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Health Education and Behavior

School Breakfast Club Programs in Australian Primary Schools, Not Just Addressing Food Insecurity: A Qualitative Study
4 days 4 hours ago
Health Education & Behavior, Ahead of Print.
Background. Many Australian primary schools have established school breakfast clubs (SBCs) to address concerns about children arriving at school hungry and the subsequent impact on learning but their effectiveness is uncertain. This study aimed to identify the perceived benefits, impacts, operational practices, and challenges of running SBCs. Method. Case studies with 10 Australian primary schools from different socioeconomic and geographic areas. Focus groups or interviews were held with 142 participants including students, parents/carers, school staff, and funding body representatives between July 2016 and October 2017. Results. There were no eligibility criteria to attend SBCs with all students able to attend, regardless of household income. Thus, participating in the SBC was often reported as a matter of choice rather than a consequence of food insecurity. Participants, including children, discussed the many social benefits of SBCs (i.e., social eating, relationship building, school connection, and engagement) as well as perceived improved classroom behavior. Challenges for program delivery included resource limitations, particularly, the reliance on volunteers and sourcing food. Discussion/Conclusion. SBCs offered a range of benefits beyond their primary goal of addressing food security. SBCs were highly valued by members of the school community for their social, welfare, well-being, and educational benefits, but program sustainability is constrained by resource limitations.
Kim Jose
Health Education Specialist Practice Analysis II 2020: Processes and Outcomes
1 week 1 day ago
Health Education & Behavior, Ahead of Print.
Introduction. The Health Education Specialist Practice Analysis II 2020 (HESPA II 2020) described the contemporary practice of health education specialists across work settings at entry and advanced levels. The purpose of the HESPA II 2020 manuscript was to report the research process and resulting data associated with the HESPA II 2020 and to provide recommendations for future practice analyses in health education. Method. Two data collection instruments were developed with the assistance of a 17-member Health Education Practice Panel to survey practicing health education specialists on the knowledge and skills needed in their ongoing roles. The instruments were designed to assess the degree to which the elements of the model had importance to practice (Importance), how often health education specialists performed the elements of the model (Frequency), and the point in time that health education specialists were expected to perform the various elements of the model (Performance Expectation). Composite scores for Sub-Competencies were calculated and subgroup comparisons were conducted to distinguish between levels of practice. Results. A total of 3,851 health education specialists provided usable responses. The final validated hierarchical model included eight Areas of Responsibility, 35 Competencies, and 193 Sub-Competencies. Of the Sub-Competencies, 114 were Entry level, 59 Advanced 1 level, and 20 Advanced 2 level. In addition, 145 knowledge items were verified. Discussion. HESPA II 2020 produced a validated hierarchical model descriptive of current practice of health education specialists across work settings. The results have implications for professional preparation, professional development, and certification.
Adam P. Knowlden
Assessment of COVID-19 Knowledge Among University Students: Implications for Future Risk Communication Strategies
1 week 1 day ago
Health Education & Behavior, Ahead of Print.
The purpose of this study was to describe population knowledge and beliefs about COVID-19 and current social media coverage to address a gap in what is known about risk communication during health crises. A survey with 27 questions was developed. Twenty-three percent (N = 1,136) of respondents started the survey. Less than half of the students reported a high health literacy level (43%, n = 365/855). When asked where students have heard about COVID-19, the majority reported the Internet and social media. Students reported a basic level of COVID-19 knowledge, but few students (18%, n = 173/966) correctly identified all three signs and/or symptoms of COVID-19. Results highlight the need for an increased public health presence on social media and the urgent need to remain diligent in educating community members about COVID-19 myths.
Amy Chesser
Disrupting the Behavioral Health Consequences of Racial Discrimination: A Longitudinal Investigation of Racial Identity Profiles and Alcohol-Related Problems
1 week 2 days ago
Health Education & Behavior, Ahead of Print.
Researchers have documented the negative associations between racial discrimination and alcohol use for young Black people, yet fewer researchers have examined these associations longitudinally and with racial identity as a protective factor. We use data from the Flint Adolescent Study (465 Black/African Americans) to investigate the relationship between discrimination and alcohol-related problems over time, and how that relationship differs with varying trajectories of racial identity (i.e., private and public regard). Among those reporting persistently moderate levels of private regard and high levels of public regard in late adolescence through emerging adulthood, increases in racial discrimination were associated with increases in alcohol-related problems over time. Findings suggest that regard for one’s racial group may function protectively in the health strategies employed in response to discriminatory events. More longitudinal research is needed to delineate how varying racial pride operates with regard to long-term discrimination and behavioral health.
Riana Elyse Anderson
Exploring the Usage of a Violence Prevention and Response App Among Community College Students
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 44S-53S, June 2020.
Sexual assault is a significant problem on college campuses. To date, much of the research on prevention and response has been conducted with students enrolled at traditional 4-year institutions. Limited research exists on 2-year institutions (also known as community colleges), which enroll a more diverse population (e.g., economic, gender, racial, and ethnic minorities) who are more vulnerable to victimization. Yet, 2-year institutions have few resources dedicated to the prevention of and response to sexual violence. Advances in technology, including mobile apps, have provided additional avenues to easily disseminate prevention and response information to college students. Mobile apps may be especially beneficial for community colleges given their diverse population and limited resources. Therefore, the present study examined a sample of community college students who reported downloading a violence prevention and response mobile app, uSafeUS, and their reasons for downloading. Participants were recruited from seven community colleges in a northeastern state and completed an online campus climate survey. Results indicate that participants who downloaded uSafeUS were more likely to perceive they were safe from campus sexual violence and receive information regarding campus sexual violence from their college than participants who did not download the app. Participants also reported downloading uSafeUS to keep themselves safe, to help a friend, and because they liked the sexual violence prevention and resource features. Female participants were more likely than male participants to download uSafeUS to keep themselves safe and because they liked the sexual violence resource information. Implications for research and practice are discussed.
Sharyn J. Potter
Developing an Effective Campus Sexual Assault Prevention Task Force: Lessons Learned From Multiple Midwestern Universities
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 17S-25S, June 2020.
Background/Aim. Developing a comprehensive prevention strategy requires a coordinated effort among campus stakeholders. Creating a campus sexual assault prevention task force consisting of key stakeholders is a way to ensure coordinated and sustainable prevention efforts. Understanding how to convene and maintain an effective campus prevention task force is important. However, there is little literature offering such guidance. In this article, we present the facilitators, barriers, and lessons learned from creating a campus sexual assault prevention task force in seven Midwestern postsecondary institutions. Method. Our data come from interviews with 25 key stakeholders, representing seven Midwestern postsecondary institutions. Questions focused on the perceived strengths and capacity to form a campus prevention task force, barriers, current campus knowledge, and attitudes toward sexual assault, current institutional support for prevention efforts, and current prevention programing. Results. Main barriers to developing a task force included (a) limited capacity, (b) lack of knowledge, (c) limited student engagement, and (d) bureaucratic structure. Facilitators included (a) strong interpersonal relationships, (b) a positive campus culture, and (c) preexisting programing.
Natabhona M. Mabachi
The Campus Sexual Assault Policy and Prevention Initiative: Findings From Key Informant Interviews
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 75S-84S, June 2020.
Addressing the widespread problem of sexual assault in college environments requires both prevention programming and policies addressing sexual misconduct in institutions of higher education. Through the Campus Sexual Assault Policy and Prevention Initiative, nine programs funded by the Office on Women’s Health approached this problem within a network of eight to 13 campuses apiece, supported by national organizations and local task forces. Near the close of the 3-year project period (June 2016–June 2019), key informant interviews were conducted with project directors and campus representatives. Contextual factors elucidating the project approaches, challenges, and successes were investigated through 31 interviews (nine grantee interviews and 22 campus representative interviews). Analyses across all interview content contributed to the development of several key themes related to staffing efforts to strengthen campus policies and prevention programs, working within institutions of varying structural characteristics, infusing efforts with trauma-informed perspectives, attending to cultural differences across campuses, and seeking to follow recommended guidelines in the context of campus-specific factors. Overall, the interviewees reported specific progress toward the program goals.
Deborah Backman
Responding to Campus Climate Data: Developing an Action Plan to Reduce Campus Sexual Misconduct
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 70S-74S, June 2020.
Hundreds of U.S. institutions of higher education have conducted campus climate surveys recently to assess students’ experiences with sexual misconduct and perceptions of institutions’ related policies and procedures. Many of these surveys were implemented in response to the recommendation by the 2014 White House Task Force to Protect Students from Sexual Assault. The several options for campus climate surveys, ranging from free measures campuses can implement themselves to full-service survey implementation packages, have streamlined and facilitated the climate data collection process. Unfortunately, there is little guidance on how institutions can use and respond to their climate data. This article presents a framework that institutions could use to develop an action plan based on findings from their campus climate survey, predicated on a process that begins before the survey is implemented and lasts long after data collection concludes. Each institution of higher education is different, and individual campus action plans can vary based on campus structure, dynamics, and climate survey findings.
Kevin M. Swartout
The Development and Piloting of a Digital Checklist to Increase Access and Usage of Campus Online Sexual Violence Resources
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 36S-43S, June 2020.
As colleges seek to respond to campus sexual assault, administrators are making policies, programs, and resources related to sexual violence available to students and members of the school community online. Keeping this content current and accessible can be challenging in the context of rapidly changing information and competing priorities across campuses. In response to this challenge, we developed a free, online protocol for campus leaders to quickly assess gaps in their online sexual violence resources. The “Digital Checklist” delineates action steps that campus administrators can take to determine whether information related to campus sexual assault is easily located, current, relevant, and accessible. We found that while schools made an effort to increase the availability of information online, the checklist helped identify gaps that, if remedied, would allow more students to access that information. The overall goal for the checklist is to provide schools with actionable, real-time, and trackable data regarding the utility and accessibility of online sexual violence information and resources and to complement other campus sexual assault prevention and intervention efforts.
Casey T. Corcoran
The Benefits and Challenges of a Regional Network to Address Campus Sexual Assault
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 26S-35S, June 2020.
To respond to the epidemic of sexual assault on college campuses, many postsecondary institutions have instituted campus climate surveys, strengthened sexual assault misconduct policies, and created sexual assault task forces to coordinate entities within the institutional setting. However, few colleges and universities have engaged with regional networks to exchange resources, research, and innovative practices across campuses. This exploratory study applies the theoretical framework of social exchange theory to examine the necessary infrastructure for a regional network to enhance campus policies and prevention programs related to sexual assault, and the efficacy of providing formal and informal opportunities for information sharing. Interviews were conducted with 10 staff and students from seven of the nine campuses in the network. The sample includes representatives from one large public university, two historically Black colleges, a community college, and three private universities, one of which is faith based. Results indicate that there are several benefits and a few challenges for college campuses that participate in a regional network. Primary benefits include resource and information exchange, as well as new opportunities for student leadership and collaboration across campuses. Some challenges include staff turnover and limited time to devote to the network, as well as distance between some campuses. Based on these findings, it is recommended that universities consider building informal or formal alliances with regional colleges for mutual benefit.
Patrick McGann
Factor Analysis of the Administrator-Research Campus Climate Collaborative (ARC3) Survey
1 week 3 days ago
Health Education & Behavior, Volume 47, Issue 1_suppl, Page 54S-69S, June 2020.
Sexual assault, dating violence, stalking, and sexual harassment present serious challenges to the health and well-being of college students across the United States. An estimated one in five female college students is sexually assaulted during college. Under the federal protection of Title IX, institutions of higher education are responsible for addressing sexual harassment and sexual misconduct as forms of discrimination, thus campus climate surveys are increasingly being conducted in campus settings to examine student beliefs and experiences about sexual assault, dating violence, stalking, sexual harassment, and related campus prevention and response efforts. The Administrator-Researcher Campus Climate Collaborative (ARC3) Campus Climate Survey was designed to assess a range of Title IX violations that include sexual harassment, dating violence, and sexual misconduct victimization and perpetration. This article used a sample of students drawn from seven universities to assess the psychometric properties of the ARC3 survey. Specifically, factor analysis (exploratory and confirmatory) was used to examine the factor structure of each module of the ARC3 survey. Results indicated that the majority of modules within the ARC3 survey were valid and reliable. Recommendations are provided for university administration to utilize a scorecard approach in order to get a brief but comprehensive view of campus safety status.
Donna Scott Tilley
Sociodemographic Differences in Secondhand Smoke Exposure in the United States
1 week 3 days ago
Health Education & Behavior, Ahead of Print.
Background. Socioeconomic disparities in secondhand smoke (SHS) exposure exist among nonsmokers. The present study examined the prevalence and socioeconomic disparities of both objective and self-reported measures of SHS exposure in various indoor environments among U.S. nonsmokers. Method. Data were drawn from the 2013–2014 and 2015–2016 National Health and Nutrition Examination Survey. The prevalence of objective measures of SHS (nonsmokers with serum cotinine levels of 0.05–10 ng/mL) and the self-reported SHS exposure status in restaurants, cars, and homes other than their own were examined for the overall population as well as by sociodemographic characteristics. Multivariable logistic regression analyses were used to assess the association between sociodemographic characteristics and SHS exposure measures. Results. The prevalence of self-reported SHS exposure in restaurants, cars, and homes other than one’s own decreased significantly between 2013–2014 and 2015–2016. We found higher odds of the objective measure of SHS exposure among non-Hispanic Blacks (aOR 2.07, 95% confidence interval [1.93, 2.81]) and males (aOR 1.12, confidence interval [1.05, 1.18]), while lower odds were found among Mexican Americans, other Hispanics, and those who had family income greater or equal to the poverty level. Compared to non-Hispanic Whites, the non-Hispanic Black group had higher odds of SHS exposure in restaurants and homes other than their own. Age was positively associated with self-reported SHS exposure measures but not the objective SHS measure. However, age was negatively associated with SHS measures in the adult sample (aged ≥ 20 years). Conclusions. Findings suggest that although SHS exposure may be decreasing in specific at-risk populations, socioeconomic disparities still exist.
Sunday Azagba
Taking Care of Yourself and Your Risk for Breast Cancer (CUIDARSE): A Randomized Controlled Trial of a Health Communication Intervention for Latinas
1 week 4 days ago
Health Education & Behavior, Ahead of Print.
Latinas in the United States are more likely to be diagnosed with late-stage breast cancer (BC) compared to non-Latinas. Literacy-appropriate and culturally sensitive cancer communication interventions can help address existing racial/ethnic BC disparities. We formatively developed a new BC prevention brochure for Spanish-speaking Latinas (≥35 years). Eligible women (n = 240) from a large public hospital in California were randomly assigned to one of three study arms: Group 1 received the new brochure, Group 2 included a community health worker (CHW) who delivered the new brochure’s content, and a control group received a standard educational brochure. Participants completed three surveys (baseline, postintervention, 3-month follow-up) with a 100% completion rate for the first two surveys and 80.4% completion after 3 months. We assessed the difference in outcomes for BC risk knowledge, perceived BC susceptibility, and BC information self-efficacy between groups. Participant mean age was 52.3 years, and 82.1% reported low English proficiency. Mean knowledge scores increased and perceived BC susceptibility improved for all groups (p ≤ .05), yet treatment effects were not significant between groups for these outcomes. BC information self-efficacy also increased from baseline to postintervention for all groups to >80%. After 3 months, only Group 2 and the control group retained their increases and treatment effects were significant only for Group 2 compared to other groups in unadjusted and adjusted models. A CHW-delivered intervention may be more effective in improving BC information self-efficacy among Latinas compared to print material alone. More research is needed to examine the efficacy of CHW-delivered interventions.
Denise D. Payán
Text Message Preferences for Surveillance Colonoscopy Reminders Among Colorectal Cancer Survivors
1 week 4 days ago
Health Education & Behavior, Ahead of Print.
Background. Surveillance colonoscopy 1-year after colorectal cancer (CRC) surgery effectively reduces CRC mortality, yet less than half of survivors undergo this procedure. Text message reminders can improve CRC screening and other health behaviors, but use of this strategy to address barriers to CRC surveillance has not been reported. Objectives. The goal of this qualitative study was to assess CRC survivor perspectives on barriers to colonoscopy to inform the design of a theory-based, short message service (SMS) intervention to increase surveillance colonoscopy utilization. Method. CRC survivors in Western Washington participated in one of two focus groups to explore perceived barriers to completing surveillance colonoscopy and preferences for SMS communication. Content analysis using codes representative of the health belief model and prospect theory constructs were applied to qualitative data. Results. Thirteen CRC survivors reported individual-, interpersonal-, and system-level barriers to surveillance colonoscopy completion. Participants were receptive to receiving SMS reminders to mitigate these barriers. They suggested that reminders offer supportive, loss-framed messaging; include educational content; and be personalized to communication preferences. Finally, they recommended that reminders begin no earlier than 9 months following CRC surgery and not include response prompts. Conclusions. Our study demonstrates that CRC survivors perceive SMS reminders as an acceptable, valuable tool for CRC surveillance. Furthermore, there may be value in integrating theoretical frameworks to design, implement, and evaluate SMS interventions to address barriers to CRC surveillance. As physicians play a key role in CRC surveillance, provider- and system-level interventions that could additively improve the impact of SMS interventions are also worth exploring.
Sarah D. Hohl
Associations Between Health Literacy and Underweight and Overweight Among Japanese Adults Aged 20 to 39 Years: A Cross-Sectional Study
1 week 4 days ago
Health Education & Behavior, Ahead of Print.
Background. Both underweight and overweight are public health concerns in Japan. Several studies examined the association between health literacy (HL) and obesity status in the general population; however, there is limited information on young adults. In addition, the association between HL and underweight status has not been extensively investigated. Aim. To examine the association between HL and underweight/overweight status among young Japanese adults aged 20 to 39 years. Method. This study was based on a cross-sectional survey of population-representative adults. HL was assessed using a questionnaire validated in Japanese adults. Body mass index (BMI) was calculated using self-reported weight and height. Participants were divided into two groups by HL score using the median score (lower vs. higher HL). The association between HL and underweight (BMI <18.5) or overweight (BMI ≥25.0) was examined using multinomial logistic regression analyses after adjusting for potential confounders. Results. In total, 476 women and 454 men were included in the analyses. Prevalence of underweight and overweight was 20.8% and 10.3% in women and 8.8% and 20.3% in men, respectively. In women, 45.1% of normal weight, 47.5% of underweight, and 30.6% of overweight had higher HL. Among men, 50.3% of normal weight, 35.0% of underweight, and 44.6% of overweight had higher HL. Bivariate analyses showed no statistically significant association between HL level and underweight/overweight status. Even after adjusting for potential confounders, these associations did not change. Discussion and Conclusion. This study suggests that HL scores may not be associated with underweight or overweight status in Japanese adults.
Ayaka Enomoto
Gender Analysis of COVID-19 Outbreak in South Korea: A Common Challenge and Call for Action
1 week 6 days ago
Health Education & Behavior, Ahead of Print.
This study aims to analyze South Korea’s experience during the COVID-19 outbreak through a gendered lens. We briefly introduce the COVID-19 outbreak in Korea, scrutinize gendered vulnerability in contracting the virus, and then analyze the gendered aspects of the pandemic response in two phases: quarantine policy and mitigation policy. The authors elicit four lessons from the analysis. First, gender needs to be mainstreamed at all stages of a public health emergency response. Second, in addition to medical care, all formal and informal care work should be considered as an essential component of health care systems. Third, a people-centered approach in health governance should be prioritized to make women’s voices heard at every level. Fourth, medical technology and resources to cope with pandemic should be produced and distributed in an equitable manner, acknowledging differential vulnerability and susceptibility.
Saerom Kim
Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago
2 weeks ago
Health Education & Behavior, Ahead of Print.
Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.
Sage J. Kim
Engage for Equity: Development of Community-Based Participatory Research Tools
2 weeks 1 day ago
Health Education & Behavior, Volume 47, Issue 3, Page 359-371, June 2020.
We developed a set of four community-based participatory research (CBPR) partnership tools aimed at supporting community–academic research partnerships in strengthening their research processes, with the ultimate goal of improving research outcomes. The aim of this article is to describe the tools we developed to accomplish this goal: (1) the River of Life Exercise; (2) a Partnership Visioning Exercise; (3) a personalized Partnership Data Report of data from academic and community research partners; and (4) a Promising Practices Guide with aggregated survey data analyses on promising CBPR practices associated with CBPR and health outcomes from two national samples of CBPR projects that completed a series of two online surveys. Relying on Paulo Freire’s philosophy of praxis, or the cycles of collective reflection and action, we developed a set of tools designed to support research teams in holding discussions aimed at strengthening research partnership capacity, aligning research partnership efforts to achieve grant aims, and recalling and operationalizing larger social justice goals. This article describes the theoretical framework and process for tool development and provides preliminary data from small teams representing 25 partnerships who attended face-to-face workshops and provided their perceptions of tool accessibility and intended future use.
Myra Parker
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Table of Contents for Health Education & Behavior. List of articles from both the latest and ahead of print issues.
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