Objectives. To increase the scale and efficacy of health promotion practice, culturally responsive approaches to well-being are needed in both communication and practice innovation. This mixed-methods evaluation sought to identify specific mechanisms used in a promising practice model and offers a potential theoretical framework to support public health programs in integrating culture and social justice into communication and intervention programs. Study Design. Rooted at the intersection of ethnographic and phenomenological worldviews, this mixed-methods, retrospective process evaluation used publicly available empirical and experiential data centered on the arts, science, and social justice to identify critical mechanisms used and incorporate them into an emergent theoretical framework. Method. The retrospective process evaluation used an ethnography-informed approach combined with scientific literature reviews. To integrate adjacent ideas into the emergent theoretical framework, a phenomenologically informed theme development approach was used. Results. The evaluation resulted in a five-step framework, called MOTIF, with the potential to be utilized in diverse situational and geographic contexts. Data that surfaced from related literature reviews revealed adjacent mechanisms from positive psychology, critical consciousness theory, and innovation design that were incorporated into the emergent framework. Conclusion. MOTIF may offer a culturally responsive public health communication and innovation process capable of promoting health equity through the cultivation of relationships between artists, community participants, and public health agencies and researchers who collectively endeavor to craft innovative solutions for population health and well-being.

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.

An increase in workforce diversity emphasizes the value of testing approaches that assess workplace inclusivity. On conducting a systematic review of quantitative and qualitative measures used to evaluate organizational inclusion, a total of fifteen articles comprising eight measures, two models, and one framework were identified. Five common themes included: equal treatment from peers and supervisors; inclusion promoted at an organizational level; empowerment; uniqueness recognized and valued; and belongingness. This review supports the rationale for creating a new scientific process to support organizational efforts to reconfigure existing talent assets to navigate culturally-fluid business landscapes comprised of an increasingly diverse American workforce.

Background: The emergence of electric pedal-assist bicycles (e-bikes) presents an opportunity to increase active transportation by minimizing personal barriers of engaging in physical activity. Objectives: The aim of this study was to assess the beliefs of individuals using e-bikes for active transport and report preliminary biometric measurements while using e-bikes for physical activity compared with conventional bikes. Methods: Participants used both conventional bicycles and e-bikes to compare energy expenditure while riding on the study route. Apple smart watches were used to track each participant's heart rate, distance, speed, and time while riding both bicycles. A total of 3 survey instruments were used to estimate beliefs: one administered before riding the bicycles, a second administered after riding a conventional bike, and the final survey completed after riding an e-bike. Survey instruments were constructed using constructs from the theory of planned behavior. Results: The study sample (N=33) included adults aged between 19 and 28 years. Paired t test analysis revealed that participants believed a conventional bike was more likely than an e-bike to benefit their physical health (P=.002) and save them money (P=.005), while an e-bike was perceived to be more likely than a conventional bike to save them time (P<.001). Paired t test analysis revealed participants significantly agreed more with the statement that they could ride an e-bike most days (P=.006) compared with a conventional bike. After participants traveled approximately 10 miles on each type of bicycle, participants' mean average heart rate while riding the e-bike was 6.21 beats per minute lower than when riding the conventional bike (P=.04), but both were significantly higher than resting heart rate (P<.001). Conclusions: This pilot study suggests that e-bikes are an active form of transportation capable of providing much of the cardiovascular health benefits obtained during conventional bike use. E-bikes may help reduce some of the obstacles to conventional bike use, such as increased transportation time, decreased convenience, and physical fatigue.

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.

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:Bullying is a global problem among children and adolescents. The purpose of this study was to explore bully victimization in Peru and to identify potential adverse mental health and social outcomes resulting from bully victimization.METHODS:This study analyzed data from an ongoing prospective cohort of children taking part in the Young Lives study. This study assessed bullying consequences on mental and emotional health in the 3 rounds of data collected among Peruvian adolescents at ages 8, 12, and 15.RESULTS:Bullying by peers was negatively related with age. A factor analysis showed that boys were significantly less likely than girls to suffer emotional and relational problems due to victimization. Additionally, bullying in rounds 2 and 3 of the cohort were significantly correlated with adverse emotional and mental health outcomes in round 3. Lastly, emotional status was positively associated with violent incidences in the schools and at home.CONCLUSIONS:This study shows significant problems with emotional and mental stress as early outcomes associated with victimization in Peru. The findings have implications for treating adolescent health issues like peer victimization. Steps should be taken to address bullying and mental/emotional health in Peru in order to combat subsequent mental health problems.

Background Sexting (sexual messaging via mobile devices) among adolescents may result in increased risky sexual practices, psychological distress and in some cases, suicide. There is very little research on sexting in developing nations, such as Peru. In particular, little is known about gender differences in the correlates of sexting. The purpose of this study was to determine the sexting prevalence and correlates of sexting among adolescent boys and girls in Cusco, Peru. Methods The study sample comprised 949 high school aged adolescents from Cusco, Peru. Adolescents responded to questions about demographics, sexting behavior, and risk/protective factors. Separate regression models were constructed to compare correlates of sexting for boys and sexting for girls. Results Twenty percent of the sample reported engaging in at least one instance of sexting. Boys reported higher rates of sexting than girls (35.17% vs. 13.19%, p = 0.000). Significant correlates for girls’ sexting included having been cyberbullied and parental factors. For boys, hypertexting, fighting, parental factors, and parental rules about sexting were significant. Conclusions Peruvian health officials with an interest in reducing the effects of sexting among adolescents may choose to target boys differently than girls. These efforts may include advising parents to set clear rules and expectations about sexting and the appropriate use of mobile devices.

Abstract Background: Bully-victimization is a widespread public health issue with significant negative effects on both social function and psychological well-being. Existing research in Peru shows high prevalence of bullying. However, researchers have yet to fully understand the phenomenon of victimization in developing regions. Objectives: The purpose of this study was to characterize victimization patterns over time, along with the predictors of victimization from a cohort of Peruvian adolescents enrolled in the young lives (YL) study. Materials and methods: This study examined data from YL, a longitudinal study of poverty, health, and development, which examined data from the older cohort of children in Peru across three rounds (ages 8, 12, and 15 years). The sample consisted of 714 children from 74 communities that represent 20 districts in Peru. Results: After adjusting for urban/rural setting, there remained a significantly lower wealth index for children who were bullied at ages 8 and 12 years. Exploratory analysis showed that although those in the lowest quartile of body mass index (BMI) were significantly more likely to be bullied at age 8 years, this association waned over time. A worse caregiver assessment of child’s health compared with others was associated with a significantly greater risk of bully-victimization. At age 8 years, caregiver education was significantly lower among those bullied compared with those who were not bullied. Conclusion: This study showed several factors as the predictors of victimization in the early years, including being male and having low BMI, low socioeconomic status, and low parental/caregiver education. Further longitudinal studies should be conducted to determine the extent to which these predictors vary in significance over time.

BACKGROUND:Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps.OBJECTIVE:The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer's health behavior.METHODS:An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements.RESULTS:This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger.CONCLUSIONS:This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors.

BACKGROUND:While extensive research has been conducted on bullying and victimization in western countries, research is lacking in low- and middle-income settings. This study focused on bullying victimization in Peru. It explored the relationship between the caregiver's perception of child victimization and the child's view of selected negative experiences occurring with other children their age. Also, the study examined the association between victimization and adolescent health risk behaviors.METHODS:This study used data from 675 children participating in the Peru cohort of the Young Lives study. Children and caregivers were interviewed in 2002 when children were 8 years of age and again in 2009 when children were 15 years of age. Measures of victimization included perceptions from children and caregivers while measures of health risk behaviors included cigarette smoking, alcohol drinking, and sexual relations among adolescents.RESULTS:Caregivers identified 85 (12.6%) children bullied at ages 8 and 15, 235 (34.8%) bullied at age 8 only, 61 (9.0%) bullied at age 15 only, and 294 (43.6%) not bullied at either age. Children who were bullied at both ages compared with all other children were 1.58 (95% CI 1.00-2.50) times more likely to smoke cigarettes, 1.57 (1.04-2.38) times more likely to drink alcohol, and 2.17 (1.41-3.33) times more likely to have ever had a sexual relationship, after adjusting for gender. The caregiver's assessment of child victimization was significantly associated with child reported bullying from other children their age. Child reported victimization was significantly associated with increased risky behaviors in some cases.CONCLUSION:Long-term victimization from bullying is more strongly associated than less frequent victimization with increased risk of cigarette smoking, alcohol drinking, and sexual relations at age 15. Hence, programs focused on helping children learn how to mitigate and prevent bullying consistently over time may also help reduce risky adolescent health behaviors such as smoking, alcohol consumption, and sexual activity.

Objective: To identify the extent to which YouTube.com videos targeting prescription drug abuse include health behavior theory in their content and design.Methods: This study used a content analysis of 209 YouTube.comvideos.Coders used an established theory-based instrument to rate each video's inclusion of theoretical constructs from four prominent health behavior theories.Each YouTube.comvideo was coded for twenty-two theoretical items, which were summed to create a total theory score.Results: The mean theory score of videos was 3.26 out of a possible 22.Among the top 10% of videos with highest theory scores, social cognitive theory constructs were coded most often and transtheoretical constructs were coded least often.Conclusion: It is not unexpected that YouTube.comvideos are largely void of theoretical content since these videos are made by a variety of organizations and sources that may not be trained in the application of health behavior theories.There is an opportunity for the organizations that create these videos to collaborate with health and behavior change experts in creating videos with more theoretical constructs, possibly resulting in better health outcomes.

Bullying is a pervasive problem that affects children and adolescents of all backgrounds. Public Service Announcements (PSAs) spread through social media present a unique opportunity to reach many young people and teach skills for dealing with bullying. The purpose of this paper is to examine health behavior theory content of anti-bullying YouTube PSAs, and other YouTube videos containing anti-bullying messages. This study design comprised a content analysis for health behavior theory of anti-bullying YouTube videos. Videos were selected from www.YouTube.com using specific search terms typed into the search tool bar. Three graduate students trained in health behavior theory coded the videos. Results demonstrate that most anti-bullying YouTube videos do not incorporate health behavior theoretical constructs. Videos containing links to other websites were found to have greater inclusion of health behavior theory constructs. Theory was also positively associated with the number of views (p < .05). This paper represents the first in-depth content analysis for health behavior theoretical constructs in YouTube videos targeting bullying PSAs. Organizations should incorporate health behavior theories when developing PSAs to maximize behavioral impact, and to achieve high viewership. Overall anti-bullying videos on YouTube are ineffective in both utilizing theory and garnering views.

Emergence of tablet computers has led to interest in their use to impact health-related behaviors of users. However, little is known regarding which devices are most effective for changing these behaviors, and whether or not these devices or accompanying applications (apps) are feasible or desired vehicles for behavior change. Four focus groups were conducted with students from a Western university who were given iPads to download diet-related apps. Participants were asked questions about preferences regarding iPad functionality, app functionality, and the likelihood of using apps and iPads for facilitating diet-related behavior change in the future. Two key themes emerged from focus group discussions on diet-related apps for iPads and their usefulness to facilitate behavior change. The first theme, lack of iPad practicality, contained three subthemes: inconvenient mid-way technology, internet access barriers, and smart-phone preference. The second theme that emerged was attitudes towards apps in general. Three subthemes were identified under the second theme: too intensive; positive functions not specific to iPads; and lack of reliable/trustworthy information. This paper is the first, to this author’s knowledge, to report the use of qualitative methods to study the practicality of using apps and iPads in changing dietrelated behaviors. Early generations of iPads may not be effective devices for facilitating behavior change among college students; and diet-related apps seem to have poor functionality that lead to cessation of use.