Trans young people face systemic barriers to physical activity participation and experience disproportionately higher rates of physical and mental health challenges compared with their cisgender peers, yet evidence-based exercise interventions tailored to this population remain limited. This study evaluated a 12-week structured, group-based, gender-affirming exercise programme for trans youth aged 12 to 24 years in Western Australia, recruited through a specialist paediatric gender diversity service and community-based health and well-being services. Using a nonrandomised effectiveness-implementation hybrid design, the study assessed both the real-world implementation outcomes and health-related effectiveness of the programme, which was collaboratively designed with trans young people, families, and health professionals and grounded in international physical activity guidelines. Twenty participants enrolled, with 18 completing postprogramme assessments. Quantitative analysis revealed modest improvements in muscular strength, endurance, power, aerobic recovery, and well-being from baseline to 12 weeks, alongside high acceptability, appropriateness, feasibility, fidelity, and retention rates. Qualitative analysis identified themes relating to pathways to participation, connection through shared experience, supportive facilitation, and perceived physical and psychological benefits. This study adds to the limited evidence base by demonstrating that gender-affirming exercise programmes are both feasible and acceptable across clinical and community settings. Findings support the broader integration of exercise into gender-affirming health care, with implications for the design of inclusive health services and physical activity policies that address the specific needs of trans youth.
Digital visual aids like smartphone applications can potentially increase uptake and maintenance of Self-Skin Examination (SSE) behaviours, which is an essential secondary prevention strategy for early detection of skin cancer. This review aimed to understand whether digital visual aids with lesion monitoring functions improve SSE behaviours without negatively impacting health outcomes. A systematic search was performed using six databases for relevant literature published before June 2025. Studies were included if they used digital interventions that could monitor skin lesions and reported outcomes on SSE behaviours or their antecedents, such as SSE knowledge, attitudes and intentions. Data were analysed following an adapted Technological Acceptance Model framework. Twenty studies conducted in the United States, the United Kingdom, or Australia involving 19 to 1,000 participants were included. Nineteen studies were randomised controlled trials (RCTs) or nested within RCTs, with one non-nested cross-sectional study. Interventions were delivered by smartphone and/or tablet applications, or websites. Studies found digital visual aids led to improved knowledge (n = 6), perceived usefulness (n = 5), ease of use (n = 7), attitudes towards SSE (n = 13), as well as intention to perform regular SSE (n = 5). Overall, there was a positive impact on health outcomes, with only two studies reporting an increase in anxiety and worry following the intervention. Three of seven studies demonstrated an increased likelihood of detecting malignant skin lesions when monitoring using digitally aided SSE. There is potential for digital visual aids to improve SSE behaviours. However, it is important to address barriers to the use of digital visual aids for SSE and to improve their integration with clinical care.
Perceived social isolation is a major public health concern in the United States and is consistently associated with adverse psychological outcomes. However, the psychological and behavioral pathways through which perceived social isolation is associated with distress remain incompletely understood, particularly in the context of digital health behaviors. Drawing primarily on Social Cognitive Theory, while also considering health anxiety, uncertainty management, and stress-and-coping perspectives, this study examined a serial mediation model in which eHealth engagement and health self-efficacy were specified as ordered mediators linking social isolation to psychological distress among U.S. adults. Data were drawn from the Health Information National Trends Survey, Cycle 7 (HINTS 7; N = 5,533). Social isolation was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation T-score, and psychological distress was assessed with the Patient Health Questionnaire-4 (PHQ-4). Serial mediation was estimated using survey-weighted regression models with jackknife replicate variance estimation, adjusting for age, sex, education, income, race/ethnicity, and chronic condition count. Social isolation was positively associated with PHQ-4 distress. Significant indirect effects were observed through health self-efficacy and through eHealth engagement alone; however, the serial indirect pathway through eHealth engagement and health self-efficacy was not significant. Findings are consistent with health self-efficacy as a theoretically meaningful pathway linking social isolation and psychological distress, whereas eHealth engagement may reflect reactive health information seeking among more isolated or distressed adults. Because the data are cross-sectional, causal interpretation is not warranted.
Community health workers (CHWs) serve as bridges between clinical care and community-based social support, yet they are often excluded from the design of the health interventions they implement. User Journey Mapping (UJM) is a tool that can enhance health behavior interventions and their implementation. As part of formative planning for the Philadelphia Community Engagement Alliance (Philly CEAL), we employed UJM methods to engage CHWs as co-designers in the implementation of an adapted chronic disease self-management intervention to promote heart health while addressing social needs. We conducted semi-structured interviews ( n = 8) with seven CHWs and one supervisor from Philadelphia’s Office of Community Empowerment and Opportunity. During the interviews, participants co-created visual workflow maps documenting daily tasks, emotional experiences, pain points, and opportunities. Individual maps were synthesized into comprehensive team maps and validated through follow-up sessions with the CHW team. Analysis revealed a four-part CHW process: community-based responsibilities, individual case management, in-office duties, and supervisory functions. Themes were identified related to the specialized skills and strengths associated with the CHW role, systemic challenges related to service workflows, and persistent emotional and psychological role-related stressors. UJM methods used in this formative work generated actionable insights for intervention refinement while positioning CHWs as expert co-designers rather than solely as the implementers of the intervention. The findings underscore the importance of integrating frontline expertise early in intervention planning to ensure programs are operationally efficient, emotionally attuned, and contextually grounded. We propose a set of methodological recommendations for embedding UJM within future public health planning, implementation, and evaluation efforts.
The health benefits of social participation are well-documented in the general population, yet its relevance for internal migrants, a growing global demographic, remains less understood. Guided by the framework of migration as a social determinant of health, this cross-sectional study examines the relationship between social participation and self-rated health (SRH) among migrants, focusing on the mediating role of health education. Using nationally representative data from the 2017 China Migrants Dynamic Survey (N = 126,717), we conducted path analysis among internal migrants. We distinguished two forms of social participation: social membership and voluntary activities. Social membership was positively associated with SRH (β = 0.025, p < .001), both directly and indirectly through higher exposure to health education (β = 0.012, p < .001). Voluntary activities showed a small positive indirect effect through health education (β = 0.006, p < .001) but an overall negative association with SRH (β = -0.052, p < .001), suggesting that the demands or stress of volunteering may offset its informational benefits. These results reveal the unequal health returns of different forms of social participation among internal migrants and highlight the need for culturally tailored health education embedded within migrants' workplace and community networks.
National Institutes of Health (NIH) predoctoral fellowships, including the Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship (general F31 and F31-Diversity awards), have long served as mechanisms to support trainees, including those who are historically underrepresented in the biomedical and behavioral sciences. In 2025, many of these awards were unjustly terminated. Since then, the status of many grants has changed among a funding landscape of partial reinstatements and continued uncertainty. In this article, we summarize historical evidence of the impact of NIH-predoctoral fellowships and explore the implications of these terminations on trainee well-being and public health more broadly. One illustrative case example of a termination (and subsequent reinstatement) of a diversity-promoting F31 grant highlights the multifaceted costs of these disruptions amid ongoing political and policy shifts.
While mainstream public health has recognized the prime role of social determinants of health (SDOH) in shaping patterns of health and disease, the field has struggled to find meaningful ways to tackle these fundamental causes of health and health inequities. Though often overlooked within the field of public health, activist campaigns have been a vital force for securing advances in confronting and modifying SDOH, from obtaining wage increases to expanding reproductive health care to securing health care for millions through the expansion of Medicaid. These examples show that social movement activism can encourage public officials to make tackling the SDOH a priority on their policy agendas and contribute to reducing the influence of the special interests who often oppose these changes. To integrate activism with public health practice more consistently, researchers, practitioners, and activists need a robust body of evidence that enables them to leverage activism to address social determinants. This narrative review seeks to explore the role that evaluation can play in strengthening health activism aimed at SDOH and making it a more accepted and familiar component of public health practice. We offer definitions of several key terms, review relevant literature on evaluation of health activism, and propose guiding questions along with real-life examples of corresponding evaluations. We aim to encourage public health practitioners to recognize the role of activism in advancing public health and to find ways to use evaluation to partner with activist campaigns seeking to modify SDOH.
BACKGROUND:Sedentary lifestyles and insufficient physical activity (PA) are major public health concerns linked to chronic disease and premature mortality. Social media has become a powerful influence on lifestyle behaviors and may both promote and hinder PA. AIM:This narrative review aims to synthesize existing evidence on the dual role of social media in shaping physical activity behaviors among sedentary populations, drawing on motivational, cognitive, and sociotechnical perspectives. METHODS:A structured search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2012 and 2025. A total of 104 eligible studies were identified and integrated using a narrative interpretive approach. RESULTS:The findings show that social media can support PA through motivation, social support, and fitness-related content, but can also encourage sedentary behavior through passive use, distraction, and social comparison. Its effects appear to depend on platform design, usage patterns, and contextual factors. CONCLUSION:The impact of social media on PA among sedentary individuals is highly context-dependent and shaped by user engagement patterns and platform design. People-centered and ethically informed digital strategies, emphasizing digital well-being and mindful engagement, are needed to leverage social media for sustainable PA promotion.
Cervical cancer remains a leading cause of mortality among women worldwide, particularly in low- and middle-income countries, yet human papillomavirus (HPV) vaccination-the most effective method of prevention-faces variable uptake and acceptance. This study addresses the problem of suboptimal HPV vaccination by examining the factors associated with parental consent for HPV vaccination of adolescent girls in two distinct Peruvian cities, the capital city of Lima and a large city in the Peruvian Amazon, Iquitos. Cross-sectional survey data were collected in 2017 from 986 women attending public health centers, and the Capability, Opportunity, Motivation, Behavior model was applied to categorize behavioral factors associated with women's willingness to vaccine their daughters for HPV. Overall, 90.1% of women reported willingness to vaccinate their daughters, with higher support in Iquitos (94.2%) than in Lima (84.7%). Women who were willing to vaccinate tended to be younger and were more likely to believe the vaccine was safe (Capability), know that it was free and be willing to pay for it (Opportunity), and know someone who had been vaccinated (Motivation). This study contributes to the literature on parental willingness to vaccinate daughters against HPV in a Latin American context applying a validated behavioral framework. Findings provide insight into psychosocial and contextual factors associated with self-reported parental willingness to vaccinate daughters against HPV. The results have implications for public health research and practice by identifying modifiable barriers and facilitators that can inform targeted vaccine promotion strategies in Peru and similar settings, particularly in informing future vaccine promotion strategies in contexts where vaccine confidence may have shifted following the COVID-19 pandemic.
Schizophrenia is a severe, chronic mental disorder that imposes a substantial burden on family members, and this burden is strongly correlated with caregivers’ increased levels of anxiety and depression. Conversely, perceived social support functions as a critical coping resource, thereby effectively moderating stress and facilitating better psychological adjustment. This quantitative study tested the mediating hypothesis that perceived social support accounts for the relationship between caregiver burden and these negative psychological outcomes. This study adopted a cross-sectional design and convenience sampling to recruit 393 patients with schizophrenia and their primary family caregivers in China. The data collected included demographic information, caregiver burden, anxiety and depression, and perceived social support levels. Statistical analyses included ANOVA, correlation analysis, and hierarchical regression analysis. The results showed that caregiver burden was positively correlated with both anxiety and depression, and that perceived social support played a partial mediating role in this relationship. The mediating effect of perceived social support was particularly strong in mitigating the association between burden and depression. The findings indicate that perceived social support is vital in alleviating psychological distress among these caregivers, suggesting that targeted interventions focusing on strengthening social support networks can effectively improve the mental health status of family caregivers of patients with schizophrenia.
Anal cancer disproportionately affects men who have sex with men, particularly those living with HIV, yet screening rates remain low. This mixed-methods study examined the acceptability of anal self-exams and companion exams as supplemental screening tools among 131 participants in Chicago, IL, and Houston, TX. Data were collected through surveys and interviews and analyzed using thematic and descriptive methods. Findings indicate strong support for normalizing self and companion exams, with participants emphasizing the importance of culturally tailored messaging, diverse representation, and visuals that reduce stigma and simplify information. Trusted community sources were preferred over unfamiliar or commercial entities. Participants responded positively to messaging that framed screening in a hopeful and empowering manner, highlighting the value of approachable, relatable communication. Despite limitations in generalizability, these results provide actionable guidance for designing interventions that increase awareness, address barriers, and promote anal cancer screening among high-risk populations. Integrating culturally relevant, trusted, and visually engaging messaging into public health initiatives may enhance the effectiveness of anal cancer prevention strategies.
Southeast Asian cancer screening rates are alarmingly the lowest across all racial and ethnic groups in the United States. This paper examines barriers to breast cancer screening among Southeast Asian women, an understudied and underserved subgroup within the broader Asian American population, participating in a culturally tailored navigation intervention. A total of 194 women were randomly assigned to either the intervention-Tailored Messaging System© group (n = 103) or the information-reminder only group (n = 91). The intervention group received tailored messages addressing barriers, beliefs, perceived risks, and self-efficacy, along with guidance to complete mammograms, delivered by trained community health advisors over 10 weeks. The information group received screening information by mail. Barriers were evaluated via a questionnaire at baseline in both groups. Results showed statistically significant differences in mammography screening by ethnicity, but not by intervention group. The Lao constituted the largest group, with 20 (37.7%) screened, followed by Cambodians at 7 (26.1%), whereas only 5 (8.5%) of the Vietnamese and none (0.0%) of the Filipina women completed mammograms. Findings indicate that some Southeast Asian women are less likely to get screened for breast cancer due to modifiable factors such as health insurance, doctors' recommendations, fears, and perceptions. Disaggregating data for Southeast Asian women subgroups is an essential step for uncovering barriers in cancer screening uptake. Public health interventions and campaigns should consider these barriers and the importance of using disaggregated data.
Generative artificial intelligence (AI) in clinical communication, including in medical imaging, presents behavior-mediated safety challenges: outcomes depend on how clinicians verify AI-generated content under time constraints. However, guidance has largely focused on predeployment validation, with less specificity about postdeployment governance in day-to-day workflows. This perspective synthesizes evidence on failure modes, automation bias, and implementation monitoring and proposes a practical framework organized around three target behaviors: trust (transparent scope limits), verify (structured cross-checks against source data), override (documented corrections that become learning signals). Drawing on behavior change and implementation science, we translate postdeployment risks into stakeholder-specific interventions, including competency-based education, equity-stratified monitoring with prespecified triggers for fairness drift, and rollback procedures. The framework extends to patient-facing AI-generated explanations, where comprehension and autonomy must be safeguarded. This approach positions governance as a health education and behavior challenge essential for safe, equitable adoption.
Lifestyle medicine, an evidence-based approach to preventing and managing chronic disease through behavior change, remains underrepresented in health professional education. Limited institutional support and funding barriers often prevent students from engaging in experiential learning opportunities that reinforce lifestyle medicine competencies. This study examines how student-led initiatives supported by targeted grant funding can serve as an alternative to promote institutional curricular adoption of lifestyle medicine. Using the American College of Lifestyle Medicine's (ACLM) project management platform, Asana, and a mixed-methods approach, we analyzed 178 reimbursement forms from the Taste of Lifestyle Medicine (TOLM) grant program. Descriptive analyses summarized the characteristics of Lifestyle Medicine Interest Group (LMIG) and non-LMIG events, while qualitative content analysis of open-ended feedback explored engagement outcomes and perceived value. Between September 2023 and May 2024, 178 funded events reached 6,278 participants across U.S. health professional institutions. More than half of these events were nutrition-focused, integrating plant-predominant meals and culinary demonstrations that generated enthusiasm and community engagement around lifestyle medicine principles. Findings illustrate how combining student advocacy with strategic grant mechanisms can overcome financial and institutional barriers to implementing lifestyle medicine education, especially events such as cooking demonstrations and culinary medicine demos. This case example shows the utilization of the Taba model in which student leadership and external funding drive curricular innovation via increasing student and faculty interest, as well as capacity building in preventive health. This model offers a scalable approach for embedding behavior change and health promotion training within the next generation of health professionals.
Online health information-seeking is common and can impact patient-provider interactions. Using Health Information National Trends Survey (HINTS) data from 2005, 2008, 2011, and 2024 (n = 20,292), this study assessed trends in the percentage of Americans who reported discussing online health information with health care providers in the past year. Next, 2024 HINTS data (n = 6,350) assessed perceptions of provider openness, provider respectfulness, and impact on patient-provider interactions among those who discussed online health information with a provider. Multivariable logistic regressions tested associations of demographic, internet, health, and healthcare-related factors with occurrence and perceptions of online health information discussions. Online health information discussions increased from 2005 (25.87%) to 2024 (36.40%). In 2024, most respondents who discussed online health information with a provider perceived those discussions positively, but approximately 14% did not perceive their provider as open or respectful, and 9% reported that discussing online information made their interactions with providers worse. Odds of discussing online information were greater among those reporting high internet search skills (adjusted odds ratio [aOR] = 1.54, 95% confidence interval [CI] = 1.06-2.24) or perceived past medical discrimination (aOR = 1.74, 95% CI = 1.25-2.43), but lower among adults aged 65+ (aOR = 0.64, 95% CI = 0.49-0.84). Odds of perceiving provider openness were higher among those reporting high internet search skills (aOR = 2.33, 95% CI = 1.09-4.97), high patient-centeredness (aOR = 6.69, 95% CI = 4.57-9.80), or excellent quality of care (aOR = 1.67, 95% CI = 1.04-2.69) in the past year. Ensuring that patients feel comfortable bringing internet research to providers and that providers respond with openness and respect may strengthen patient-provider relationships and encourage patient engagement, especially among patients with limited internet search skills.
Breast cancer is the leading cause of cancer-related deaths among women in Brazil. Early detection through mammography is an effective strategy to reduce mortality; however, access remains unequal across regions. The Pink October campaign, promoted annually by Brazil's Ministry of Health, aims to raise awareness and encourage breast cancer screening. This study evaluates the heterogeneous effects of the Pink October campaign across Brazil's five regions using an interrupted time-series approach with data from 2015 to 2024. We analyzed monthly screening rates among women aged 50 to 69, the target population for biennial mammography. Results indicate a significant increase in screening rates during the campaign period, with notable variation across regions. The Northeast showed the highest relative increase (+57.42%), followed by the South (+29.73%). In contrast, the North and Central-West regions exhibited more modest gains. The regional disparities appear to be associated with differences in primary health care coverage, as the regions with the greatest increases also report higher Family Health Strategy coverage. These findings suggest that national awareness campaigns, while broadly effective, must be complemented by local capacity-building strategies to ensure equitable outcomes. Tailored implementation based on local health system strength can maximize the effectiveness of health promotion efforts and reduce persistent geographic inequalities in access to breast cancer prevention services.
BackgroundSedentary behavior, a common unhealthy habit, is associated with increased prevalence of chronic kidney disease (CKD), whereas active components in coffee may exert protective effects on renal function. However, the joint association of sedentary behavior and coffee consumption with the prevalence of CKD remains uninvestigated.ObjectivesThis study aimed to evaluate the independent and joint associations of sedentary behavior and coffee consumption with CKD prevalence based on cross-sectional data from National Health and Nutrition Examination Survey (NHANES) 2007-2016.MethodsA total of 20,696 participants were included. Weighted logistic regression models assessed the association of sedentary behavior and coffee consumption with CKD prevalence. The ratio of odds ratio (ROR) was introduced to evaluate the joint association of sedentary behavior and noncoffee consumption. Subgroup analyses explored differences across populations, and sensitivity analyses tested the robustness of findings.ResultsAfter full adjustment for covariates, compared with the group sitting for <4 hr/day, sitting for 6-8 hr/day and ≥8 hr/day were associated with 24% (odds ratio [OR] = 1.24, 95% confidence interval [CI]: 1.02-1.50) and 18% (OR = 1.18, 95% CI: 1.03-1.35) higher CKD prevalence, respectively. Compared with noncoffee drinkers, daily coffee drinkers with 592.0 g (>2.09 cups) were associated with 16% lower CKD prevalence (OR = 0.84, 95% CI: 0.71-0.99). In joint analysis, the CKD prevalence was higher among noncoffee drinkers with sedentary behavior (OR = 1.36, 95% CI: 1.20-1.53) than coffee drinkers with sedentary behavior or noncoffee drinkers without sedentary behavior. The joint effect (ROR = 1.18) exceeded the expected value under the multiplicative model. Subgroup analyses revealed significant interaction effects only in body mass index and diabetes subgroups (p < .05). Sensitivity analyses further confirmed the robustness of the above associations.ConclusionBoth sedentary behavior and noncoffee consumption are potential factors for CKD prevalence. Their joint association exceeds the expected multiplicative value. Reducing sedentary time and consuming coffee in moderation may be potential strategies for managing CKD prevalence.
American Indian and Alaska Native (AIAN) people living on reservations and in urban areas have been disproportionately impacted by the ongoing opioid epidemic, as demonstrated by higher opioid overdose fatality rates. AIAN communities have mobilized to address opioid misuse through community-centered approaches, including revitalizing and enhancing Indigenous epistemologies. While Tribal and urban Indian opioid misuse prevention programs aim to support critical healing, these programs often have funding requirements that prioritize Western evaluation methodologies that may not be responsive to the successful implementation of culturally grounded solutions. Indigenous evaluation is a long-relied-upon practice to adjust and improve community efforts using Indigenous ways of knowing and continuous community involvement. Although Indigenous evaluation approaches have been used in education, violence prevention, youth-focused, and other Indigenous public health programs, the literature lacked an actionable guide for implementing Indigenous evaluation approaches for opioid overdose prevention programs. Leveraging professional and cultural expertise, lived experience, and a multi-year, community-based participatory consultation process, Seven Directions developed the Indigenous Evaluation Toolkit for Tribal Public Health Programs: An Actionable Guide for Organizations Serving American Indian/Alaska Native Communities through Opioid Prevention Programming.
Public altruistic protective behavior is pivotal in public health emergencies, yet integrated evidence on how multidimensional risk communication shapes it is limited. Grounded in the protective action decision model (PADM) and risk communication theory, this study aims to construct a multidimensional communication strategy impact model encompassing information sources, communication content, narrative style, and communication media, with risk perception introduced as a mediating variable and trust in authoritative information sources as a moderating variable, to systematically examine how these factors affect public altruistic protective behavior. Taking the pandemic as a typical public health emergency scenario, a questionnaire survey of 1,417 respondents across 11 Chinese provinces revealed that (1) all dimensions of risk communication exert significant positive association with altruistic protective behavior, (2) risk perception mediates the relationship between risk communication and altruistic behavior, and (3) trust in authoritative sources negatively moderates the path from information sources to risk perception, displaying a "high-trust attenuation effect." This study provides theoretical support for more precise governmental messaging and altruistic mobilization.
Peer-led physical activity programs can support healthy aging, yet the leader-related factors that sustain their delivery are not well understood. This study investigates how peer-leader attributes and motivation influence leadership outcomes critical for program sustainability. A 12-week prospective survey was conducted with 131 trained walking group leaders (mean age = 62.7 years). Guided by the Self-Determination Theory, we examined how autonomous and controlled volunteer motivation and peer-leader attributes related to leadership outcomes. Participants completed measures of motivation at baseline (Time 1), perceptions of peer-leader attributes at midpoint (Time 2), and leadership outcomes at the end of the study (Time 3). Exploratory factor analysis identified three leadership attributes: supportive disposition, responsive leadership, and relational influence. Hierarchical regression analyses tested how these attributes, alongside autonomous and controlled motivation, predicted role satisfaction, perceived efficacy, and continuation intentions. Results showed that responsive leadership predicted both role satisfaction and perceived efficacy, while Relational Influence predicted satisfaction. Autonomous motivation also contributed to higher satisfaction and efficacy, with these models explaining around 23% to 26% of variance. Continuation intentions were minimally predicted by individual factors, suggesting other organizational influences. This study adds to the literature by providing a validated, brief measure of peer-leader attributes and clarifying how specific leader behaviors and motivations shape rewarding leadership experiences. For public health research and practice, findings indicate that selecting and training peer leaders should emphasize responsiveness and participant-focused behaviors, alongside supporting leaders' psychological needs for autonomy. While these factors enhance satisfaction and efficacy, sustaining long-term participation may require broader organizational support, offering guidance for program design and policy initiatives.
