PurposeTo evaluate the effect of an educational intervention based on the Oral Health and Your Pregnancy booklet on the knowledge, attitudes, and behaviors of pregnant women in primary care in Cuiabá, Brazil.DesignQuantitative pre-post intervention study without a control group.SettingA primary healthcare unit in Cuiabá, Mato Grosso, Brazil.Sample374 pregnant women in the first to third trimester.InterventionA 30-minute lecture and practical demonstration of oral hygiene.MeasuresSociodemographic questionnaire, indicators of oral-health and dietary knowledge/practices, and OHIP-14.AnalysisDescriptive statistics, paired t-tests, Wilcoxon signed-rank tests, and chi-square tests.ResultsKnowledge about the relevance of oral health during pregnancy increased from 38% to 72% (χ2 = 44.27; P < 0.001), awareness of disease transmission to newborns increased from 10% to 63% (χ2 = 36.41; P < 0.001), and self-reported oral pain/discomfort decreased from 60% to 35% (χ2 = 21.87; P < 0.001).ConclusionThe intervention improved short-term oral-health knowledge and self-perception. The absence of a control group and immediate post-intervention assessment limit causal and long-term inferences.
PurposeThis pilot study investigated how retailer training can enhance retailer confidence and participants' shopping experiences to increase WIC benefit redemption.DesignThree groups of retailers were randomized to (1) receive standard training, (2) receive training supplemented with a brief video, and (3) receive no training. Training groups were surveyed before and after training for confidence with WIC-related tasks.SettingWIC-authorized retailer locations in Missouri.Sample44 retailers participated.MeasuresRetailer confidence and total WIC items redeemed before and after training.AnalysisBefore and after training and within and between groups, Pearson's Chi-squared tests compared retailer confidence and analysis of variance and Tukey HSD post-hoc tests compared monthly averages of items redeemed overall and by WIC food category.ResultsConfidence improved for both training groups (standard training: 65% vs 94% (P < 0.00), video: 58% vs 92% (P < 0.00), though the increases in confidence were not different between groups (P = 0.59). Monthly average items redeemed were no different within or between stores or study groups before or after the training.ConclusionsIncreased retailer confidence post-training supports the continued implementation of training and technical assistance. Future programming and research could examine the effects of training on WIC participants' shopping experiences and meeting stocking requirements more specifically.
PurposeTo examine the association between perceived social/emotional support (PSES) and leisure-time physical activity (LTPA) among U.S. adults with self-reported cognitive disabilities, and to explore moderation by age and race.DesignCross-sectional analysis of 2023 Behavioral Risk Factor Surveillance System (BRFSS) data.SettingU.S., nationally representative telephone survey.Sample15 326 non-institutionalized adults with self-reported cognitive disability based on a BRFSS item.MeasuresPrimary exposure was self-reported PSES (good, medium, poor). Outcome was LTPA (yes/no). Covariates included race/ethnicity, age, sex, education, smoking status, household income, health insurance, depressive disorder, physical health, and mental health.AnalysisSurvey-weighted bivariate analyses and multivariable logistic regression examined associations between LTPA and PSES. Adjusted logistic regression models tested the moderating effects of age on association between PSES and LTPA, stratified by race/ethnicity.ResultsIn adjusted models, adults reporting poor vs good support had higher odds of physical inactivity (OR = 1.33, 95% CI: 1.08-1.63). Significant moderation was observed: among Black adults aged 55-64, poor support was linked to more than 2-fold higher odds of inactivity (poor vs good: OR = 2.79, 95% CI: 1.24-6.32; medium vs good: OR = 2.07, 95% CI: 1.15-3.76); among White adults, associations persisted across multiple age groups.ConclusionHigher PSES was associated with greater LTPA among adults with cognitive disabilities, with variation by age and race. Interventions should integrate culturally tailored support strategies.
PurposeThis study examined associations between restorative sleep and subjective well-being, self-rated health, and positive lifestyle factors among community-dwelling adults (20-64 years) and older adults (≥65 years) in Japan, and identified sleep-promoting behaviors related to restorative sleep.DesignCross-sectional study.SettingCommunity-based survey in Japan.SampleStratified random sample of 5000 residents aged ≥20 years in City B, Prefecture A; 2371 valid responses analyzed (47.4%).InterventionNot applicable.MeasuresRestorative sleep, subjective well-being, self-rated health, and positive lifestyle factors were assessed by self-administered questionnaires.AnalysisLogistic regression was conducted separately for adults (20-64 years) and older adults (≥65 years), adjusting for age, sex, body mass index, alcohol consumption, smoking, and sleep medication; χ2 tests examined sleep-promoting behaviors.ResultsIn adults, restorative sleep was associated with subjective well-being (AOR = 1.92, 95% CI: 1.35-2.73), self-rated health (AOR = 2.27, 95% CI: 1.63-3.15), exercise habit (AOR = 1.85), diet balance (AOR = 1.40), and purpose in life (AOR = 1.40). In older adults, it was associated with self-rated health (AOR = 2.12, 95% CI: 1.19-3.77) and availability of a confidant (AOR = 2.62, 95% CI: 1.44-4.78). Getting up at a fixed time every morning and avoiding worries while in bed were related to restorative sleep in both groups.ConclusionRestorative sleep was associated with health, psychosocial, and lifestyle factors with age-specific patterns. Limitations include cross-sectional, self-reported data, so causality cannot be inferred.
PurposeResearch has documented changes in food insecurity (FI) in the U.S. during COVID-19, including initial spikes and widening inequities followed by eventual declines. Yet a lack of representative longitudinal data has limited efforts to examine FI trajectories.DesignWe use data from the Panel Study of Income Dynamics (PSID) to examine household-level changes in U.S. FI status from pre-pandemic to pandemic periods, evaluate the relationship between experiencing pandemic-induced financial hardship (FH) and FI, and test for mediating and moderating effects of FH on FI.SettingUnited States.SampleThe analytic sample includes 8097 adults from the 2019 and 2021 waves.MeasuresThe outcomes are dichotomous measures of FI in 2019 (25%) and 2021 (22%) derived from the U.S. Food Security Survey Module. The independent variable is a dichotomous FH (22%) measure, measured in 2021.AnalysisWe charted the change in reporting FI from 2019 to 2021 using t-tests and identified which individuals in our sample had higher FI rates in 2021. Females (FI = 53%), Hispanic Americans (FI = 60%), single households (FI = 54%), and those with less than a college degree (FI = 52%) had higher FI in 2021. Using logistic regression techniques, we estimated the association between FH and FI in 2021.ResultsWe find that pandemic FH is significantly associated with experiencing FI, even when controlling for relevant individual and household characteristics and pandemic experiences (OR = 4.83, P < .01). Black respondents who experienced a pandemic-induced FH were almost 3 times more likely to experience FI, while the odds of experiencing FI amidst an FH were lower among respondents who did not identify as Black (OR = 2.7).ConclusionThe findings provide early evidence for the relevance - and unequal impact - of pandemic-induced FH on household FI throughout the pandemic.
Purpose To determine whether the specificity of mandates in Wisconsin’s state comprehensive planning statute is associated with the inclusion and actionability of healthy eating and active living items in local comprehensive plans. Design Retrospective, cross-sectional, multilevel policy content analysis. Setting Wisconsin. Sample 93 local comprehensive plans, stratified by urbanicity and regional planning commission area. Measures Local comprehensive plans were scored using the Healthy Living and Active Design Scorecard for Comprehensive Plans. Wisconsin’s state comprehensive planning statute was evaluated for general or specific mandates for each item in the Scorecard. Analysis Difference in weighted percentage of municipalities scoring for items not mandated, mandated with general language, and mandated with specific language; one-sided Welch difference of means tests. Results Mandating an item with general language is associated with a 33.6 percentage point higher inclusion rate in local plans and mandating an item with specific language is associated with a 50.2 percentage point higher inclusion rate in local plans. All differences are statistically significant at the 0.05 confidence level. Conclusion Healthy eating and active living items that are mandated by state statute are more likely to be included in local comprehensive plans than items that are not mandated. Mandated items are also more likely to be included in local comprehensive plans in an actionable manner, which may make them more likely to be implemented.
Purpose To examine demographic, socioeconomic, and health related correlates of the combined behavioral pattern of high screen time and physical inactivity among Texas high school students. Design Cross-sectional study using Youth Risk Behavior Survey data. Setting Texas high schools. Sample 32 227 students in grades 9-12 from 2001-2023. Measures Screen time was dichotomized as high (≥3 hours/day) vs low (<3 hours/day). Physical activity was categorized as low (0-3 days/week) vs high (>3 days/week of ≥60 minutes/day). Demographic, body mass index, mental health, substance use, and dietary variables were assessed. Analysis Weighted prevalence estimates and multivariable logistic regression models were used, adjusting for potential confounders. Results Approximately 25% of students exhibited both high screen time and low physical activity. Female students had 75% higher odds (95% CI: 1.54-2.00) of this behavioral combination compared to males. Black, Hispanic, and Other/Multiracial students had 2-3 times higher odds compared to White students. Students perceiving themselves as very overweight had 2.5 times higher odds of both high screen time and low physical activity (95% CI: 1.82-3.50) compared to those who perceived themselves as having about the right weight. Depression and drug use were associated with increased odds, while fruit and vegetable consumption showed protective effects. Conclusion Comprehensive, culturally tailored interventions targeting both behaviors simultaneously are needed, particularly among underrepresented racial/ethnic groups and students with mental health challenges.
PurposeDetermine feasibility of estimating economic externalities associated with influences that products of individual corporations have on their customers' health behaviors.DesignOur methodology included four steps: (1) model influence of company product(s) on user behavior at the population level; (2) calculate relative risks of developing selected diseases/conditions associated with product use; (3) estimate the number of cases of selected disease/conditions that could be attributed to the company's influence; and (4) summarize annual cost of attributable cases.SettingUnited States.SampleThree companies: Burger King, Netflix and Niantic Labs.MeasuresAnnual US healthcare costs associated with the use of commercial products and services by adults.AnalysisWe estimated costs and benefits (costs avoided) by linking product use and population exposure with relative risks of major chronic conditions, as established in dose-response meta-analysis studies, to calculate population attributable fractions and then linking potentially attributable cases to annual healthcare costs.ResultsAnnual cost potentially attributable to Burger King was $4.9 billion and Netflix $32.4 billion; annual benefit attributable to Niantic Labs was $322 million.ConclusionWe demonstrated a methodology for estimating economic externalities that could be associated with the use of different commercial products/services.
Purpose This feasibility study explored the application of the Interactive Systems Framework for Dissemination and Implementation (ISF) to promote physical activity (PA) in elementary schools, leveraging resources from Active Schools. Approach A convergent parallel mixed-methods design was used to examine implementation efforts and student PA outcomes. Setting Data were collected from eight elementary schools across the United States. Participants The study included eight Active Schools Champions (physical education teachers) and 371 students. Methods Champions completed the School Wellness Readiness Assessment (SWRA) and the Comprehensive School Physical Activity Program (CSPAP) Policies and Practices Questionnaire. A survey and interview based on the Consolidated Framework for Implementation Research (CFIR) also captured barriers and facilitators. Concurrently, student PA patterns were assessed using the Youth Activity Profile (YAP). Results Schools demonstrated moderate readiness (mean SWRA = 3.7) and implemented an average of 64% of CSPAP best practices. Student PA exceeded national recommendations, averaging 70 minutes per day, with most of this activity occurring during the school day. Organizational barriers, such as a lack of administrative support, were identified. Conclusion The findings document the successful implementation of CSPAP and provide insights into organizational barriers and facilitators. This study highlights the value of accessible, evidence-based resources and needs assessment tools, while also revealing challenges related to time-intensive professional development and disparities in readiness across different school locales. The results will inform future interventions and resources to promote more equitable PA opportunities.
PurposeThis mixed-methods study investigated determinants of behaviors and intention related to sedentary behavior (SB) reduction among Korean white-collar workers by applying the Integrated Behavioral Model (IBM) in a collectivist workplace context.DesignSequential exploratory mixed-methods design.SettingKorean workplaces where excessive SB may be a concern.SampleTwenty-one workers participated in the qualitative phase, and 497 employees from 21 workplaces completed the survey.MeasuresThree semi-structured focus group interviews across job-position groups explored social norms and barriers to SB reduction. Insights informed selected survey items and interpretation. The survey assessed individual, job, and health factors, IBM constructs (attitudes, norms, self-efficacy, skills, intentions), SB reduction practices, and workplace factors.AnalysisData were analyzed using thematic coding and multilevel regression.ResultsParticipants reported high SB and often avoided standing to prevent drawing attention, though some developed strategies to reduce sitting. Intention to reduce SB was associated with positive emotions, beliefs that colleagues reduce sitting, high self-efficacy, low job stress, and lower job position. SB reduction behavior was associated with stronger intentions, better skills/abilities, and more sit-stand workstations.ConclusionApplying the IBM within a collectivist cultural framework underscores the relevance of perceived norms and hierarchical workplace dynamics for health-related behaviors. Workplace health promotion may benefit from emotional benefits, skill building, and position-specific, norm-based strategies acknowledging organizational hierarchy and employees' sensitivity to social norms, alongside practical support and supportive environments.
In the year of America's semi quincentennial, many are reflecting on our nation's proclaimed right to happiness. What would our Founding Fathers make of our acrimonious and divisive politics, of the role of social media in the diminished self-images of our youth, or of the steady rise in depression and suicidal ideation over the past decade? This editorial joins debates about what conditions are contributing to declines in happiness and challenges health promotion professionals to focus on the proven role that common health practices play in bolstering emotional well-being.
PurposeInterest in reusable menstrual products has expanded substantially over the last decade. However, there is limited published research on user experiences with these products in terms of their effectiveness in menstrual management. We assessed the acceptability of, and user experiences with, the menstrual disc-one of the newest types of reusable products-in terms of ease/difficulty of use (i.e., insertion, removal), leakages and overall comfort.Design/ApproachWe conducted a qualitative pilot study and provided students with menstrual discs to use over two menstrual cycles.SettingThe study was conducted on a mid-sized college campus in Massachusetts, U.S.ParticipantsWe recruited fourteen students who menstruate.MethodStudents completed two diary entries-one per menstrual cycle-about their experiences using the menstrual disc.ResultsThe menstrual disc was well received overall, and most students liked the long wear time, fewer changes required and the ability of the disc to self-empty. Although many students struggled with insertion initially, this improved with subsequent uses. Students noted that removal was easy but messy, which made changing in public bathrooms difficult. A few experienced major leakages when the disc became overfull. Almost all expressed willingness to use the disc as their main menstrual product.ConclusionThe menstrual disc potentially expands the range of more comfortable and convenient reusable menstrual products and should be included in reproductive health education.
PurposeTo evaluate the feasibility and potential effects of a nutrition intervention in a private Facebook group and integrated with food delivery for urban low-income pregnant women.DesignOne-group pretest-posttest intervention design.SettingA private Facebook group was utilized to implement nutrition lessons along with home food delivery of cooking ingredients.SampleTwenty-six pregnant women enrolled in the study.InterventionSix weekly nutrition lessons with cooking videos and food delivery were implemented.MeasuresA mixed methods approach was used. Outcomes of the intervention were measured with Family Meal Questions, Food Behavior Checklist, and Perceptions of Meal Planning and Cooking Scale. Qualitative semi-structured interviews were also conducted.AnalysisDescriptive statistics and independent samples t-tests were performed. Interview data were analyzed using thematic codes.ResultsSweetened beverage intake decreased (Δ = -0.5; P = 0.035); using food labels when food shopping increased (Δ = 0.7; P = 0.046); and overall eating habits improved (Δ = 1.6; P = 0.015). Perceptions of "meal planning" and "shopping and cooking" significantly improved (both Δ = 0.5; P < 0.05). Self-reported general health rating significantly improved (Δ = 0.7; P = 0.045). Participants provided positive feedback on the cooking demonstrations, social media format, and dietary behavior changes.ConclusionImplementing nutrition lessons on a private Facebook group was feasible. Further studies are needed to confirm its impact on dietary behaviors and health outcomes among urban low-income pregnant women.
PurposeExamine the long-term association between asthma and mental health conditions in Australian men.DesignRetrospective cohort study.SettingTen to Men project from four waves (2014-2022).Subjects16,021 Australian men (aged ≥ 18 years) at baseline.MeasuresExposure was self-reported asthma. Outcome measures were depression, anxiety and their comorbidity, assessed through self-reports and validated screening tools. Key covariates included survey year (waves), sociodemographic, lifestyle variables and comorbidities.AnalysisChi-square test (χ²) of independence for prevalence analysis and generalised estimating equation models for examining associations between asthma and mental health conditions, adjusting for relevant covariates.ResultsAcross survey years, the prevalence of depression ranged from 12.8% to 33.2%, while anxiety ranged from 17.3% to 51.3%. Comorbid depression with anxiety ranged from 11% to 28%, with the highest prevalence reported in 2020. Asthma was significantly associated with higher risks of depression (RR = 1.23, 95% CI: 1.16, 1.30), anxiety (RR = 1.12, 95% CI: 1.05, 1.18), and comorbid depression with anxiety (RR = 1.27, 95% CI: 1.17, 1.38). Significant risk factors included survey year (2020 and 2022), sleep disturbances and being a former or current smoker.ConclusionA significant association between asthma and mental health disorders, particularly depression, anxiety, and their comorbidity was identified in Australian men. These highlight the need for an integrated approach to respiratory and mental health care, with particular emphasis on targeted screening and interventions.
Context Physical inactivity is a major contributor to chronic disease, disability, and premature mortality in the United States and is associated with substantial healthcare expenditures. Although regular physical activity improves health outcomes, individuals with chronic conditions often require structured supervision to exercise safely and effectively. Building upon this context, the objective of this review is to synthesize evidence on the clinical, psychosocial, and economic impacts of supervised exercise interventions (SEIs) and to examine policy and implementation factors influencing their adoption. To achieve this objective, a structured literature review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Eligibility Criteria Studies published in English between 2010 and 2024 that involved adults aged 18 years or older and evaluated supervised exercise interventions with reported clinical, psychosocial, economic, or policy-related outcomes were included. Study Selection PubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using predefined keywords. Reference lists of relevant studies were also reviewed to identify additional eligible articles. Main Outcome Measures Clinical outcomes (eg, mortality, aerobic capacity, HbA1c), psychosocial outcomes (eg, adherence, depression, quality of life), and economic and policy outcomes (eg, cost-effectiveness, reimbursement). Results Twenty studies met the inclusion criteria. Across cardiovascular, metabolic, oncologic, pulmonary, and geriatric populations, SEIs were associated with improved clinical outcomes, including reduced rehospitalization and mortality, enhanced aerobic capacity, improved glycemic control, and reductions in fatigue and depressive symptoms. SEIs were cost-effective across disease categories, with several studies reporting healthcare cost savings within 1 year. However, disparities in referral and participation persisted among racial and ethnic minorities, rural populations, and individuals with lower socioeconomic status. Conclusion SEIs are effective and scalable strategies for managing chronic diseases and preventing secondary complications. Evidence indicates that supervised exercise improves clinical, psychosocial, and economic outcomes across diverse populations. Expanding reimbursement and strengthening integration within health systems will be critical to improving equitable access to SEIs.
PurposeThe aim of this study was to optimize essential components for Food is Medicine (FIM) interventions by selecting the modes with the least participant burden and lowest cost-to-burden ratio delivery in community-based outpatient settings.DesignRandomized crossover (Phase 1) and parallel (Phase 2) design pilot trials.SettingCommunity-based outpatient healthcare clinic in Jackson, Mississippi.ParticipantsForty-eight participants were randomized and 32 completed the program.InterventionThe 12-week, phase 2 trial included an integrated and a traditional delivery of two psychosocial-structural combinations of study arms.MeasuresThe primary outcomes were participant burden and cost-to-burden ratio.AnalysisRepeated measures ANOVA were used to analyze differences across time, in intervention arms, and within groups ANOVA to analyze for modality combination differences.ResultsParticipants were mostly women, had a mean age of 40, all identified as Black or African American, and about one-third had not attained a 4-year degree or higher. The study found that face-to-face delivery had the lowest cost-to-burden ratio and achieved higher attendance and satisfaction compared to virtual modalities, though both formats showed high use of meals/vouchers and reduced added sugar intake over time (F(3) = 5.62, P = .001). Attrition was more common among younger (P < .01), less-educated (P = .02), and lower-income participants (P < .01), with recruitment largely driven by social networks.ConclusionThe face-to-face modality was found to be a better approach than the virtual modality, with limited impact of an integrated delivery in this population.
The phrase "apples and oranges" is defined as comparing "things that are very different". This phrase and its meaning apply to the differences between lifestyle behaviors, such as physical activity and nutrition, and obesity. Physical activity and healthy nutrition as behaviors are very different from obesity as a disease and, when obesity is considered as a "self-inflicted" condition due to unhealthy lifestyle behaviors, we are incorrectly comparing "things that are very different". Conversations should begin with highlighting evidence demonstrating that adoption of healthy lifestyle behaviors leads to significant health benefits irrespective of weight loss.
PurposeThis study explores how social support and social norms influence Black and Hispanic adults' experience in a weight management program, and if this varies based on race, ethnicity, and gender.ApproachSemi-structured interviews and egocentric social network assessments.SettingSingle primary care site in New York City.ParticipantsTwenty Black and Hispanic adults in a weight management program.MethodInterviews explored social influences on weight loss and differences based on demographics. Network composition and functions were characterized through social network analyses.ResultsParticipants favored informational and tangible support to achieve health goals, through shared experiences and assistance, but felt social gatherings and unhealthy dietary norms undermined behavior change. Females described emotional strain, weight stigma, and the burden of balancing multiple social roles, whereas males emphasized health-related motivations and cultural dietary challenges. Among 276 network members identified, females tended to disclose program participation to friends, while males tended to disclose participation to people that provided them with health advice. Variability in social influence types and sources was primarily associated with gender, not race or ethnicity.ConclusionsSocial influences potentially play an important role in Black and Hispanic adults' engagement in a weight management program, with notable gender differences. Incorporating social network members to facilitate specific forms of support and overcome unique social pressures may enhance the effectiveness of weight loss interventions.
