OBJECTIVE:Poor dental hygiene is deleterious to overall health. The objective of this study is to assess factors that influence dental health behaviors of college students by applying constructs of the TPB. PARTICIPANTS:Three hundred and seventy (n = 370) college students, between the ages of 18 to 24, were recruited from a large university in the southeastern United States. METHODS:Survey data were collected electronically via Qualtrics; binary logistic regression was used for analysis. RESULTS:The sample (n = 370) consisted primarily of students aged 21 (n = 124, 33.5%), female (n = 337, 91.1%), and Non-Hispanic White (n = 294, 79.5%). Only 233 (63%) met the recommendations for brushing; and only 74 (20%) met the recommendation for interdental cleaning. Bivariate regression analysis indicated subjective norms and perceived behavioral control were significant. CONCLUSIONS:Findings indicate that interventions should focus on normative beliefs and perceived behavioral control by exploring external factors and teaching students how to master the practice of dental hygiene behaviors.

OBJECTIVE:The purpose of this study was to examine the health literacy and quality of information on online Web sites about osteoporosis using the suitability assessment of materials (SAM) method. METHODS:The search terms "osteoporosis" and "weak bones" were entered separately into three different search engines: Google, Bing, and Yahoo. Five Web sites were found on all three search engines for each search term, totaling 10 Web sites. Four different researchers graded the Web sites using the SAM scale and then averaged them. RESULTS:For the osteoporosis search term Web sites, 60% were rated superior and 40% were rated adequate by the SAM method. The average reading grade level was 10.2, with 20% of Web sites rated superior and 40% rated adequate. Sixty percent of Web sites contained graphics, with only one Web site rated superior. In addition, 80% of Web sites were found to be unsuitable for having a summary. For the weak bones search term Web sites, 80% were rated adequate and only 20% were rated superior. The reading grade level was 9.8, with 40% of the Web sites rated adequate and 60% rated not suitable. CONCLUSIONS:Web sites about osteoporosis contain a higher reading grade level than the national average of 7th grade. Most Web sites lack an ending summary of key points and graphics to aid comprehension. Health information Web sites about osteoporosis need to contain a lower reading grade level, more graphics, and summaries to increase the comprehension of readers.

ObjectiveIdentify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs).ParticipantsCollege students with STBs in the 2018-2020 Healthy Minds Study.MethodsCross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions.ResultsPositive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress.ConclusionsUnique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Background Dental diseases are associated with chronic health conditions and decreased psychological and sociological wellbeing. Young adulthood presents a pivotal stage as dental hygiene behaviors developed and practiced during this time persist into later life. The Theory of Planned Behavior (TPB) is a commonly used theoretical framework to examine intention to engage in dental behaviors.Purpose To systematically summarize research studies using TPB questionnaires to assess predictive factors of oral hygiene behaviors among young adult populations.Methods A four-phase article identification process ensured articles met the inclusion criteria. Quality appraisal assessments were used to evaluate questionnaire construction methodology.Results Twelve articles met the study's inclusion criteria. Each study incorporated supplemental predictive factors such as oral health knowledge and expected social outcomes in addition to the TPB constructs.Discussion Evidence from this systematic review suggests that TPB is a useful theoretical framework for designing questionnaires that assess dental hygiene behaviors of young adults.Translation to Health Education Practice Health education specialists should administer oral hygiene behavior surveys that utilize TPB and TPB-related constructs to better understand factors associated with improved intentions toward dental hygiene behaviors among young adults.

Background: Dental neglect results in dental caries, gum disease, and contributes to chronic diseases such as heart disease, stroke, diabetes, and cancers. Poor oral health habits developed in childhood persist into adulthood and can contribute to chronic diseases. School settings are a practical platform for teaching oral health skills. Purpose: The purpose was to assess the effectiveness of school-based, primary prevention oral health interventions for children and adolescents and to examine these programs for health behavior theory applications. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement and Checklist was used in reporting systematic review data. EBSCOhost database was utilized to search interventions by applying inclusion criteria. Data extraction occurred in four distinct phases to ensure all examined interventions met acceptable standards. Results: Eight interventions satisfied the inclusion criteria. Each study utilized oral health knowledge as an outcome variable. Two of the eight interventions stated that they utilized a specific health behavior theoretical framework. Each study applied health behavior concepts. Interventions were efficacious for improving oral health knowledge. Translation to Health Education Practice: Oral health education interventions in schools appear to be effective in providing dental skills and oral health knowledge.

OBJECTIVES:The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women.METHODS:Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors.RESULTS:The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035).CONCLUSIONS:Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Abstract Objective: When breast-feeding is not possible, commercially made human milk substitute is recommended. Some consumers would prefer to make their own homemade infant formula (HIF) and may seek information on this practice from internet sources. The purpose of the current study was to investigate the content of blogs posting HIF recipes. Design: Blog postings were identified through a comprehensive search conducted using the Google search engine and the following search terms along with the term ‘blog’: ‘Make Your Own Baby Formula’, ‘Homemade Baby Formula’, ‘Do It Yourself (DIY) Baby Formula’, ‘DIY Baby Formula’, ‘Baby Formula Recipe’ and ‘All Natural Baby Formula’. A quantitative content analysis of blogs offering recipes for HIF was completed. Blogs that met the inclusion criteria were reviewed for disclaimers, blogger’s credentials, rationale for HIF use, advertisement or sale of recipe ingredients and recipe ingredients. Setting: Worldwide Web. Results: Fifty-nine blogs, featuring one hundred forty-four recipes, met inclusion criteria. Among reviewed blogs, 33·9 % did not provide a disclaimer stating breast milk is the preferred option, 25·4 % recommended consulting a healthcare professional before using, and 76·3 % and 20·3 % either advertised or sold ingredients or recipe kits, respectively. Credentials of bloggers varied and only seven bloggers identified themselves as ‘nutritionists’. The three most frequently mentioned recipe ingredients were whole raw cow’s milk (24·3 %), raw goat’s milk (23·6 %) and liver (14·5 %). Conclusions: Clinicians should be aware of this trend, discuss source of formula with parents, advocate for appropriate infant feeding practices and monitor for side effects.

BACKGROUND Current guidelines advise against using enteral nutrition (EN) support for patients with advanced dementia (AD) because of negative outcomes. However, research suggests that some registered dietitian nutritionists (RDNs) in acute-care settings still recommend EN for this patient population. The purpose of this study was to identify workplace characteristics that influence the EN recommendations of acute-care RDNs who care for patients with AD. METHODS A random sample of 5000 RDNs in the United States were invited to participate in a web-based survey in which RDNs self-reported the likelihood that they would recommend EN for a patient with AD. Inclusion criteria specified that participants were at least 18 years of age, were an RDN in the United States, and currently provide nutrition care to older adults with dementia. χ2 tests compared RDN recommendations by workplace characteristics. Logistic regression was used to determine factors associated with recommending EN for patients with AD. RESULTS Respondents included 204 acute-care RDNs. RDNs in rural or suburban locations were 2.4 times more likely to recommend EN compared with those in urban facilities (95% CI, 1.1-5.1). RDNs who were the only nutrition provider at their facility were 3.3 times more likely to recommend EN than those in facilities with multiple RDNs (95% CI, 1.4-7.9). CONCLUSION Acute-care RDNs who are isolated either in rural facilities or because they lack other RDN colleagues at their facility may benefit from targeted interventions to increase knowledge and promote adherence to evidence-based guidelines.

BACKGROUNDCurrent guidelines discourage tube-feeding older adults with advanced dementia (AD), as this practice does not improve nutrition status or survival and decreases quality of life in these patients. Because registered dietitians (RDs) often provide feeding recommendations for patients with AD, this study aimed to identify factors that influenced RDs' feeding tube recommendations for older adults with AD.METHODSA random sample of RDs who work with older adults in the United States completed a validated, electronic survey. Logistic regression analysis was used to identify factors related to the likelihood of RDs recommending a feeding tube for patients with AD. Independent variables included participant demographics and the 6 subscales of the Attitudes Toward Tube-Feeding in Advanced Dementia Questionnaire, which measured individual and environmental influences on RDs' recommendations.RESULTSAmong the 662 RDs who responded, 72.2% were unlikely to recommend a feeding tube in patients with AD, and 15.4% were likely to do so (with the remaining being "neutral"). Factors associated with avoiding recommending a feeding tube include significantly higher total knowledge [odds ratio (OR) = 1.47, 95% CI (1.30, 1.66)] and personal values scores [OR = 7.51, 95% CI (3.96, 14.24)] and employment in long-term care settings [OR 3.29, 95% CI (1.38, 7.80)].CONCLUSIONIn this survey, most RDs were likely to make recommendations that are consistent with current guidelines for tube feeding patients with AD. RDs who work outside the long-term care setting may benefit from additional training. Future research is needed to understand how personal values may influence recommendations.

Background: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. Research Aims: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. Methods: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic (N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys (n=14) were taken home and returned to the researcher by mail after completion. Results: Cronbach’s alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610,p <.001) with breastfeeding intention scores. Conclusions: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women’s self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.

Identifying modifiable factors that influence bone status during adulthood to maximize bone quality is a potential primary strategy in the prevention of osteoporosis in later life. We investigated the impact of body height, body weight, body mass index, and body composition on calcaneal bone characteristics as measured with quantitative ultrasound in 441 Chinese adults (238 women) aged 20–55 yr from the middle areas of China. Body composition, including fat-free mass (FFM), muscle mass, and fat mass were obtained by bioelectrical impedance analysis. Bivariate correlation analysis demonstrated a significant negative correlation between age and broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) both in men (r = −0.177, p < 0.05; r = −0.499, p < 0.001; r = −0.530, p < 0.001, respectively) and women (r = −0.344, p < 0.001; r = −0.336, p < 0.001; r = −0.369, p < 0.001, respectively). Body height, body weight, FFM, and muscle mass had positive correlations with BUA, SOS, and SI in both genders, with FFM having the strongest correlation with BUA, SOS, and SI in men (r = 0.351, p < 0.001; r = 0.391, p < 0.001; r = 0.406, p < 0.001, respectively) and women (r = 0.331, p < 0.001; r = 0.288, p < 0.001; r = 0.324, p < 0.001, respectively). Fat mass had a positive correlation with BUA (r = 0.331, p < 0.001), SOS (r = 0.288, p < 0.001), and SI (r = 0.324, p < 0.001) in women, which was not found in men. Multivariate regression analysis revealed that, in both genders, FFM was a positive predictor for all 3 quantitative ultrasound variables.

Registered Dietitians (RDs) should participate in interdisciplinary feeding discussions for patients with advanced dementia, but research on how RDs make such feeding recommendations is scarce. This study developed and validated a theory-based questionnaire to assess the knowledge, beliefs, and attitudes of RDs regarding feeding tube use among older adults with advanced dementia. The instrument was drafted based on the Social Ecological Model, and face and content validity were established through an expert panel review. Pilot testing with 70 RDs provided an initial measure of internal consistency reliability and reduced the number of items in the survey. Efficacy testing with 662 RDs allowed for a second analysis of internal consistency reliability and eliminated additional items. Construct validity was then established using validation by extreme groups and exploratory factor analysis, yielding six subscales, each with adequate internal consistency and test-retest correlation coefficients: (I) Total Knowledge, (II) Knowledge Self-Efficacy, (III) Religion/Spirituality/Culture, (IV) Personal Values, (V) Perceived Organization and Training, and (VI) Perceived Policy. The survey, based on the Social Ecological Model, was deemed a valid and reliable tool to assess RDs' knowledge and attitudes regarding feeding tube use among older adults with advanced dementia.

Dementia is a progressive, debilitating disease that often results in weight loss, malnutrition, and dehydration. Feeding tubes are often prescribed; however, this practice can lead to complications. The purpose of this systematic review was to examine the use of feeding tubes in elderly demented patients from a social ecological perspective. Results indicated that family members often receive inadequate decision-making education. Many health care professionals lack knowledge of evidence-based guidelines pertaining to feeding tube use. Organizational and financial reimbursement structures influence feeding tube use. Feeding practices for patients with advanced dementia is a complex issue, warranting approaches that target each level of the Social Ecological Model.

OBJECTIVE:To explore predictors of intention of college students to use calorie labels on fast-food menus and differences in calories ordered after viewing calorie information.DESIGN:Quasi-experimental design. Participants selected a meal from a menu without calorie labels, selected a meal from the same menu with calorie labels, and completed a survey that assessed demographics, dietary habits, Theory of Planned Behavior constructs, and potential barriers to use of calorie labeling.SETTING:A southern university.PARTICIPANTS:Undergraduate university students (n = 97).MAIN OUTCOME MEASURES:Predictors of intention to use calorie labels and whether calories selected from the nonlabeled menu differed from the labeled menu.ANALYSIS:Confirmatory factor analysis, exploratory factor analysis, multiple regression, and paired t tests.RESULTS:Participants ordered significantly fewer calories (P = .02) when selecting from the labeled menu vs the menu without labels. Attitudes (P = .006), subjective norms (P < .001), and perceived behavioral control (P = .01) predicted intention to use calorie information but did not predict a difference in the calories ordered. Hunger (P = .03) and cost (P = .04) were barriers to using the calorie information.CONCLUSIONS AND IMPLICATIONS:If students can overcome barriers, calorie labeling could provide information that college students need to select lower-calorie items at fast-food restaurants.

Military suicide has become a public health crisis. To explore diagnosed depression and symptoms that indicate the presence of undiagnosed depression in veteran respondents, researchers analyzed data from the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS). Independent variables were analyzed to explore associations between depressive conditions and key demographic and behavioral predictors. Results indicated increased likelihood of having a diagnosed condition in veterans of Gulf War I, women, veterans without a domestic partnership, physically inactive veterans, and smokers. Results indicated increased likelihood of undiagnosed depressive conditions in recent Iraq/Afghanistan veterans, women, Hispanic veterans, binge drinkers, and smokers. This inquiry was intended to offer insights that may guide the planning and implementation of targeted resilience programming for the veteran community.

OBJECTIVE:National data consistently report that males participate in leisure time physical activity (LTPA) at higher rates than females. This study expanded previous research to examine gender differences in LTPA of college students using the theory of planned behavior (TPB) by including 2 additional constructs, descriptive norm and self-efficacy, from the integrated behavioral model. PARTICIPANTS:Participants were college students (N = 621) from a large public university in the southeastern United States. METHODS:A self-report, classroom-based assessment with validated and reliable measures of LTPA, TPB constructs, descriptive norm, self-efficacy, and demographics was conducted in fall 2009. RESULTS:Regression analyses revealed attitude (β = .119), intention (β = .438), self-efficacy (β = .166), body mass index (BMI) (β = -.084), and sports participation (β = .081) as significantly associated with LTPA for females (R (2) = .425, p < .001), whereas intention (β = .371) was significant for males (R (2) = .202, p < .001). CONCLUSIONS:Practitioners should consider tailoring promotional materials to address these gender differences in efforts to increase LTPA participation among college students.

Purpose: The purpose of this study was to evaluate the effectiveness of a theory-based computer-tailored osteoporosis prevention program on calcium and vitamin D intake and osteoporosis health beliefs in young women. Additionally, this study tested whether adding bone density testing to the intervention improved the outcomes. Methods: One hundred (n = 100) women aged 19 to 25 years were randomly assigned to one of 2 groups. One group (n = 50) received the computer-tailored program with brief counseling and the second group (n = 50) received the same intervention plus bone density testing of the heel (quantitative ultrasound [QUS])feedback. Results: Participants within both groups statistically significantly increased calcium and vitamin D intake from baseline to 1 month after the interventions. Both groups also experienced statistically significant decreases in perceived barriers to obtaining adequate vitamin D intake. Discussion: The theory-based computertailored osteoporosis prevention program resulted in significant improvements in osteoporosis beliefs and calcium and vitamin D intakes. The bone density test did not improve results. Translation to Health Education Practice: Though future research is needed, this preliminary study holds promise for health education practice to use theory to plan osteoprotective computer programs for young women.

BACKGROUND African American women report low levels of physical activity (PA) and are disproportionately burdened by related chronic diseases. This pilot study tested a 6-month theory-based (Social Cognitive Theory, SCT) culturally-relevant website intervention to promote PA among African American female college students. MATERIALS AND METHODS A single group pre-post test design (n=34) was used. PA and associated SCT constructs (outcome expectations, enjoyment, self-regulation, social support) were assessed at baseline, 3 months and 6 months. RESULTS The sample was comprised of mostly obese (M BMI= 35.4, SD=6.82) young adults (M age= 21.21 years, SD=2.31). Fifty percent of the sample completed all assessments. Intent-to-treat analyses showed that participants reported a significant median improvement in moderate-to-vigorous physical activity from 82.5 minutes/week (M=81.76, SD=76.23) at baseline to 115.0 minutes/week (M=122.44, SD=97.93) at 3 months (Wilcoxon z=2.39, p=.02). However these gains appear to have attenuated by 6 months (Median= 82.5 minutes/week, M=96.73, SD=84.20; Wilcoxon z=1.02, p=.31). Significant increases from baseline to 6 months were found in self-regulation for PA (p=.02) and social support for PA from friends (p=.02). Changes in the SCT variables were not significantly associated with changes in PA; however, this may have been due to small sample size. CONCLUSIONS Future studies with larger samples and more aggressive retention strategies (e.g., more frequent incentives, prompts for website use) are needed to further explore the applicability of web-based approaches to promote PA in this at-risk population.