American Journal of Health Promotion

Purpose Self-care is recognized as an important element in the comprehensive management of patients with heart failure. The study aimed to explore the correlations of self-care behaviors in chronic heart failure patients in Kermanshah, West Iran. Design Descriptive and analytical cross-sectional. Setting Hospital. Sample The research population included 597 (246 female and 351 male) patients with chronic heart failure visiting Imam Ali Cardiovascular Hospital in Kermanshah in 2022. Measures Demographic information, European Heart Failure Self-care Behavior Scale. Analysis Independent-sample t test, ANOVA, and Kruskal-Wallis in SPSS-24. The significance level was set at 5%. Results The participants’ age was 63.04 ± 14.1 years. The mean and standard deviation of the participants’ self-care behaviors was 2.91 ± 31.00, and only 20.60% of the patients reported engaging in satisfactory self-care behaviors. Self-care behaviors were significantly related to Income level, ethnicity, family history of background disease, history of co-morbidity, history of addiction, access to medical centers, and not with any other variables. Conclusion Based on the study’s results, most participants exhibited moderate self-care behaviors, suggesting that these patients may need preventive educational interventions to acquire the knowledge, skills, and attitudes necessary for effective self-care behaviors. Therefore, it is essential to design and implement a health promotion educational intervention aimed at convincing these patients to make lifestyle changes and adhere to their dietary and medication regimens to improve self-care behaviors.

Purpose This study aims to evaluate causal relationships among eating rate, caloric intake, and weight gain using longitudinal data and to clarify how caloric intake mediates the effect of eating rate on weight gain. Design A longitudinal cohort study with a 4-year follow-up. Setting Data were collected from Daihatsu Co, Ltd employees, a major Japanese automobile manufacturer with 4 plants in Japan. Subjects Of the 12,816 working-age Japanese individuals who underwent health checkups in 2020, 7,784 without excess weight or non-communicable diseases were included. Intervention The eating rate was self-reported, and caloric intake was calculated based on cafeteria meal choices. Measures Annual change in body mass index (BMI), calculated as the difference in BMI between consecutive years. Analysis Mediation analyses using a mixed-effects model were conducted to assess whether caloric intake mediates the effect of eating rate on BMI. Results Caloric intake in the fast-eating and ordinal-eating groups exceeded that of the slow-eating group by 19.21 kcal [9.28, 29.13] and 10.01 kcal [1.20, 18.81], respectively. Higher caloric intake was associated with a more significant BMI increase, rising by .09 [.06, .13] per interquartile range increase. The proportion of mediated impact among the impact of eating rate is .19% [.09, .32]. Conclusion Faster eating independently contributes to BMI increases, with minimal mediation by caloric intake. Interventions targeting eating pace may prevent obesity, though the study population may limit generalizability.

Objective Co-creation is crucial for fostering active patient engagement in health management. However, the efficacy of co-creation in chronic disease management varies, and there is a lack of detailed description regarding co-creation practice. This study aimed to explore the effectiveness of co-creation on health outcomes and cost-effectiveness, detailing its implementation. Data Source PubMed, Embase, Scopus, Cochrane Library and Web of Science. Study Inclusion and Exclusion Criteria We included peer-reviewed randomized controlled trials, published in English, that analyzed the effects of co-creation on physical health, participation outcomes, psychological health, self-efficacy and cost-effectiveness. Data Extraction Two researchers independently screened the articles and assessed the quality of the 16 included studies using a pre-prepared checklist. Data Synthesis Meta-analyses were conducted to summarize the characteristics, outcomes, and risk of bias of the included studies. Results The results showed that co-creation significantly enhanced patients’ physical health ( P = 0.006) and participation outcomes ( P = 0.009). Subgroup analysis revealed that co-creation combined with theory was better than co-creation without theory in improving physical health ( P = 0.007). However, no significant difference was observed between the two groups regarding psychological health, self-efficacy and cost-effectiveness ( P = 0.29) ( P = 0.11) ( P = 0.50). Conclusion Co-creation effectively improved patients’ physical health and participation outcomes, without affecting psychological health, self-efficacy, and cost-effectiveness. Social determinants were found to play a more crucial role in influencing physical health of patients. Additionally, age disparities might impact the cost-effectiveness of co-creation. Future research should explore the influence of intergenerational co-creation on health promotion.

Purpose This study examines the mediating roles of social media use and trust in the relationship between experts’ health recommendations being conflicting and changing and their intention to receive cancer screening tests using the O 1 -S-O 2 -R model. Design Cross-sectional. Setting Data were extracted from the Health Information National Trends Survey (HINTS) 6. Subjects Of 6252 individuals, 5014 were used in the final analysis. The total weighted sample size is 255,489,241. Measures Conflicting & Changing Health Recommendations ( O 1 ): How often experts’ health recommendations seem to conflict and change. Social Media Use ( S ): The use of social media to seek and share health information. Trust in Cancer Information ( O 2 ): Trust in cancer information from doctors, government health agencies, and scientists. Interest in Cancer Screening in the next year ( R ). Analysis Multiple and logistic regressions were performed with the weighted sample. A PROCESS mediation model with a 5000 bootstrapping sample was also performed. Results The perception of health recommendations from experts conflicting was a positive, marginally significant predictor of social media use for seeking and sharing health information ( P = .08), which generated higher trust in cancer information from government health agencies ( P < .05) and higher intention to receive cancer screening tests within the next year ( P < .01). Conclusions With strong digital health literacy and appropriate social media algorithms, social media could reinforce cancer screening behaviors.

Purpose The impact of gun violence on mental health is not limited to individuals who have experienced a shooting. This report enumerates, for the entire US population, the prevalence of anxiety and stress about gun violence. It also describes evidence-informed interventions that may improve these symptoms by reducing gun violence. Design Surveys representing the US population. Setting United States. Subjects Adults and adolescents. Measures Self-reported anxiety and stress. Analysis Descriptive frequencies. Results On 3 surveys of adults (N sizes 2015 to 3192), between 27% and 38% selected “extremely anxious”, 26% to 35% selected “somewhat anxious”, and 12% selected “not at all anxious” when asked about gun violence concerns. When asked, 37% of respondents stated that they had avoided going somewhere over the past 6 months due to fear or anxiety about gun violence. In a survey of teens (N = 743) and their parents (N = 1058), 25% of teens selected “very worried” and another 32% “somewhat worried” about the possibility of a shooting happening at their school. In response to the same question, 24% of parents selected “very worried” and another 39% “somewhat worried”. Conclusion Anxiety and stress about gun violence are pervasive in America. Secure gun storage, universal background checks and extreme risk protection orders are among the interventions that reduce gun violence and may thereby reduce the anxiety and stress it generates.

Half of fatal firearm injuries, now the leading cause of death for Americans under the age of 20, occur in a home. We are asking health coaches and other health promotion professionals to help us prevent these deaths with 4 simple actions. • If you have firearms, always store them securely. • Add secure firearms storage to your safety checklist. • When arranging play dates or parties for children and adolescents, ask whether firearms are stored securely. If an unsecured firearm is in the home, change the venue. • Help normalize asking by encouraging members of your social network to ask too.

Background Pre-exposure prophylaxis (PrEP) is a critical tool for HIV-prevention, yet PrEP uptake among Black sexual minority men (BSMM) is relatively low, despite greater HIV vulnerability. Stigma in healthcare settings can be a substantial barrier to PrEP use among BSMM, with implications for the HIV epidemic. We used a sequential explanatory mixed-methods approach to assess quantitative relationships between anticipated healthcare stigma and reduced PrEP use among BSMM, and qualitatively explore stigmatizing experiences within healthcare settings among this population. Methods We utilized 2 data sources. First, cross-sectional data from a pilot sample of BSMM (n = 151) was collected in late 2020 in the United States. We tested for associations between healthcare stigma and PrEP use using modified Poisson regression. Subsequently, we selected participants (n = 23) from this sample in the D.C. metropolitan area for qualitative interviews starting in 2022; we used thematic analysis to investigate forms of experienced and anticipated healthcare stigma related to PrEP use. Results We found 82% lower PrEP use associated with an interquartile range increase in anticipated healthcare stigma after adjustment (aPR = 0.18, 95% CI 0.06, 0.59). Subsequently, our qualitative investigation revealed that identity-specific stigma, negative socioeconomic assumptions, and assumptions of sexual risk were prevalent themes in the healthcare stigmatization experienced by BSMM. Identity-based and socioeconomic stigma were heavily interlinked due to longstanding structural racism and homophobia. Assumptions of sexual risk were particularly complex. Conclusion We discovered a significant negative relationship between anticipated healthcare stigma and PrEP use, further elucidated in our qualitative findings. This builds upon our previous work exploring intracommunity PrEP stigma among BSMM. Healthcare stigma serves as an additional obstacle to accessing PrEP for BSMM. This highlights its importance as a target for provider-level health equity policy and research interventions. Future research exploring this stigma in specific healthcare settings is recommended.

Objective This systematic review summarizes the effectiveness and the dose of walking interventions on specific cognition domains in older adults, including executive function, memory, attention, processing speed, and global cognition. Data source Published randomized controlled trials in PubMed, Embase, and Web of Science until 10 May 2023. Study Inclusion and Exclusion Criteria Studies include older adults without Alzheimer’s or related dementias, involving a walking intervention and performance-based neuropsychological assessments for executive function, memory, processing speed, attention, or global cognition. Data Extraction Two independent research assistants reviewed 8424 studies and included 17 studies. Data Synthesis Participant demographics, intervention features (type, intensity, time, frequency, duration, format, and context), cognitive assessment tools, and main findings. Results Nine studies found a favorable effect of walking interventions on at least one cognitive domain. Walking interventions improved executive function (n = 6) and memory (n = 3). These studies delivered the intervention individually (n = 3) for at least 40 minutes (n = 6) each time, three times per week (n = 8), between 6 to 26 weeks (n = 8), and walking at a moderate to vigorous intensity (n = 7). Conclusion Walking interventions may improve specific domains of cognitive function in older adults, particularly executive function and memory. More standardized reporting of intervention design and participant compliance based on published guidelines is needed to determine the dose-response association and the long-term effect of walking interventions on cognition.

Purpose To assess the association between secure firearm storage and economic instability. Design Cross-sectional survey. Setting California, Minnesota, Nevada, and New Mexico. Sample Respondents to the 2022 and 2023 Behavioral Risk Factor Surveillance System who reported presence of a firearm in or around the home. Measures Economic instability was defined by receipt of food stamps, experiencing threats to shut off utilities, inability to pay bills, employment instability, unreliable transportation, and food insecurity. Firearm storage was dichotomized to “loaded and unlocked” or “all other storage”. Analysis Logistic regression with complex survey weights. Results Among survey respondents who reported a firearm in or around the home (n = 29,977), 25.8% (95% CI: 24.7-26.8%) reported at least one indicator of economic instability, and 17.4% (95% CI: 16.5-18.3%) stored at least one firearm loaded and unlocked. After controlling for age, sex, and the presence of a child in the home, the odds of storing a firearm loaded and unlocked were 1.26 (95% CI 1.07-1.48) times higher for those experiencing economic instability compared to those who were not. Conclusion These results provide evidence for the association between economic instability and firearm storage behaviors. In promoting secure firearm storage, economic instability may need to be considered as a correlate of that behavior.

Purpose To examine multimorbidity prevalence by race/ethnicity and unique health disparities for Native Hawaiian and Other Pacific Islanders (NHPI). Design Cross-sectional study. Setting This study uses combined data from the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS. Sample 38,965 adults, including a representative sample of 2,026 NHPIs. Measures Self-reported diagnoses of ten chronic conditions and race/ethnicity, including Non-Hispanic (NH) Whites, NH Blacks, NH Asians, NH NHPIs, Hispanics and NH Mixed Race. Covariates include age, sex, marital status, education, family income, and employment status. Analysis We used multinomial logistic regression models to evaluate the adjusted association between race/ethnicity and number of chronic conditions: none, 1, and ≥ 2 (multimorbidity). Results Compared to Whites, Asians and Hispanics (aRRR = 0.39, P < .001 and aRRR = 0.59, P < .001) had significantly lower odds of having multimorbidity relative to no chronic condition. In contrast, Black Americans and NHPIs (aRRR = 1.27, P < .001 and aRRR = 1.22, P < .05) had significantly higher odds of multimorbidity compared to Whites. Of note, NHPIs showed significantly higher odds of multimorbidity compared to Asians (aRRR = 3.07, P < .001). Conclusion Our findings highlight significantly higher risk of multimorbidity for NHPIs relative to Whites as well as Asians. This underscores the importance of disaggregating NHPI data from Asians as a whole. Future studies should incorporate additional social factors relevant to the NHPI community.

Purpose American medical students exhibit higher rates of depression, anxiety, and psychological distress than age-matched members of the general population, yet the majority of students do not seek help for these conditions. A necessary precursor to help-seeking is disclosure, or the sharing of one’s diagnosis or symptoms with others. This pilot study aims to explore mental health disclosure decision-making among medical students. Design Semi-structured qualitative interviews. Setting Students were interviewed virtually using Zoom. Participants 20 students enrolled in nine American undergraduate medical education institutions (MD or DO). Method Interviews were audio-recorded and transcribed. Using Constructivist Grounded Theory (CGT) and iterative cycles of analysis with focused and theoretical coding, a preliminary framework was developed to represent mental health disclosure decision-making among medical students. Results The proposed framework presents three factors that impact students’ disclosure decisions: Assessing Anticipated Outcomes , Evaluating Priorities , and Determining Appropriate Recipients . The framework also identifies two moderating variables— Disclosure Goals and Severity and Type of Symptom s—that affect students’ perspectives on outcomes and recipients. Conclusion This pilot study highlights the complexity of student disclosure decision-making. While limited by the small sample size, the results suggest the importance of considering student perspectives on disclosure recipients, communication surrounding disclosure outcomes, and the flexibility of student schedules when pursuing future projects related to medical student well-being and mental health disclosure.

Objective To evaluate the evidence base regarding employer-sponsored health and wellbeing (HWB) programs in relation to addressing workforce health inequities. Data Source Multiple databases were systematically searched to identify research studies published between 2013 and 2022 regarding employer-sponsored HWB programs. Study Inclusion and Exclusion Criteria Researchers included studies based on the following criteria: (1) described an employer-sponsored initiative to improve employee HWB; (2) included employees as the population of interest; (3) provided detail regarding participant demographics, and (4) included outcomes measures. Data Extraction Four researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 3420 articles identified, 98 studies were eligible and abstracted. Data Synthesis Data synthesis focused on research approach and design, as well as work setting, HWB program characteristics, and approach to inclusion of historically underrepresented or low-wage subpopulations. Results The majority of studies highlighted programs focused on improving employee physical health (54) and/or mental health (24) or the workplace environment (27). Fourteen studies incorporated a randomized experimental design. Though nine studies intentionally recruited historically underrepresented populations and ten studies involved low-wage workers, none included race or ethnicity as independent variables. Various facilitators and barriers to employee participation were explored. Conclusions Despite increasing employer focus on workforce HWB, few studies explored the program implications on historically underrepresented or low-wage populations or subpopulations.

Artificial intelligence shows both perils and promises as a way to address the difficulties in accessing professional support such as health coaching and health counseling. Chatbots are being used by millions of users to address their loneliness, to provide emotional support and to provide coaching and motivation. This editorial reviews the ethics and controversies attendant to the use of AI in mental health. ChatGPT is put to the test by this author, a trained health coach, who came away impressed with a Bot’s capacity for connecting psychological theories to the practice of health coaching. Still, many unanswered questions need the attention of health promotion professionals to help distinguish between the benefits compared to the risks of employing AI in health coaching and mental health counseling.

Purpose To examine the associations between baseline social determinants of health (SDOH) and physical activity (PA) in children and parents cross-sectionally (baseline) and longitudinally (18-months later). Design Cross-sectional and longitudinal. Setting Family Matters Cohort Study, Minneapolis-St. Paul, Minnesota. Sample Parents with children aged 5-9 years (n = 1146). Measures Parent self-reported (1) 25 SDOH factors mapped across 5 domains and (2) parent and children moderate-to-vigorous intensity physical activity (MVPA). Analysis Adjusted linear regression models. Results Each of the SDOH domains were positively associated with parents and children MVPA levels (all P < 0.05), except Economic Stability (all P > 0.05). Families with high family functioning reported higher MVPA among children, cross-sectionally (β 1.27; 95% CI [0.67, 1.87]) and longitudinally (β 0.87; 95% CI [0.29, 1.46]). Parents exhibited higher levels of MVPA both cross-sectionally (β 0.66; 95% CI [0.11, 1.21]) and longitudinally (β 0.73; 95% CI [0.21, 1.26]) when they had greater social capital. Children also exhibited increased MVPA (β 1.10; 95% CI [0.41, 1.79]) when living in areas with high walkability to recreational places. Conclusion Results indicate that SDOH may shape the PA habits of parents and children in a racially/ethnically diverse population. To advance health equity and support engagement in PA, researchers and clinicians should take into consideration SDOH factors related to a family’s educational, social, home, family functioning, and neighborhood environments.

Purpose This study aimed to examine the relationship between distinct adolescent social connectedness profiles and psychological distress in a summer care program. Design A longitudinal design was employed to capture changes over 10 weeks in summer. Setting The study was conducted in a community-based care program which provided weekday care over a 10-week summer period. Sample The sample consisted of 47 adolescents aged 10-14 years attending a summer care program. Measures Social connectedness was assessed using adult and peer subscales of the Hemingway Measure of Adolescent Connectedness, while psychological distress was measured using the Kessler Psychological Distress Scale (K10). Analysis Two-step cluster analysis was used to identify distinct social connectedness profiles, and generalized estimating equations (GEE) examined psychological distress patterns between profiles over time, controlling for age and sex. Results Two profiles emerged from the analysis: “baseline bonders” (n = 21) with moderate-low connectedness scores, and “strong socializers” (n = 26) with high connectedness scores, particularly with adults. GEE analysis revealed a significant time-by-profile interaction (β = −4.42, P = .017). Baseline bonders showed significant improvement in psychological distress (initial M = 22.46, final M = 19.20), while strong socializers remained stable (initial M = 17.38, final M = 18.54). Conclusion Distinct social connectedness profiles were associated with differential program effects on psychological distress. Findings suggest the need to better understand connectedness and distress profiles and trajectories across summer programing.

Purpose The National Board of Health and Wellness Coaches (NBHWC) requires 50 practice sessions for board exam eligibility, which can be challenging for students. The purpose of this report is to present a supervised practicum model to meet this need while supporting an employee health program. Design Mixed Methods Observational. Setting Academic. Subjects 22 students, 6 faculty, and 50 employees participated in Employee Coaching Connection (ECC). Intervention ECC is a 12-week health and wellness coaching program for employees delivered by students. Measures Surveys were developed and data collected for students, faculty, and employee participants. Results Statistics included descriptive and thematic analyses. On average students conducted 5.6 group, and 14.9 individual coaching sessions. Student confidence providing individual and group coaching increased 17.27% and 22.38% ( P < .001) respectively. Faculty mentors were unanimously “very satisfied” with student learning. Seventy percent of employees reported the program as “very beneficial” in helping reach health goals, and 88% would recommend the program to a colleague. Conclusions This was an observational study of the ECC program. Future studies are needed to evaluate efficacy and cost effectiveness. Data from this study support HWC curricula as a tool to address the need for student clinical experiences while also supporting employee health.

Objective: To review the literature exploring the mental health of graduate students in Canada. Data Source: Articles identified in EMBASE, CINAHL, PsycInfo, Medline, Sociological Abstracts, Nursing and Allied Health, and ERIC. Study Inclusion and Exclusion Criteria:Two independent reviewers screened articles that: (1) focused on graduate students’ mental wellbeing; (2) used empirical study designs (3) were published in English; (4) were conducted in Canada. Data Extraction: Twenty-two articles met the inclusion criteria. Data was extracted on the following variables: author(s); year of publication; study design; methodology; clinical characteristics of participants; number of participants; demographic characteristics of participants, journal discipline and university. Data Synthesis: We used Dedoose, a qualitative data management program, to perform qualitative content analysis and characterize the data and identify emerging themes. Results: The content analysis led to three related themes from the included studies: Determinants of mental health in graduate students are myriad; 2) Coping Strategies for Graduate Student Stress; and 3) Bridging Support: Enhancing Mental Well-Being. Conclusion: Our study's findings highlight the significance of investigating the mental well-being of graduate students in Canada. This review showed that by promoting mental well-being, universities and institutions can create a supportive atmosphere that encourages open dialogue, provides access to counseling and other mental health resources, and implements strategies to mitigate the challenges faced by graduate students.

Purpose To examine the bidirectional relationships between sleep quality and cognitive function in older Chinese, and further examine the sex differences in the relationships using the random intercept cross-lagged panel model. Design A secondary observational analysis of a physical activity clustered randomized controlled trial (The Stay Active While Aging). Setting Eight villages in Sichuan, China. Subjects A total of 511 adults aged 60 or older. The response rate was 97.3%. Measures The Pittsburgh Sleep Quality Index was used to examine sleep quality. Cognitive function was assessed by the Telephone Interview for Cognitive Status. Results The mean age was 71.0 (SD, 5.710) years and 227 (44.4%) were men. Sleep quality in the previous wave was associated with cognitive function in the subsequent wave (β = −0.135, [95%CI -0.244 to −0.026], wave 2 to 3; β = −0.108, [95%CI -0.204 to −0.013], wave 4 to 5). Cognitive function in the previous wave was associated with sleep quality in the subsequent wave (β = −0.404, [95%CI -0.566 to −0.242], wave 3 to 4; β = −0.224, [95%CI -0.392 to −0.055], wave 4 to 5). Such relationships were significant only in women. Conclusions There were bidirectional relationships between sleep quality and cognitive function in older adults, especially in women. Future cognition interventions may find it helpful to improve sleep quality, and vice versa, particularly in women.

Although healthcare workers may be aware of the risks of physical inactivity, their levels of physical activity (PA) are similar to those of all US adults, with less than half engaging in sufficient PA. The purpose of this health promotion was to encourage daily PA among employees in a large academic healthcare system. We also tested whether individualized progress updates further influenced PA. This 10-week program was available to all employees of NYU Langone Health. Employees could sync their phone or accelerometer via app or web browser to count.it – the vendor chosen to monitor and manage step counts. Participants were asked to voluntarily provide basic information (age, sex, job role, work location) and complete the Physical Activity Vital Sign (minutes/week and intensity of PA) at enrollment and 10 weeks. For 10 weeks, participants were sent a message through their employee ‘MyChart’ portal with a link to information on the benefits of PA, and a reminder of that week’s step-count challenge. Those meeting criteria for weekly challenges were included in gift card raffles. Participants were randomized 1:1 to receive the standard message ± additional emails detailing their progress. 3528 employees registered to participate (8% of all employees) although active users diminished over time (1225 at week 10). Average daily steps remained stable throughout (7319 + 4540 in week 1, 7229 + 5010 in week 10). Although there was no difference in any individual week, receipt of personalized feedback was associated with significantly higher average step counts throughout the 10-wk intervention as a whole ( P = 0.01). Age and an urban work location were positively associated with steps, while female sex and a clerical job role were negatively associated with steps counts (all P < 0.005). Our findings provide important insight for workplace interventions to promote PA. They further suggest specific groups that may benefit from targeted efforts.

Purpose This study examined how the potential health benefits of movement behaviors – physical activity (PA), sedentary time, and sleep – vary by neighborhood perceptions among Latinos. Design Cross-sectional analysis of baseline data from churchgoing Latino adults participating in an ongoing randomized controlled trial to promote PA. Setting East Los Angeles, California, and surrounding neighborhoods. Sample Sample of 728 churchgoing Latinos (77% female, mean age 52 years). Measures Movement behaviors included self-reported leisure-time PA and sleep duration, and accelerometer-based sedentary time. Survey assessed perceived neighborhood crime safety, traffic safety, aesthetics, and social cohesion. Outcomes included self-reported stress, depressive symptoms, diabetes, and hypertension; and objectively-measured body mass index. Analysis Linear or logistic regression assessed associations of the movement behaviors with neighborhood measures, and their interactions, in relation to the health outcomes. Results Sleep was associated with lower perceived stress [B(SE) = −0.41 (0.09), P < .0001] and major depression [OR, 95% CI = 0.54, 0.42-0.69]. Leisure-time MVPA was associated with lower obesity [OR, 95% CI = 0.60, 0.41-0.88] and sedentary time was associated with higher diabetes [OR, 95% CI = 1.03, 1.00-1.05]. Perceived neighborhood safety from crime, social cohesion, and aesthetics had significant interactions with movement behaviors ( P < 0.05) in relation to four outcomes. Conclusion Interaction models suggest interventions targeting neighborhood crime safety, aesthetics, and social cohesion may be key for maximizing the health benefits of movement behaviors among Latinos.

Background: School recess provides several benefits to elementary school students, including physical, emotional, and social health benefits. Despite these benefits, there is a growing shift toward reducing or reallocating recess time in school. Furthermore, not all students have equitable access to recess and its benefits due to disparities in recess policies and implementation by socioeconomic status of the communities served by the school and academic or behavioral conduct of individual students. Conclusions: Strong state-level legislation requiring recess for all elementary schools and for all elementary school children is necessary to ensure equitable access to recess and its benefits.

Purpose Asian and pacific region countries are considered to be high risk countries for Human Immunodeficiency Viruses (HIV). There is little literature quantifying the relationship between education of HIV/AIDS and its principal socioeconomic determinants through a spatial analysis. The purpose of this study was to assess the knowledge and awareness about HIV among the women in Thailand, and its direct and indirect association with sociodemographic factors including sexual education, level of education, area of living and wealth index through a structural equation modelling approach. Design Cross-sectional analysis using data from the 2022 UNICEF Multiple Indicator Cluster Survey (MICS). Setting Thailand. Subjects A total of 3671 women from the 2022 MICS dataset. Measures Key variables included knowledge and misconceptions about HIV, sexual education, education level, area of residence, marital status, and wealth index. Analysis Structural equation modeling was used to assess direct and indirect effects of sociodemographic factors on HIV-related knowledge and misconceptions. Results The direct effect of sexual education on knowledge, transmission and misconception about HIV/AIDS is significant (β = 0.051, P = .002). The mediation effect test found that the sexual education and education indirectly affected knowledge, transmission and misconceptions about HIV/AIDS through the mediation effect of women’s marital status (β = −0.068, P = .018) and wealth index (β = 0.007, P = <.001). Conclusion Sexual education alone is insufficient to improve health literacy on HIV/AIDS, as other mediating factors such as education level, wealth index, marital status and area of residence are also key drivers. To achieve Sustainable Development Goal (SDG) 3 by 2030, it is essential to enhance HIV/AIDS related health education for women through multifaceted intervention programs that address these mediating factors.

Background Targeting cardiovascular fitness (CVF), rather than weight loss, may be a more acceptable and feasible outcome among Latinos. Purpose The purpose of this study was to test the short-term efficacy of Athletes for Life (AFL), a fitness- and lifestyle-focused behavioral intervention to improve CVF and performance among Latino families. Methods Latino parent-child dyads (n = 137) were randomized to either AFL program or a waitlist control condition. AFL consisted of 24 group family-based, nutrition and sport/fitness oriented 90-minute sessions (twice-weekly). Measures included 1-mile run/walk time, three-minute step test, accelerometer-measured physical activity, body mass index (BMI), waist circumference, DEXA-measured % body fat, cardiometabolic risk biomarkers, and sociodemographic characteristics. Group differences at post-intervention were tested using ANCOVA analyses adjusting for outcome values at baseline and demographic variables. Results Parents were primarily female (93%), aged 38.3 ± 6.9 years, and 96% Latino and children were 8.8 ± 1.7 years old and 58% female. Intervention participants showed significantly faster adjusted post-intervention 1-mile run/walk times compared to control group participants (difference of −76.6 seconds P < 0.01 and −44 seconds P = 0.04, respectively). Parents also showed a significantly higher adjusted relative VO 2 max (ml/kg/min) compared to control group parents (43.91, SE = 0.41 vs 42.93, SE = 0.44, respectively, P < 0.01). There were no significant post-intervention group differences on physical activity, BMI, waist circumference, % body fat or cardiometabolic biomarkers P > 0.05. Conclusions The AFL program successfully improved aerobic performance among underserved Latino families with no observable changes in adiposity. These results support that fitness may be a more viable and acceptable outcome among Latino families than weight loss.

In 2025 the changes in national leadership cast a surprising light and ineffable shadows on America’s race, gender and class dynamics. Unexpectedly, women and people of color did not vote as a monolithic force in favor of one side or another of culture wars. In the health promotion discipline alarms are being sounded that America’s new political leadership will use their newfound popularity among a wider constituency to question the integrity of public health and challenge the value of science writ large. This editorial argues that neither retreating from nor resisting expected changes to public health policies will be as effective as walking into the shadows and looking carefully for common ground. The three opportunities with the best chances for seeking compromise in polarized communities relate to personalized lifestyle medicine, repackaging diversity, equity and inclusion (DEI) initiatives and policy advocacy for health literacy in the digital age.