colorectal Cancer Screening Completion Amid Centralized Outreach: A Mixed Methods Study

Purpose To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices. Approach Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire. Setting Single urban academic healthcare system. Participants Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment. Method Using Andersen’s Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method. Results Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening. Conclusions Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.

Individual and Collective Positive Health Behaviors and Academic Achievement Among U.S. High School Students, Youth Risk Behavior Survey 2017

Purpose We examined associations between academic grades and positive health behaviors, individually and collectively, among U.S. high school students. Design Cross-sectional study design. Setting: Data were from the 2017 national Youth Risk Behavior Survey. Response rates were 75% for schools, 81% for students, and 60% overall (n = 14,765 students). Subjects Youth in grades 9th–12th. Measures We focused on youth behaviors that can prevent or delay the onset of chronic health conditions. Seven dietary, 3 physical activity, 2 sedentary screen time, and 4 tobacco product use behaviors were assessed. Variables were dichotomized (0/1) to indicate that a score was given to the positive health behavior response (e.g.,, did not smoke cigarettes = 1). A composite score was created by summing each positive health behavior response among 16 total health behaviors. Analysis Multivariable logistic regression analyses for each individual health behavior, and a multivariable negative binomial regression for the composite score, were conducted with self-reported academic grades, controlling for sex, grade in school, race/ethnicity, and body mass index (BMI) categories. Results Controlling for covariates, students who reported mostly A’s had 2.0 ( P < .001) more positive health behaviors; students who reported mostly B’s had 1.3 ( P < .001) more positive health behaviors; and students who reported mostly C’s had .78 ( P < .001) more positive health behaviors, compared to students who reported mostly D’s/F’s. Conclusions Higher academic grades are associated with more positive individual and cumulative health behaviors among high school students. Understanding these relationships can help inform efforts to create a healthy and supportive school environment and strive for health equity.

Motivations and Experiences in a Physical Activity Program for Cancer Survivors: Findings from Key Informant Interviews

Purpose LIVESTRONG at the YMCA is an evidence-based 12-week physical activity (PA) program for cancer survivors. The purpose of our study was to understand the factors that motivated cancer survivors to begin the program, how the program impacted their habits, and how their experience influenced their motivation to continue with the program. Approach or Design Key informant interviews Setting Phone interviews conducted between April 15 and June 1, 2020. Participants 27 cancer survivors in Texas who previously participated in the LS program. Method Participants completed a 30- to 60-minute interview with one of four interviewers. All interviews were recorded, transcribed, and analyzed for themes. Results Most interviewees were motivated to begin the program because of a desire to feel better after treatment. The most cited motivator to continue in the program was the community of cancer survivors. During the program, interviewees enjoyed learning different exercises, the community of cancer survivors, and the supportive teachers. Nearly all interviewees adopted or changed a healthy habit as a result of the program. Conclusion These results could be used by healthcare professionals to better understand what motivates cancer survivors to participate in a PA program. Results could also be used to plan or modify other PA programs for cancer survivors.

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions

Purpose Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. Design Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. Setting Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. Subjects Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). Measures Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. Analysis Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. Results The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen’s d .1-.2). Conclusions Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

The “Best of 2021 List” of Health Promotion Researchers

Each year the editorial team of the American Journal of Health Promotion selects our “Best of the Year List” of health promotion studies from the prior year. This editorial features the Editor’s Picks Awards, the Editor in Chief Awards, the Michael P. O’Donnell Award and the Dorothy Nyswander Award for the research and writing published in 2021 in this journal. Our criteria for selection includes: whether the study addresses a topic of timely importance in health promotion, the research question is clearly stated and the methodologies used are well executed; whether the paper is often cited and downloaded; if the study findings offer a unique contribution to the literature; and if the paper is well-written and enjoyable to read. Awardees in 2021 offered new insights into addressing discrimination against race or sexual identity, preferred sources of information about COVID-19 and the impact of community and workplace interventions on healthy lifestyles. This year’s award winning research spans from character to culture relative to improving well-being.