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Health Education and Behavior

Building Community in the HIV Online Intervention Space: Lessons From the HealthMPowerment Intervention
1 day 21 hours ago
Health Education & Behavior, Ahead of Print.
BackgroundMobile health platforms can facilitate social support and address HIV (human immunodeficiency virus) stigma but pose challenges for intervention design and participant engagement. Giddens’s structuration theory, that individuals are shaped by—and shape—their communities through rules and resources that give them power to operate within these environments, provides a useful analytic framework for exploring these dynamic intervention spaces.MethodData were drawn from an online randomized controlled trial intervention (HealthMpowerment) for young Black men who have sex with men to reduce condomless anal intercourse. We applied a conversational analysis informed by structuration theory to 65 user-generated conversations that included stigma content. We aimed to understand how the interdependent relationship between the intervention space and participants’ contributions might contribute to behavior change.ResultsThirty five intervention participants contributed to the analyzed conversations. Our analysis identified three types of conversational processes that may underlie behavior change: (1) Through intervention engagement, participants established norms and expectations that shaped their discussions; (2) participants used anecdotes and anonymity to reinforce norms; and (3) intervention staff members sought to improve engagement and build knowledge by initiating discussions and correcting misinformation, thus playing an integral role in the online community.ConclusionsThe lens of structuration theory usefully reveals potential behavior change mechanisms within the social interactions of an online intervention. Future design of these interventions to address HIV stigma should explicitly characterize the context in which individuals (study staff and participants) engage with one another in order to assess whether these processes are associated with improved intervention outcomes.
Natalie A. Blackburn
Role of Dental Nutrition Knowledge and Socioecological Factors in Dental Caries in Low-Income Women
2 days 22 hours ago
Health Education & Behavior, Ahead of Print.
Dental caries is a chronic oral condition that disproportionately affects low-income women. The aim of this research was to investigate relationships between dental nutrition knowledge, socioecological factors, and prevalence of dental caries in low-income women. This quantitative cross-sectional study involved 220 women who were recruited from Central Texas. Participants completed demographics, the Dental Nutrition Knowledge Competency Scale, United States Adult Food Security Survey Module, and the Multidimensional Home Environment Scale. Two dentists measured dental caries via the Decayed, Missing, Filled Teeth Index. Regression models were conducted to test the effects of dental nutrition knowledge and Multidimensional Home Environment Scale factors on dental caries. Finally, mediation analysis explored relationships between dental nutrition knowledge and dental caries, adjusting for Multidimensional Home Environment Scale scores. Results showed that dental nutrition knowledge and Multidimensional Home Environment Scale score were significantly associated with dental caries. Subscales of self-efficacy for eating healthy, oral hygiene practices, emotional eating, availability of unhealthy foods at home, and social support were related to dental caries. The relationship between dental nutrition knowledge and caries was mediated by Multidimensional Home Environment Scale scores. This research emphasizes the role of dental nutrition knowledge and socio-ecological factors on prevalence of dental caries. Public health interventions to reduce dental caries should involve strategies that increase dental nutrition knowledge and encourage behavior change in low-income populations.
Prageet K. Sachdev
Utilizing a Multidimensional Health Literacy Framework to Assess Cervical Cancer Screening Nonadherence
2 days 22 hours ago
Health Education & Behavior, Ahead of Print.
Health literacy is an amenable factor that can improve screening uptake. However, associations between the multidimensional health literacy domains and cervical cancer screening nonadherence are not known and should be considered to improve screening rates. The current quantitative study assessed the associations of multiple health literacy domains with cervical cancer screening nonadherence. Women aged 30 to 65 years without a hysterectomy were surveyed online (N = 812). Assessing, understanding, and appraising measures from the European Health Literacy Survey Questionnaire were adapted for cervical cancer screening. The outcome variable measured the application of cervical cancer information regarding adherence to the 2012 cervical cancer screening guidelines (yes/no). Adjusted logistic regression odds ratios (aORs) estimated nonadherence. Most of the women were non-Hispanic (81.4%) or White (68.1%), and aged 30 to 39 years (40%). The majority of the women (71%) were adherent to screening recommendations. The model with all domains of health literacy had the best model fit statistics compared with other models with different health literacy components. Older age and lack of insurance were statistically significant for screening nonadherence. Difficulty understanding health information (aOR = 3.15; 95% confidence interval [CI; 1.80, 5.51]) and less worry about cervical cancer (aOR = 1.74; 95% CI [1.03, 2.94]) were associated with higher odds of nonadherence. Higher cervical cancer knowledge (aOR = 0.93; 95% CI [0.87, 0.98]) and Hispanic ethnicity (aOR = 0.36; 95% CI [0.21, 0.61)] were associated with lower odds of nonadherence. Incorporating a multidimensional health literacy framework may better inform the need to develop easily understood interventions that address cervical cancer perceived vulnerability and acknowledge systemic sociodemographic influences on screening perceptions.
Annalynn M. Galvin
The Implementation of Comprehensive Health Education to Improve Household Contacts’ Participation in Early Detection of Tuberculosis
2 days 22 hours ago
Health Education & Behavior, Ahead of Print.
Lack of participation of household contacts is the main problem of early detection of tuberculosis (TB) in Indonesia. A comprehensive health education (CHE) program has been developed to encourage the participation of household contacts. This study aimed to assess the implementation of the CHE to improve participation of household contacts in early detection of TB. This was a quasi-experimental study conducted between November 2018 and June 2019 in Badung District, Bali, Indonesia. Twelve public health centers (PHCs) were randomly allocated to six PHCs implementing the CHE and six PHCs implementing standard health education (SHE). The CHE was developed through a pilot study using the health belief model supplemented with perceived stigma and social support to identify the factors that influence participation. The participation was measured using a TB register with a cross-check to the health care officer until 2 months after health education was provided. Four hundred and twenty-eight household contacts enrolled in this study—216 in the CHE group and 212 in the SHE group. The CHE group’s participation was 28.2%, with 10 new TB cases found; in the SHE group, the participation was 15.6%, with 3 new TB cases found. The CHE increased the household contact participation by 1.83-fold (95% confidence interval [1.19, 2.81]) and case findings by 3.13-fold (95% confidence interval [0.85, 11.56]). The CHE implementation should be scaled up to other areas with a high level of TB transmission. The content and technique of the CHE could also be incorporated in contact investigation guidelines and materials for the TB campaign.
I Wayan Gede Artawan Eka Putra
Do Migrants Receive Tuberculosis Education in China? Evidence From the China Migrants Dynamic Survey
4 days ago
Health Education & Behavior, Ahead of Print.
BackgroundMigrants are the key population for tuberculosis (TB) transmission in China. However, it remains unknown how many migrants have received TB education and through what means.ObjectivesTo identify the rate and methods of TB education among migrants in China by using nationally representative data.MethodThis study used secondary data analysis. The data were derived from the China Migrants Dynamic Survey 2014–2017. A total sample of 745,926 migrants was included in the following analysis. Information on TB education was collected through a self-report questionnaire. We used hierarchical logistic regression models to explore the relationship between the independent variables and the receipt of TB education.ResultsOnly 30.4% (n = 226,458) received TB education. Among all age-groups, participants between 65 and 69 years old had the highest TB education rate (33.4%). Bulletin boards (86.5%–91%), media (73% to 86.7%), and books/magazines (59.2%–67.4%) were the most common ways for migrants to receive TB education.ConclusionsOur study showed the rates of TB education in each region of China and indicated the significant disparity among the seven regions. Traditional media, off-line medical consultation, community advocacy, and bulletin boards should be the primary methods of delivering TB education. TB education campaigns targeting migrants with a low socioeconomic status should be actively promoted.
Zheng Zhu
Protection Motivation During COVID-19: A Cross-Sectional Study of Family Health, Media, and Economic Influences
4 days ago
Health Education & Behavior, Ahead of Print.
BackgroundProtection motivation to practice preventive behaviors is necessary for sustained mitigation during coronavirus disease 2019 (COVID-19); however, limited research exists on the ecological sources of influence for COVID-19 protection motivation.AimTo explore sources of influence (family health, media consumption, and loss of work hours) on COVID-19 protection motivation.MethodAn online quantitative survey of U.S. adults (N = 501) aged 18 years or older was administered using Qualtrics with participants recruited through Amazon Mechanical Turk. Data were collected on constructs related to the protection motivation theory and theory of planned behavior as well as sources of influence and intention to socially distance and socially isolate during COVID-19. Constructs were further defined through exploratory and confirmatory factor analyses. Structural equation modeling was used to determine relationships between constructs.ResultsA two-factor model was identified with threat appraisal as one factor and subjective norms appraisal, coping appraisal, and behavioral intention loading as another factor. Higher news media consumption and loss of work hours due to COVID-19 were both significant predictors of increased threat appraisal. Family healthy lifestyle and family health resources were significantly related to increases in the subjective norms, coping appraisal, and behavioral intention appraisal factor.ConclusionsFamily health, news media consumption, and loss of work hours are associated with COVID-19 protection motivation. COVID-19 protection motivation might be enhanced through policies and messaging that can affect ecological sources of influence.
Carl L. Hanson
Exposure to E-Cigarette Product Placement in Music Videos Is Associated With Vaping Among Young Adults
4 days 21 hours ago
Health Education & Behavior, Ahead of Print.
BackgroundThe prevalence of electronic-cigarette (e-cigarette) product placement in music videos is on the rise and currently unregulated. This promotional activity is concerning given the popularity of music videos among young adults.AimsWe examined associations between self-reported levels of exposure to music videos with any e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use.MethodA representative sample of young adults (18–24 years of age), residing in California (n = 1,280), completed online surveys assessing self-reported exposure to music videos with e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. Adjusted and weighted regression analyses were used for statistical analyses.ResultsParticipants exposed to any e-cigarette product placement or imagery in music videos were more likely to report lifetime e-cigarette use (relative risk ratio [RRR]: 2.81) and past 30-day use (RRR: 3.64) compared with participants with no exposure. Additionally, participants with greater levels of exposure were more likely to report lifetime e-cigarette use (RRR: 1.13) and past 30-day use (RRR: 1.20) compared with participants with lower levels of exposure. Among those with any exposure, participants younger than 21 years of age (i.e., under the tobacco purchasing age in the United States) were more likely to report lifetime e-cigarette use (RRR: 4.68) compared with those aged 21 years and older.Discussion and ConclusionRestricting e-cigarette product placement or imagery in music videos may minimize marketing exposure and risk for vaping among young adults, especially among those under the tobacco purchasing age.
Anuja Majmundar
Exploring Barriers to Medication Adherence Among African American Emerging Adults With Uncontrolled Asthma
1 week 1 day ago
Health Education & Behavior, Ahead of Print.
African American emerging adults (age 18–29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.
Karen Kolmodin MacDonell
Policing Is a Public Health Issue: The Important Role of Health Educators
1 week 1 day ago
Health Education & Behavior, Ahead of Print.
For decades, marginalized communities have been naming the harms of policing—and the systemic racism that undergirds it—for health and well-being. Only recently have policing practices and racism within policing gained more widespread attention in public health. Building on social justice and emancipatory traditions in health education, we argue that health educators are uniquely prepared to use the evidence base to reframe narratives that drive aggressive policing and their disproportionate impacts on communities of color, promote disinvestment in militarized policing, and build relationships with community-based organizations and community organizers developing community-centered approaches to safety. Using public health institutions and institutions of higher education as examples, we suggest specific strategic actions that health educators can take to address policing as a public health issue. Health educators are uniquely poised to work with diverse community and institutional partners to support social movements that create community-centered, equitable approaches to public safety and health.
Paul J. Fleming
Trojan Horse: An Analysis of Targeted Advertising to Reduce Sexually Transmitted Diseases Among YMSM
1 week 1 day ago
Health Education & Behavior, Ahead of Print.
BackgroundMen who have sex with men (MSM) increasingly use internet-based websites and geospatial apps to seek sex. Though these platforms may be useful for public health intervention, evaluations of such interventions are rare. We sought to evaluate the online behavior of young MSM of color in Philadelphia and the effectiveness of using ads to link them to DoYouPhilly.org, where users can order free condoms, lubricant, and sexually transmitted infection test kits delivered via the U.S. postal service.MethodData collection and analyses were conducted in two phases. First, we performed keyword research and analyzed web browser logs using a proprietary data set owned by Microsoft. Subsequently, we ran a Google Ads campaign using the keywords identified in the preliminary phase, and directed targeted users to the DoYouPhilly.org condom or test kit ordering pages. Results were analyzed using MATLAB 2018.ResultsTest kit advertisements received 5,628 impressions, 157 clicks, and 18 unique conversions. The condom advertisements received 128,007 impressions, 2,583 clicks, and 303 unique conversions. Correlation between the click-through rate and the conversion rate per keyword was ρ = −.35 (P = .0096) and per advertisement was ρ = .40 (P = .14). Keywords that directly related to condoms were most effective for condom ordering (42% conversion rate vs. ≤2% for other classes), while keywords emphasizing the adverse effects of unprotected sex were most effective in test kit ordering (91% conversion rate vs. 13% and 12% for other classes).ConclusionsOnline advertisements seemed to affect real-world sexual health behavior, as measured by orders of condoms and test kits, among a group of young MSM living in the same community.
Ayla Tolosa-Kline
Implementation Adherence and Perspectives of the Childcare PhysicaL ActivitY (PLAY) Policy: A Process Evaluation
3 weeks 1 day ago
Health Education & Behavior, Ahead of Print.
The Childcare PhysicaL ActivitY (PLAY) policy was an evidence-informed, eight-item institutional-level policy document targeting children’s physical activity, outdoor play, and sedentary time. Nine childcare centers in London, Ontario, participated in this cluster, randomized controlled trial. Early Childhood Educators allocated to the experimental group, from five childcare centers in London, Ontario, implemented the policy for young children (18 months to 4 years) for 8 weeks and documented adherence to each policy item (i.e., dose) in daily logs. Program evaluation surveys (n = 21) and interviews (n = 10) were completed postintervention to assess Early Childhood Educators’ perspectives of feasibility, context, enjoyment, communication between researchers and childcare staff, and likelihood of future implementation. Descriptive statistics were calculated, and thematic analysis was conducted. Adherence to policy items ranged from 16.5% (for delivery of shorter, more frequent outdoor periods) to 85.9% (for delivery of unstructured/child-directed play). Participants reported effective communication between the research team and childcare centers (0 = not at all effective to 5 = very effective; M = 4.20; SD = 0.83) but noted that they were unlikely to continue the implementation of more frequent outdoor periods (0 = not at all likely to 5 = extremely likely; M = 2.19; SD = 1.21). Interview themes included weather as a prominent barrier and the use of verbal prompts as a solution for implementing the policy. As this was a small and short-term intervention, this pilot study offers important insight on larger scale policy interventions aimed at increasing physical activity and minimizing sedentary time among children enrolled in childcare.
Monika Szpunar
Visualizing Health Equity: Qualitative Perspectives on the Value and Limits of Equity Images
3 weeks 2 days ago
Health Education & Behavior, Ahead of Print.
BackgroundHealth educators and advocacy groups often use side-by-side visual images to communicate about equity and to distinguish it from equality. Despite the near-ubiquity of these images, little is known about how they are understood by different audiences.AimsTo assess the effectiveness of an image commonly used to communicate about health equity.MethodIn 167 interviews with health stakeholders in Greater Cleveland, Ohio, in 2018 to 2019, a commonly used health equity image was shown to participants, who were asked to interpret its meaning. Interviewees included 21 health professionals, 21 clinicians, 22 metro-wide decision makers, 24 community leaders, and 79 community members.ResultsAbout two thirds of our socioeconomically, racial/ethnically, educationally, and professionally diverse sample said the equity image helped clarify the distinction between “equality” and “equity.” Yet less than one third offered an interpretation consistent with the image’s goals of foregrounding not only injustice but also a need for systemic change. Patterns of misinterpretation were especially common among two groups: ideological conservatives and those of lower socioeconomic status. Conservatives were most likely to object to the image’s message.ConclusionsEquity images are widely used by public health educators and advocates, yet they do not consistently communicate the message that achieving equity requires systemic change. In this moment of both public health crisis and urgent concern about systemic racism, new visual tools for communicating this crucial message are needed.
Sarah S. Willen
Home Snack Environments in the United States: Latent Class Analysis Findings From a Home Food Environment Survey
3 weeks 2 days ago
Health Education & Behavior, Ahead of Print.
Snacking occasions have increased in frequency and energy density in recent decades, with considerable implications for diet. Studies have linked presence of foods in the home with intake of those foods. This study examines home snack food inventories among a large sample of U.S. adults using latent class analysis findings to present latent classes of home snack food inventories and multinomial regression to model classes as correlates of percent of calories from fat. Participants (n = 4,896) completed an online household food environment survey including presence of 23 snack foods in the home and demographics. Less healthy snack foods were more commonly reported than healthier snack foods (M = 4.3 vs. M = 3.5). Among White and Latinx participants, high-income households reported greater numbers of both healthier and less healthy snack foods than lower income households, with larger income-based differences in inventory sizes for healthier snack foods. Latent class analysis revealed three classes by inventory size (Small, Medium, and Large) and three classes by inventory content (Healthy Snacks, Standard American, and Limited Standard American). Compared with the Small Inventory class, the Healthy Snacks class had lower caloric intake from fat (p = .002), the Large and Medium Inventory classes had much higher caloric intake from fat (p < .0001), and Standard American and Limited Standard American class members had somewhat higher caloric intake from fat (p < .0001, and p = .0001, respectively). Future research should explore the role of snacks in Americans’ diets, their impact on diet quality and health, and how interventions can support healthy home food and snack food environments to foster healthy eating.
April Hermstad
Developing Visual Messages to Support Liquefied Petroleum Gas Use in Intervention Homes in the Household Air Pollution Intervention Network (HAPIN) Trial in Rural Guatemala
3 weeks 2 days ago
Health Education & Behavior, Ahead of Print.
BackgroundHousehold air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda.AimsWe conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households.MethodWe conducted ethnographic research, including direct observation (n = 36), in-depth (n = 18), and semistructured (n = 6) interviews, and 24 focus group discussions (n = 96) to understand participants’ experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households.ResultsWe identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages.DiscussionWe created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.
Mayarí Hengstermann
Identifying Barriers to and Facilitators of Using a Mobile Fruit and Vegetable Market Intervention Delivered to Low-Income Housing Sites: A Concept Mapping Study
3 weeks 3 days ago
Health Education & Behavior, Ahead of Print.
BackgroundMobile fruit and vegetable (F&V) markets may be a promising strategy to improve F&V intake among low-income and racial/ethnic minority groups. However, challenges remain in terms of maximizing the reach and utilization of such markets. Therefore, this study identifies perceived barriers to and facilitators of utilizing a mobile F&V market among residents who lived in low-income housing that received the markets. Specifically, this article reports the results of the follow-up acceptability study of the “Live Well, Viva Bien” (LWVB) intervention.MethodWe conducted concept mapping with residents in housing communities that received the Fresh to You (FTY) markets. Participants generated, sorted, and rated statements concerning barriers to and facilitators of market use. We compared the rating data by residents’ level of market utilization and created a map representing how statements clustered into conceptual themes.ResultsWe retained 66 unique participant-generated statements. Eight thematic clusters emerged; four pertained to barriers: financial/promotion, produce-related, scheduling/knowledge, and logistic/awareness barriers, and four related to facilitators: produce/staffing, promotion, accessibility, and multilevel market facilitators. There was a strong correlation in ratings between participants who more frequently versus less frequently shopped at the markets (r = 0.94).ConclusionsParticipants identified financial barriers, market promotion, ease of market accessibility, produce variety and quality, and staffing as key factors influencing FTY market use. This study highlights the importance of identifying the perceived barriers to and facilitators of mobile F&V market use among target populations to inform future efforts to scale up such approaches.
Akilah Dulin
Social Media Preference and Condom Use Behaviors: An Analysis of Digital Spaces With Young African American Males
4 weeks 2 days ago
Health Education & Behavior, Volume 48, Issue 2, Page 190-198, April 2021.
Background. African American adolescents and young adults have an increased likelihood of engaging in risky sexual behaviors. With rising rates of sexually transmitted infections among this population, deeper consideration is now being focused on using social media to engage, educate, and improve sexual behavior in this group. Purpose. To determine why social media is useful and how it may affect the attitude, norms, and perceived behavioral control on condom use among young African American males (YAAMs) ages 18 to 21. Method. Group-depth interviews (n = 41, mean age = 19, SD = 1.2) were conducted in metro Detroit to understand and describe the who, what, where, why, and how regarding social media use and preference among YAAMs) ages 18 to 21, and their condom use behaviors. Results. The most popular reasons for using social media were for educational purposes, entertainment, browsing the site, self-expression, seeking out or maintaining relationships with friends and family, and social justice. YouTube was stated as the easiest site to promote condom use education. YAAMs would seek out condom use education on social media sites if someone respected in the community or someone famous promoted condom use messages on the sites or if it was used to show where condoms were available for free or for purchase. Conclusion. Understanding how YAAMs use social media may help researchers design better questions to address disparities within this population. More important, it can help health care providers, families, and the community promote healthy behaviors and lifestyle changes among YAAMs.
Jade C. Burns
Effect of Disability-Specific Education on Student Attitudes Toward People With Disabilities
1 month ago
Health Education & Behavior, Ahead of Print.
Attitude is a multidimensional and complex notion that considerably empowers or limits the major life activities of humans. Health professionals’ attitudes toward people with disabilities are significant factors in the rehabilitation process. Soon after completing their coursework, the final-year students from health science meet the patients and rehabilitate them. This study accordingly aims to assess the attitude toward disability among final-year health science students before and after administering a disability-specific structured teaching program. A total of 243 final-year undergraduate health science students from medical, dental, physical therapy, pharmacy, laboratory sciences, radiology sciences, and nursing aged between 21 and 27 years participated in this study. This work employed the Scale of Attitudes Toward Disabled Persons (SADP) to measure attitudes among participants. The mean pre- and posttest SADP scores were 83.59 ± 15.45 and 107.83 ± 62, respectively (p < .001). Students from medical, dental, physical therapy, and nursing showed significant positive attitudes toward disability compared with other students, whereas college students in the final year of health science generally had poor attitudes toward disability. The results indicate that the disability-specific structured teaching program is effective in improving the attitude toward disability among final-year health science students. Accordingly, the authors recommend modifying the disability-related content in the health sciences curriculum.
Khalid A. Alahmari
Are Women Ready to Prevent Osteoporosis? Change Stages for Preventive Behaviors
1 month ago
Health Education & Behavior, Ahead of Print.
ObjectiveEvaluate the prevention behaviors for osteoporosis (OP) in women (physical activity and calcium intake) and their readiness to perform these behaviors.MethodWomen aged ≥30 years in four large cities of Mexico were interviewed. The geographical areas were selected randomly and stratified according to socioeconomic status and age. A questionnaire designed to assess OP-related prevention behaviors, as well as attitudes and stages of change of the transtheoretical model toward these behaviors, was used.ResultsEight hundred and six women were interviewed: 4.2% reported diagnosis of osteopenia, 5% of OP, 2.3% had suffered a fracture, and 11.9% had a family history of OP. A large proportion of participants did not do physical activity (56.2%) and did not have the recommended intake of calcium (61.3%). More than 80% of these participants were in lower stages of change (precontemplation and contemplation) for performing physical activity and 86.4% for calcium intake, which means a lack of readiness to change their behaviors. The absence of readiness to change preventive behaviors was related to negative attitudes toward both behaviors (OR = 1.81, 95% CI [1.04, 3.14] physical activity; OR = 3.09, 95% CI [1.81, 5.29] calcium intake). Both of these behaviors were associated with known risk factors for OP.ConclusionVery high percentage of women are not ready to perform the behaviors necessary to maintain bone health. This phenomenon was not as a result of clinical risk factors for OP but because of the negative attitudes and beliefs of women related to physical activity and calcium intake.
Patricia Clark
Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico
1 month ago
Health Education & Behavior, Ahead of Print.
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants (N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.
Alelí M. Ayala-Marín
Knowledge of a Drug-Related Good Samaritan Law Among People Who Use Drugs, Vancouver, Canada
1 month 1 week ago
Health Education & Behavior, Ahead of Print.
BackgroundAcross the United States and Canada drug-related Good Samaritan laws (GSLs) have been enacted to encourage observers of acute drug overdose events to contact emergency medical services (EMS) without fear of legal repercussions. However, little is known about the working knowledge of GSLs among people who use illicit drugs (PWUD). We sought to evaluate the prevalence and factors associated with accurate knowledge of a GSL among PWUD in Vancouver, Canada, 1 year after the GSL was enacted.MethodWe used data from participants in three community-recruited prospective cohort studies of PWUD interviewed between June and November 2018. Multivariable logistic regression was used to identify factors associated with accurate knowledge of the GSL.ResultsAmong 1,258 participants, including 760 males (60%), 358 (28%) had accurate knowledge of the GSL. In multivariable analyses, participants who reported ever having a negative police encounter (defined as being stopped, searched, or detained by the police) were less likely to have accurate knowledge of the GSL (adjusted odds ratio [AOR] = 0.70; 95% CI [0.54, 0.90]), while those involved in drug dealing were more likely to have accurate knowledge of the GSL (AOR = 1.50; 95% CI [1.06, 2.06]).DiscussionDespite having been enacted for a full year, approximately three quarters of participants did not have accurate GSL knowledge, warranting urgent educational efforts among PWUD. Additional research is needed to understand whether GSLs can mitigate the fears of legal repercussions among those engaged in drug dealing and with past negative experiences with the police.
Soroush Moallef
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5 hours 25 minutes ago
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