BackgroundAdults with disabilities in the United States experience disproportionately high rates of depressive disorders due to various biopsychosocial factors.PurposeGuided by the ecological systems framework, this study examined the mediating role of healthcare access and the moderating effect of physical activity (PA) in the association between body mass index (BMI) and depressive disorders among U.S. adults with disabilities.MethodsData were drawn from the 2020-2023 Behavioral Risk Factor Surveillance System (N = 305,633). Logistic regression and moderated mediation were conducted using JASP, controlling for sociodemographic covariates.ResultsFemales (OR = 1.791), cognitive disability (OR = 4.142), and healthcare access (OR = 1.631) were associated with greater odds of depressive disorders. In contrast, PA (OR = 0.973), older age (OR = 0.420), and higher income (OR = 0.864) were protective. BMI had a direct effect on depressive disorders (beta = .070) and an indirect effect through healthcare access (beta = .002), moderated by PA, such that higher activity levels weakened the direct effects of BMI on depressive disorders.DiscussionFindings emphasize multilevel biopsychosocial factors influencing depressive disorders within ecological systems.Translation to Health Education PracticeInterventions should promote inclusive, disability-sensitive programs integrating weight management, PA, and mental health education.
Background The morbidity of adolescent overweight and obesity has escalated into a pressing global epidemic, adversely impacting physical health and contributing to a spectrum of psycho-logical issues. It is crucial to identify effective intervention strategies aimed at enhancing the mental health of these adolescents. As digital behavior technology develops, physical activity (PA)-based digital health (DH) has gained attention as a promising approach due to its convenience and accessibility. Purpose Existing data concerning the efficacy of this intervention in addressing mental health issues among overweight and obese adolescents present inconsistent findings. This study systematically evaluated the effects of PA-based DH interventions on the psychological status of over-weight and obese adolescents, aiming to provide health and physical educators with actionable insights to inform intervention design and program planning. Methods The review, registered on PROSPERO, included comprehensive searches for Embase, PubMed, Web of Science, and the Cochrane Library to locate eligible randomized controlled trials (RCTs) and quasi-experimental studies aimed at assessing how PA-based DH influence psychological outcomes among overweight and obese adolescents. The Cochrane ROB-2 tool was utilized for evaluating the risk of bias. Seventeen studies satisfying all inclusion criteria were identified. Data were construed through the random effects model (REM) via the Review Manager software. Results The meta-analysis includes 17 studies involving 970 participants. PA-based DH interventions targeting psychological well-being significantly improved self-efficacy (SMD = 0.44, 95% CI [0.11, 0.77], p = .009), depression (SMD = -0.47, 95% CI [-0.87, -0.06], p = .02), and psychosocial outcomes (SMD = 0.60, 95% CI [0.06, 1.14], p = .03). However, no significant effects were observed on self-esteem (SMD = 0.46, 95% CI [-0.02, 0.94], p = .06), quality of life (QOF, SMD = 0.34, 95% CI [-0.11, 0.79], p = .14), and stress (SMD = -0.16, 95% CI [-0.49, 0.18], p = .36). Discussion PA-based DH demonstrates effectiveness in enhancing self-efficacy, reducing depression, and improving psychosocial outcomes for overweight or obese adolescents. However, its effects on self-esteem, QOF, and stress levels are still inconclusive and need indepth investigation. Greater focus should be placed on the design of DH programs, including intervention cycles, frequencies, session duration, dose effects, and long-standing interventions, aimed at optimizing the design and effectiveness of future interventions.
Background: Type 1 Diabetes Mellitus (T1DM) demands lifelong insulin adherence, yet glycemic control remains suboptimal especially in urban adult population where socio-economic and lifestyle factors add complexity. Purpose: To investigate the factors interfering with adherence to dietary glycemic control among adults with T1DM patients. Methods: A cross-sectional quantitative study of 200 urban T1DM adults used structured questionnaires, including the Morisky medication adherence scale, with data analyzed through descriptive and inferential statistics. Results: 77.1% of participants exhibited low adherence. Significant associations were found between adherence and factors such as age, gender, education, income, and food habits (p < .05). Psychosocial, financial, medication, and patient-related factors significantly influenced adherence, while healthcare access did not show a statistically significant impact. Conclusion: Adherence to dietary glycemic control in T1DM is influenced by a complex interplay of behavioral, socio-economic, and cultural factors. Interventions must be context-specific, incorporating financial support, behavioral counseling, and culturally sensitive education to improve outcomes. Translation to Health Education Practice: The study's findings highlight the need for tailored health education interventions that address psychosocial, financial, and behavioral barriers to glycemic control. Empowering patients through culturally sensitive education and self-management support can significantly enhance adherence and improve long-term outcomes in Type 1 diabetes Mellitus (T1DM) care.
Background Women face unique health challenges that are often compounded by gaps in reproductive and preventive health knowledge. Women's Health Day (WHD), a single-day university-based event, was developed to provide women's health education while facilitating access to preventive health. Purpose To evaluate the effectiveness of WHD in improving students' awareness of women's health topics. Methods Participants (n = 340) rotated through interactive educational tables addressing women's health topics and were provided with free health services and products. Pre- and post-event questionnaires assessed self-reported awareness of ten health topics using a 5-point Likert scale. Results Awareness significantly increased across all topics, including contraception, STIs, breast and cervical cancer screening, menstrual health, reproductive anatomy, and mental health (p < .001). Baseline awareness was lowest for breast and cervical cancer screening, which showed the greatest post-event increases. Sixty-one participants received preventative services and 259 received health products. Discussion This study supports the use of WHD as an efficient strategy for promoting women's health awareness and preventative health behaviors. Translation to Health Education Practice Similar programming may be implemented by health educators in university and community settings to enhance women's health education and improve access to preventive care.
Background: In advancing best practices of diabetes empowerment education programs such as DEEP (TM), capacity building in-network from systems theory underscores the importance of continual learning about program delivery among implementing organizations. Purpose: As part of HEART ATX, a community health worker (CHW)-led initiative aimed at promoting health of at-risk populations in Texas, we examined the impact of DEEP (TM) on diabetes prevention and self-management practices and related factors among ethnically diverse adults, along with participant highlights and improvement recommendations. Methods: A one-group pretest/posttest, mixed-methods design was implemented based on a pooled analysis of self-report data from DEEP (TM) classes implemented 2021-24. Results: Participants (n = 336; 81.0% female; mean 59.6 years) reported significant increases in fruit/vegetables consumed (p < .001), food portion measuring and counting carbs (p <= .003), and physical activity (p < .001), and significant decreases in sugary drinks (p < .001). Significant improvements were also found in diabetes knowledge (p = .028) and perceived problems (p < .001). Class highlights included: participatory nature, goal-setting, and social support. Recommendations included: schedule flexibility, more experiential activities, and participants as change agents. Discussion: Findings provide practice-based evidence of CHW-implemented DEEP (TM) for diabetes prevention and management among urban-based, ethnically diverse adults.
BackgroundYouth with behavioral health challenges, such as major depressive, generalized anxiety, or attention deficit disorders, often experience reduced health-related quality of life (HRQoL). Integrated care models grounded in the wraparound approach offer coordinated, family-centered strategies to address complex behavioral and physical health needs.PurposeThis report details a Certified Health Education Specialist (CHES (R))-led health education intervention within a wraparound-based behavioral health home (BHH) and explores its impact on youth HRQoL using the Pediatric Quality of Life Inventory (TM) (PedsQL (TM)).MethodsSince 2014, a BHH providing health education within a Wraparound-based care management system utilized the PedsQL (TM) 4.0 for internal program evaluation. Paired pre- and post-intervention data were reviewed to assess changes in physical (physical functioning), psychosocial (emotional, social, and school functioning), and overall HRQoL.ResultsSignificant improvements were observed across all HRQoL domains following participation in Wraparound-based integrated care.DiscussionFindings support the effectiveness of wraparound-based integrated care in improving youth well-being within behavioral health systems.Translation to Health Education PracticeHealth education and CHES (R) professionals played a fundamental role in this wraparound-based integrated care program. CHES (R) professionals are well positioned to develop, implement, and sustain holistic, integrated care frameworks that enhance HRQoL and strengthen responses to youth behavioral health needs.
Background: Awareness that heart disease is the leading cause of death declined from 65% in 2009 to 44% in 2019 among women over the age of 25. It is unclear whether this decline has disproportionately affected Black women who have a higher risk of heart disease than White women. Purpose: This study examined the possible race and sex differences among young adults regarding their awareness of heart disease as the leading cause of death, their concern about developing heart disease, and their motivation to improve their heart health and reduce their heart disease risk. Methods: A cross-sectional survey was distributed to 404 young adults who were Black or White and aged 20 to 39. Results: Racial disparities were not reflected in awareness or motivation to improve heart health or reduce disease risk. However, Black respondents reported lower levels of concern about developing heart disease compared to White respondents. Discussion: A lack of concern may contribute to worse heart health among young Black women. This is alarming given that this population is disproportionately affected by heart disease. Translation to Health Education Practice: Health educators need to tailor messaging and advocacy strategies to raise Black women's awareness of their heart disease risk.
Background Emotional dysregulation, defined as difficulties in monitoring, evaluating, and modulating emotional responses in accordance with situational demands, has been increasingly linked to psychosocial functioning among university students. Purpose This study examined the association between leisure-time engagement, leisure satisfaction, physical activity, and emotional dysregulation among undergraduates in a Nigerian university context. Methods Using a cross-sectional correlational design, involving 446 students using stratified random sampling techniques. The Brief Emotional Dysregulation Scale (BEDS), Leisure Satisfaction Measure (LSM), and Physical Activity Questionnaire (PAQS) were used in data collection. Descriptive statistics were used to determine prevalence rates, while Pearson correlation, multiple regression, and moderation analyses were conducted using the Hayes PROCESS Macro to examine relationships among the study variables. Results The prevalence of moderate emotional dysregulation was 59.6 (20.1% reporting low and 20.2% reporting high levels). There was a positive relationship between leisure satisfaction and physical activity (r = .41, p < .01) and negative relationship between leisure satisfaction and emotional dysregulation (r = -.34, p < .01). Emotional dysregulation was also negatively correlated with physical activity (r = -.55, p < .01). Moderation analysis revealed that the positive influence of satisfaction with leisure on emotional regulation was enhanced by the promotion by physical activity (beta = .72, p = .05). Conclusion The findings underscore the significance of structured leisure activities and regular exercise in promoting emotional stability among university students. Translation to Health Education Practice Interventions that encourage balanced leisure and physical activity would significantly help reduce emotional dysregulation, thereby improving students' mental health and academic performance. These relationships should be further investigated in future research in different populations and settings.
BackgroundApproximately 12% of U.S. adults have mobility limitations, a group that may be at increased risk for poor bone health. Despite the importance of bone mineral density (BMD) as an indicator of skeletal health, recent syntheses of how BMD has been examined in this population are lacking.PurposeTo examine the literature regarding BMD among people with specific mobility limitations including spinal cord injuries (SCIs).MethodsMEDLINE, PubMed, and CINAHL were searched for studies published between 2014 and 2025. Twenty-five studies met the inclusion criteria.ResultsStudies consistently reported lower BMD in people with mobility limitations compared to those without mobility limitations. People with higher severity and duration of disability had lower BMD. Physical activity exerted a positive influence on BMD. Limitations of studies examined included small sample sizes and underrepresentation of female participants.DiscussionEvidence indicates consistently reduced BMD and elevated osteoporosis burden among adults with mobility limitations, with low BMD risk enhanced by severity and duration of disability and modifiable behaviors.Translation to Health Education PracticeFindings support targeted screening, tailored physical activity promotion, nutrition and risk factor counseling, and advocacy for research and programs that adequately represent women and incorporate sex-specific assessment of bone health needs.
BackgroundUniversities are well suited for tobacco-free advocacy efforts; university tobacco policy can change social norms around tobacco use, reduce secondhand smoke exposure, and help prevent occasional tobacco users from transitioning to daily use.PurposeThis study took place in 2019 at a Midwestern public regional comprehensive university as part of a campaign to update campus tobacco policy. Researchers sought to increase the visibility of tobacco waste on campus under the current policy.MethodsResearchers invited undergraduate students to create collages using nonhazardous tobacco waste collected on campus and participate in focus group discussions about their experiences. After verbatim transcription, researchers conducted template analysis to identify key themes.ResultsUndergraduate students (N = 16) shared concerns about human health and the natural environment on campus. Though students were passionate about reducing tobacco use on campus, they were uncertain that policy changes would be effective.DiscussionIn addition to engaging students in advocacy, policy change, and research, collages were displayed on campus and via social media. Students were able to create art to express their feelings about tobacco use and contribute to successful efforts to update university policy.Translation to Health Education PracticeCollage can be an effective way to elicit discussion and create powerful visuals to use in advocacy. Engaging young adults in policy advocacy as students and increasing their civic engagement may help them develop skills and self-efficacy for advocacy activities in the future.
Background: Energy drinks (EDs) are a broad category of beverages that typically include high levels of caffeine along with taurine, simple sugars, inositol, B vitamins, flavorings, preservatives, and acidity regulators. Purpose: This study aimed to assess how the Theory of Planned Behavior explains energy drink consumption among college students in the Kurdistan Region of Iraq, examining the effects of attitude, subjective norms, and perceived behavioral control on consumption intentions and behavior, and the influence of past consumption on recent use. Methods: This cross-sectional study was conducted among 726 participants at Raparin University between September 2025 and December 2025.ResultsThe mean age of the students was 21.03 years (95% CI: 20.87, 21.18). Compared to non-consumers, student consumers reported significantly more positive attitudes, stronger subjective norms, and higher intention to consume energy drinks. Discussion: The discussion emphasizes constructs of the Theory of Planned Behavior and energy drink consumption, situating the findings within a broader theoretical framework. Translation to Health Education Practice: This study supports the role of health educators in monitoring behavioral trends, planning future programs, and assessing the success of subsequent health education initiatives within college settings by offering baseline data on energy drink consumption and its psychosocial correlates.
