Research indicates that individuals who are not part of mainstream cultures may be disproportionately vulnerable to bully victimization. In response to culturally-motivated bullying vignettes, we explored bystander intervention/upstanding behavioral intentions in an experimental design involving 294 college student participants. Participants were randomly assigned to conditions that presented vignettes involving race-, gender-, and sexual orientation-based bullying. Race of victim was significantly related to upstanding behaviors. Perceived emergency of the situation and previous experience with upstanding interventions were also predictive of upstanding behavior. Empathy for the victims and intentions to comfort them were the primary rationales cited for preferring specific upstanding behaviors. Findings have implications for designing culturally-motivated bullying prevention programs in school and campus settings.

The purpose of this study was to validate an inclusive, holistic, evidence-based index to measure the impact of organizational culture on employee wellbeing. This study utilized a new Cultural Wellbeing Index (CWI), a composite of other validated cultural metrics including inputs of hope, trust, and belonging. Internal validity of the index was measured using Cronbach’s alpha and Pearson correlation. Four logistic regression models were completed to test the correlative power of the CWI to employee health, retention, engagement, and job satisfaction. CWI shows strong internal validity and strong correlative and predictive power with employee wellbeing metrics among the population surveyed.

Objective: In this paper, we describe prescription medication, over-the counter (OTC) medication, vitamin, and herbal remedy use during pregnancy by Hispanic women in Utah County. Methods: Self-identified Hispanic women (N = 138) in Utah County, Utah completed a questionnaire in a non-profit community health center. Questions addressed use of prescription and non-traditional medications as well as demographic factors and characteristics. Associations between variables were analyzed with Pearson chi-square tests of independence with Monte Carlo simulations. Results: Our results showed that 53% of patients surveyed used prescription medications, 27% used OTC medications, 79% used prenatal vitamins, and 60% used herbal remedies. Maternal age was associated with doctors discussing OTC medications at prenatal visits (p = .002). Women reporting one birth were most likely to use the Internet (p = .019); women with "elementary education" were unlikely to identify "doctor" as their primary information source (p = .022). Physicians did not always discuss OTC or alternative remedies with their patients. Conclusions: There remains a need for patient and provider education on the topic of traditional and alternative remedies. This education can foster trust and cooperativity between patient and physician and ensure high quality perinatal care among Hispanic women.

The characteristics of household resilience, an emerging development paradigm, remain uncertain. This paper's purpose was to identify the characteristics of self‐perceived resilient households in rural Burkina Faso. Among 46 participants, self‐perceived resilience status was established through ‘resilience diaries’. Diary results were compared with a series of socio‐economic, community and household variables of interest. Major factors associated with household resilience included poverty status, savings accumulation and the use of livestock as an income‐generating activity. These findings provide insights into factors likely to strengthen household resilience and provide direction for practitioners interested in building and measuring changes in household resilience. Copyright © 2018 John Wiley & Sons, Ltd.

Background: The Integrated Child Development Services (ICDS) Scheme, launched in 1975 by the Government of India, provides various health services to children and their mothers at ICDS centres. Objectives: The purpose of this study is to understand 1) the extent to which women living in Rajasthan, India utilize services provided by ICDS centres and 2) the factors that are associated with their use. Methods: Freedom from Hunger and Freedom from Hunger India Trust, in collaboration with two local partners in Rajasthan, India, conducted a baseline assessment with 403 pregnant women and women with young children belonging to self-help groups to compare use of ICDS centres with key demographic variables and measures of poverty, food security and nutrition, curative care related to diarrhea, coping strategies, and household decision-making. Results: The results revealed that households that accessed ICDS services were more likely to report receiving nutrition information from ICDS centres, to purchase ORS in the last year, and to give oral rehydration solution (ORS) to children who had diarrhea. Women who decide how much food to serve each family member or spend money without discussing it first with someone else were more likely to receive benefits from ICDS centres. Those who spoke with their spouse about household nutrition needs were less likely to report accessing ICDS services. Conclusion: Interventions aimed at increasing utilization of ICDS centres in this region may find it beneficial to increase female participation in health care decisions, likely through spousal communication and gender relations.

................................................................................................................................................. 3 Acknowledgements ................................................................................................................................ 4 Introduction ............................................................................................................................................ 6 Methods ................................................................................................................................................. 7 Results .................................................................................................................................................... 9 Discussion and Conclusion .................................................................................................................... 13 References ............................................................................................................................................ 15

The purpose of this paper was to investigate disparities in mental healthcare delivery in American Indian/Alaska Native populations from three perspectives: public health, legal policy and mental healthcare and provide evidence-based recommendations toward reducing those disparities. Data on mental health funding to tribes were obtained from the Substance Abuse and Mental Health Services Administration. As a result of analysis of these data, vital statistics and current literature, we propose three recommendations to reduce mental health disparities. First, where possible, increase mental health funding opportunities for federally-recognized tribes. Second, model funding practices on principles of tribal self-determination. Finally, support diverse interventions that are culturally-based and culturally-appropriate.

Background: Too few adults in developed countries get sufficient daily physical activity, which contributes to the burden of chronic disease.Social media sites may be effective methods of promoting health behavior change, especially when elements of health behavior theory (HBT) are incorporated.However, no research to date has specifically assessed the integration of HBT in physical activity-related pins on Pinterest.Purpose: A content analysis was conducted to assess the level of HBT in physical activity-related pins on Pinterest. Methods:A coding rubric was used to code a total of 461 physical activity-related pins for the presence of HBT (Theory of Planned Behavior, Social Cognitive Theory, and Health Belief Model) constructs.A total theory score was computed to provide a global assessment of theory integration.Pin characteristics were also analyzed using descriptive statistics.Adjusted linear regression analysis identified characteristics of pins related to inclusion of HBT in pins. Results:The average total HBT score was 2.35 out of a possible 9. Compared to private individuals, pins produced by organizations integrated significantly more HBT constructs (mean 2.23 vs. 2.01; p=.005).Other factors such as targeting the whole body, and exercise not requiring equipment also had high integration of HBT.The HBT construct 'outcome expectations' appeared most often in pins.Discussion: Pinterest pins can be used for health promotion among its users with the integration of HBT in the pins.Select pin characteristics are predictive of theory integration.The average total HBT score of 2.35 in all of the pins studied suggests that physical activity pins are lacking adequate levels of HBT. Conclusion:Pinterest is an inexpensive, user-friendly platform where health educators can easily generate theory-based pins that may influence physical activityrelated behaviors.Pinterest pins could also be used to disseminate information regarding physical activity to all its users with very low costs.

Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

Many bicycling collisions are attributable to individual rider behavior. Prior research demonstrates gender differences in active transportation. Research for on-road, in-traffic riding behavior between genders is limited. In this study, bicycle commuters (n=671) traveling to a large, metropolitan university in Provo, Utah were directly observed over two weeks during fall, 2014 at peak morning and peak night commute times. Data were collected for passing bicyclists: Rider characteristics and behaviors. 23.10% of bicycle commuters were female, 22.21% wore bicycle helmets, 3.24% used hand signals to indicate turning or slowing, and 10.94% used both a front and rear light while riding at night. Significant associations were observed between gender and road position even after controlling for rider and environmental factors (women more often used the crosswalk (OR=1.72, 95% CI [1.22, 2.34]), sidewalk (OR=1.39, 95% CI [1.01, 1.93]), and traveled in the wrong-direction (OR=1.41, 95% CI [1.01, 1.94])); and use a night headlight (OR=1.40, 95% CI [1.40, 5.76]). Bicyclists' behavior changed with traffic volume and day/night conditions. Understanding gender differences will be important for targeting different risk factors and promoting safe commuting among all genders.

Background: There is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory.Objectives: The objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT.Methods: A content analysis was conducted on pins collected from Pinterest identified with the search terms "nutrition infographic" and "healthy eating infographic." The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes= 1, no= 0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<. 05).Results: The mean total theory score was 2.03 (SD 1.2). Perceived benefits were present most often (170/236, 72%), followed by behavioral capability (123/238, 51.7%) and perceived severity (79/236, 33.5%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=. 01), photographs of real people (P=. 001), cartoon pictures of food (P=. 01), and the presence of references (P=. 001). The number of repins (P=. 04), likes (P=. 01), and comments (P=. 01) were positively associated with the inclusion of HBT.Conclusions: These findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information.

Background: While bullying is recognized as a major public health concern worldwide, little research has been conducted on prevalence and predictors of bullying in Latin American countries such as Peru. Considering the negative effects that may be experienced by bully victims, including poor academic performance, psychological distress and in extreme cases suicide, identifying the factors associated with peer victimization is important to effectively addressing peer bullying. The purpose of this study was to estimate the prevalence of peer victimization in a sample of high school students in Cusco, Peru and to explore the relationship between victimization and potential correlating factors. Methods: A cross-sectional study of 949 high school aged adolescents from Cusco, Peru was undertaken. Adolescents from Cusco high schools were recruited and required to obtain parental consent to participate. The final sample of students completed a survey to answer questions about demographics, bullying, their parents’ parenting behaviors, the status of their home internet connection, and academic performance. Chi-square tests and adjusted logistic regression analysis were calculated using Stata version 12.1 and were used to assess potential risk factors associated with being bullied among boys and girls. Results: Over 20% of the sample reported being mistreated or bullied by peers. More boys than girls reported being bullied (28.5% vs. 19.5%; p = 0.002). Girls whose parents engaged in more positive parenting behaviors were less likely to be bullied, while having a home Internet connection and spending more than 60 minutes on social media during the previous day were associated with an increased risk of being bullied. Among boys, no variables were significantly associated with being bullied. Conclusions: Health practitioners may want to design bullying interventions that differ for boys and girls. Interventions for girls could benefit from increased parental involvement in particular. The association between time spent on social media and bullying among girls could also be investigated. Further research is needed to understand predictors of being bullied among males in this region.

BACKGROUND:The emergence of Apple's iPhone provides a platform for freelance developers to design third party apps, which greatly expands the functionality and utility of mobile devices for stress management. This study provides a basic overview of the stress management apps under the health and fitness category of the Apple App store and appraises each app's potential for influencing behavior change.METHODS:Data for this study came from a content analysis of health and fitness app descriptions available in the App Store on iTunes. Trained research assistants used the Precede-Proceed Model (PPM) as a framework to guide the coding of paid stress management apps and to evaluate each app's potential for effecting health behavior change.RESULTS:Most apps were rated as being plausible (96.9%) and intending to address stress management (98.5%), but only 63.3% were rated as recommendable to others for their use. Reinforcing apps were less common than predisposing and enabling apps. Less than one percent (0.39%) of apps included all three factors (predisposing, enabling and reinforcing).CONCLUSIONS:Practitioners should be cautious when promoting the use of stress management apps, as most provide only health-related information (predisposing) or suggestions for enabling behavior, but almost none include all three theoretical factors recommended for behavior change.

Background: Although the Health & Fitness category of the Apple App Store features hundreds of calorie counting apps, the extent to which popular calorie counting apps include health behavior theory is unknown. Objective: This study evaluates the presence of health behavior theory in calorie counting apps. Methods: Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. Results: Each app was given a theory score to reflect the extent to which health behavior theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, My Diet Coach obtained the highest theory score of 15. MapMyFitness and Yumget received the lowest scores of 0. The average theory score among the apps was 5.6. Conclusions: Most of the calorie counting apps in the sample contained minimal health behavior theory.

BackgroundSeveral thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. ObjectiveThe purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior interventions. MethodsWe conducted a review of the literature in September 2014 using key search terms in several relevant scientific journal databases. Only English articles pertaining to health interventions using mobile phone apps were included in the final sample. ResultsThe 24 studies identified for this review were primarily feasibility and pilot studies of mobile apps with small sample sizes. All studies were informed by behavioral theories or strategies, with self-monitoring as the most common construct. Acceptability of mobile phone apps was high among mobile phone users. ConclusionsThe lack of large sample studies using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals in changing their health behaviors. Of these studies, there is early evidence that apps are well received by users. Based on available research, mobile apps may be considered a feasible and acceptable means of administering health interventions, but a greater number of studies and more rigorous research and evaluations are needed to determine efficacy and establish evidence for best practices.

Objectives. We examined the use of low-cost social media platforms in communicating public health messages and outline the laugh model, a framework through which public health organizations can reach and engage communities.Methods. In August 2014, we developed an online campaign (Web site and social media) to help promote healthy family meals in Utah in conjunction with the state and local health departments.Results. By the end of September 2014, a total of 3641 individuals had visited the Utahfamilymeals.org Web site. Facebook ads reached a total of 29 078 people, and 56 900 people were reached through Twitter ads. The per-person price of the campaign was 0.2 cents, and the total estimated target population reach was between 10% and 12%.Conclusions. There are 3 key takeaways from our campaign: use of empowering and engaging techniques may be more effective than use of educational techniques; use of social media Web sites and online marketing tactics can enhance collaboration, interdisciplinary strategies, and campaign effectiveness; and use of social media as a communication platform is often preferable to use of mass media in terms of cost-effectiveness, more precise evaluations of campaign success, and increased sustainability.

BACKGROUND:Physical activity games developed for a mobile phone platform are becoming increasingly popular, yet little is known about their content or inclusion of health behavior theory (HBT).OBJECTIVE:The objective of our study was to quantify elements of HBT in physical activity games developed for mobile phones and to assess the relationship between theoretical constructs and various app features.METHODS:We conducted an analysis of exercise and physical activity game apps in the Apple App Store in the fall of 2014. A total of 52 apps were identified and rated for inclusion of health behavior theoretical constructs using an established theory-based rubric. Each app was coded for 100 theoretical items, containing 5 questions for 20 different constructs. Possible total theory scores ranged from 0 to 100. Descriptive statistics and Spearman correlations were used to describe the HBT score and association with selected app features, respectively.RESULTS:The average HBT score in the sample was 14.98 out of 100. One outlier, SuperBetter, scored higher than the other apps with a score of 76. Goal setting, self-monitoring, and self-reward were the most-reported constructs found in the sample. There was no association between either app price and theory score (P=.5074), or number of gamification elements and theory score (P=.5010). However, Superbetter, with the highest HBT score, was also the most expensive app.CONCLUSIONS:There are few content analyses of serious games for health, but a comparison between these findings and previous content analyses of non-game health apps indicates that physical activity mobile phone games demonstrate higher levels of behavior theory. The most common theoretical constructs found in this sample are known to be efficacious elements in physical activity interventions. It is unclear, however, whether app designers consciously design physical activity mobile phone games with specific constructs in mind; it may be that games lend themselves well to inclusion of theory and any constructs found in significant levels are coincidental. Health games developed for mobile phones could be potentially used in health interventions, but collaboration between app designers and behavioral specialists is crucial. Additionally, further research is needed to better characterize mobile phone health games and the relative importance of educational elements versus gamification elements in long-term behavior change.

Food insecurity remains a significant problem in India, especially among women and children. The purpose of this paper is to measure food security and describe associated factors in rural Rajasthan, India. Pregnant women and women with young children belonging to self-help groups were surveyed for this study. Factors associated with food insecurity for both women and children included increased poverty, low dietary diversity, belonging to a tribe, and failing to save money to cover food expenses. For women, using more coping strategies and having a husband who made decisions about how money the woman earned was used were associated with food insecurity, while not having received food from an Integrated Child Development Service center was associated with food insecurity in children. These findings suggest that actions for improving food security may include facilitating saving for food needs, improving decision-making power among women, and increasing ties to organizations that cater to child development needs.