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Pfleger E, Lutz R, Drexler H. [Environmental risks and health literacy: a systematic review]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:85-98. [PMID: 37823907 PMCID: PMC10776732 DOI: 10.1007/s00103-023-03782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Environmental factors can play an important role in pathogenesis. However, the understanding of the relationship between environmental risks and health in the general population appears to be poor. The aim of this systematic review is to describe the state of research on the relationship between health literacy (HL) or environmental health literacy (EHL) and environmental risks differentiated by the researched environmental risks, the affected population, the measurement and level of HL or EHL, and their interaction with other variables. METHODS A systematic literature search was conducted using the Pubmed, Scopus, and LIVIVO databases. Original studies in German or English that investigated HL or EHL in the context of an environmental risk or pollutant in a population were included. The Navigation Guide was used to assess the methodological quality of the studies. RESULTS Twenty-four studies were included in the qualitative analysis. The operationalization of HL or EHL was heterogeneous in 22 studies. Nine studies referred to environmental issues in general, and 15 studies analyzed individual environmental risks. Eleven studies referred to the general population, 12 to specified target groups, and 1 study examined both. The level of HL or EHL proved to be in need of improvement in all populations. Interventions such as trainings were able to increase HL or EHL. DISCUSSION The heterogeneous operationalizations impede the comparability of the studies. Future work should target the standardization of methodological aspects. Overall, it appears that interventions such as trainings were conducive to improving HL or EHL. In practice, this should therefore be given greater focus in order to increase HL or EHL.
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Affiliation(s)
- Elisabeth Pfleger
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestraße 9-11, 91054, Erlangen, Deutschland.
| | - Regina Lutz
- FOM Hochschule für Oekonomie & Management, Essen, Deutschland
| | - Hans Drexler
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestraße 9-11, 91054, Erlangen, Deutschland
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Stein MD, Krause C, Rogers E, Silwal A, Helme D, Slater M, Beard D, Lewis N, Luster J, Stephens K, Lefebvre C. Lessons Learned from Developing Tailored Community Communication Campaigns in the HEALing Communities Study. JOURNAL OF HEALTH COMMUNICATION 2023; 28:699-705. [PMID: 37752882 PMCID: PMC10591725 DOI: 10.1080/10810730.2023.2262948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
This paper outlines lessons learned from tailoring communication campaigns to increase demand for, and reduce stigma toward, evidence-based practices to reduce opioid overdose deaths in 66 communities participating in the HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS). We present nine lessons gathered about how to engage local communities in both virtual and in-person opioid messaging and distribution between February 2019 and June 2022. The research team created four communication campaigns and did extensive, tailored marketing and promotion to assist communities in implementing evidence-based clinical activities to reduce opioid overdose mortality. Various strategies and venues were used to amplify HCS messages, using free and paid outlets for message distribution, focusing primarily on social media due to the COVID-19 pandemic. Increasing the availability of medications for opioid use disorder and naloxone, as HCS attempted, is not enough; getting people to accept and use them depends on communication efforts. This paper focuses on the process of preparing communities for communication campaign activities, which we hope can help guide other communities preparing for opioid or substance-related campaigns in the future.
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Affiliation(s)
| | - Carol Krause
- National Institute on Drug Abuse, Bethesda, MD, USA
| | | | | | | | | | | | | | | | - Kara Stephens
- Oak Ridge Associated Universities, Oak Ridge, TN, USA
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Zhou M, Ramírez AS, Chittamuru D, Schillinger D, Ha S. Testing the effectiveness of narrative messages using critical health communication. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:139-146. [PMID: 36919470 PMCID: PMC10330019 DOI: 10.1080/17538068.2023.2189363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Latinos suffer from health disparities associated with excessive consumption of sugar-sweetened beverages. This study aimed to test the effectiveness of messaging using critical health communication approaches and delivered by two narrative modalities (video and comic book) with similar content that aims to empower Latinos to advocate for social change and to make individual behavior change related to sugary beverage consumption. METHODS Participants (N = 129 Mexican American women between 18 and 29 years) completed an online survey before and after exposure to an embedded stimulus. Participants were randomly assigned to a stimulus, a narrative message in video or comic book format, both developed using critical health communication approaches that focused on individual harms and social causes of sugary beverage consumption. RESULTS Paired sample t-test results showed that both narrative messages increased intentions to reduce sugary beverage consumption (Video: P < 0.01; d = 0.43; Comic: P = 0.03; d = 0.28). Both groups also demonstrated significant improvements in sugary beverage-related media literacy (Video: P = 0.01, d = 0.34; Comic: P = 0.05, d = 0.25), public health literacy (Video: P = 0.05, d = 0.24; Comic: P = 0.01, d = 0.32), and empowerment to engage in sugary beverage-related community movements (Video: P = 0.003, d = 0.38; Comic: P = 0.034, d = 0.27). CONCLUSIONS This study provides initial evidence indicating the effectiveness of narrative messages in two modalities using critical health communication for promoting individual behavioral intention and social activation in reducing sugary beverage consumption.
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Affiliation(s)
- Mi Zhou
- Department of Nutrition, Food Science, and Packaging, San Jose State University
| | | | | | - Dean Schillinger
- Division of General Internal Medicine and Health Communications Research Program, Center for Vulnerable Populations, Zuckerberg San Francisco General, Hospital and Trauma Center, University of California San Francisco
| | - Sandie Ha
- Public Health Department, University of California Merced
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Schillinger D, Cortez G, Lee M. The "Survival Pending Revolution" COVID-19 vaccination campaign: an example of critical communication theory in action. Front Public Health 2023; 11:1134104. [PMID: 37404275 PMCID: PMC10316422 DOI: 10.3389/fpubh.2023.1134104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/21/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction We carried out a two-phase, qualitative evaluation of a novel public health campaign to promote COVID-19 vaccination among youth and young adults of color (YOC), called Survival Pending Revolution. The campaign, commissioned by California's Department of Public Health, was created by YOC spoken word artists, under the direction of the organization, Youth Speaks. Methods In phase 1, we describe the communication attributes of the campaign's nine video-poems, coded the content of the pieces, and applied thematic analysis to describe the themes conveyed. In phase 2, we carried out a comparative health communication study to assess the content's potential value. We exposed a sample of the target audience (YOC) to the content of Survival Pending Revolution and a widely viewed comparator campaign (The Conversation). Using a focus group, we solicited participants' views using a semi-structured approach. Using thematic analysis, we summarized the reactions that arose when participants reflected on the attributes of each campaign. Results Findings from phase 1 reveal how engaging YOC artists who embrace Youth Speaks' philosophy of harnessing "life as primary text" resulted in content that is aligned with critical communication theory, focusing on structural determinants of health, including themes of overcoming oppressive systems, health and social inequities, and medical discrimination and mistrust. Findings from phase 2 reveal that this arts-based campaign based on such critical communication theory, when compared to a more traditional campaign, promotes message salience, fosters emotional engagement, and provides a form of validation among historically oppressed groups such that they may be more open to, and potentially act on, the COVID-19 vaccination communications to which they are exposed. Discussion As an example of critical communication, the Survival Pending Revolution campaign encourages health-promoting behavioral decisions while calling out the structural determinants of health that shape risks of exposure and constrain free choice. Engaging uniquely gifted members of marginalized populations as creators and messengers of campaigns lead to content that is aligned with a critical communication approach, whose goal is to aid disparity populations in both resisting and navigating systems that continue to locate them on the margins of society. Our evaluation of this campaign suggests that it represents a promising formative and interventional approach to engendering trust in public health messaging and promoting health equity.
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Affiliation(s)
- Dean Schillinger
- Health Communications Research Program, University of California, San Francisco, San Francisco, CA, United States
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Power J, Lea T, Melendez-Torres GJ, Lyons A, Norman T, Hill AO, Bourne A. Health literacy, financial insecurity and health outcomes among people living with HIV in Australia. Health Promot Int 2022; 37:6823574. [DOI: 10.1093/heapro/daac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Summary
It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant’s confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Toby Lea
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
- Centre for Social Research in Health, UNSW Sydney , John Goodsell Building, Sydney, NSW , Australia
| | | | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
- Kirby Institute, UNSW , Wallace Wurth Building, Kensington, NSW , Australia
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Thompson HR, Mendelson J, Zamek M, Cortez G, Schillinger D. Impact of an Arts-based Public Health Literacy Program Delivered Online to High School Students during the COVID-19 Pandemic. JOURNAL OF HEALTH COMMUNICATION 2022; 27:520-534. [PMID: 36222288 PMCID: PMC9671859 DOI: 10.1080/10810730.2022.2131942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic, coupled with the domestic socio-political unrest of 2020, provides a critical opportunity to reframe how we engage with youth around health and disease risk. The Bigger Picture (TBP), a spoken word, arts-based public health literacy campaign, uses a social justice and racial equity frame to activate youth around social determinants of health, including salient topics such as type 2 diabetes, COVID-19, climate change, and police violence. This quasi-experimental study determined the impact of providing an online adaptation of TBP during the COVID-19 pandemic to urban, low-income, diverse high school students (3 intervention schools assigned to receive TBP-based spoken word program; 3 comparison schools received a non-health focused spoken word program). We used outcomes derived from the Culture of Health framework, including: (1) health-related mind-sets and expectations; (2) sense of belonging; and (3) civic engagement. Students completed pre/post surveys; a subset of adults and youth from all 6 schools completed semi-structured interviews. TBP participation resulted in measurable shifts in students' mind-sets around structural drivers of health and health inequity and increases in plans for future civic engagement. Arts-based programming with an intentional focus on the social ecological model and health equity appears to impact young people, even when delivered online.
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Affiliation(s)
- Hannah R. Thompson
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Jackie Mendelson
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Maya Zamek
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | - Dean Schillinger
- University of California San Francisco (UCSF) Division of General Internal Medicine at San Francisco General Hospital, San Francisco, California, USA
- UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, USA
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Patton SR, Cushing CC, Lansing AH. Applying Behavioral Economics Theories to Interventions for Persons with Diabetes. Curr Diab Rep 2022; 22:219-226. [PMID: 35267141 PMCID: PMC9951181 DOI: 10.1007/s11892-022-01460-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To introduce behavioral economics (BE), provide a description of how recent prevention and treatment interventions in persons with diabetes have incorporated BE in their intervention strategies, and discuss how BE could be used to inform new treatments for the clinical setting or research. RECENT FINDINGS In most of the trials described, researchers incorporated BE into their design in the form of incentives, which can align with present bias, optimism bias, and loss aversion. With only two exceptions, these trials reported preliminary support for using incentives to promote lifestyle modifications and diabetes-related tasks. Additionally, two trials reported promising results for behavior change strategies informed by default bias, while three trials reported promising results for behavior change strategies informed by social norms. Recent trials incorporating BE in prevention and treatment interventions for persons with diabetes generally report promising results, though gaps exist for research and clinical deployment.
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Affiliation(s)
- Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, USA.
| | - Christopher C Cushing
- Clinical Child Psychology Program, University of Kansas, 2011 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA
| | - Amy Hughes Lansing
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT, 05401, USA
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Shin Y, Pettigrew J. Testing Narrative Persuasion of a Culturally Grounded, School-Based "Dale Se REAL" Entertainment-Education Intervention and Peer Communication on Nicaraguan Adolescent Substance Use. JOURNAL OF HEALTH COMMUNICATION 2022; 27:222-231. [PMID: 35722984 DOI: 10.1080/10810730.2022.2090030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Guided by narrative engagement theory and social cognitive theory, the present study investigates effects of narrative persuasion and peer communication on Nicaraguan adolescent substance use. Eighth-grade students in Nicaragua were recruited to participate in the culturally grounded, school-based prevention intervention Dale se REAL and to watch five entertainment-education intervention videos that teach drug refusal communication strategies. Using the cross-sectional survey (N = 224), a path analysis was run to examine the mediated moderation effects of narrative engagement (e.g., interest, realism, and identification with main characters) and peer communication about the intervention videos (e.g., frequency and valence of communication) on adolescent refusal self-efficacy and substance use behaviors. Results revealed that realism was significantly related to adolescent refusal self-efficacy and frequent peer communication moderated the association between refusal self-efficacy and the past 30-day marijuana use. Findings suggest that health communication scholars should take into consideration social factors and cultural contexts for adolescent substance use prevention research.
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Affiliation(s)
- YoungJu Shin
- Hugh Downs School of Human Communication, Arizona State University, Tempe, Arizona, USA
| | - Jonathan Pettigrew
- Hugh Downs School of Human Communication, Arizona State University, Tempe, Arizona, USA
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Zhou M, Chittamuru D, Ha S, Schillinger D, Ramírez AS. Protocol: Effectiveness of message content and format on individual and collective efficacy in reducing the intention to consume sugar-sweetened beverages. Contemp Clin Trials 2022; 115:106711. [PMID: 35189374 PMCID: PMC9018616 DOI: 10.1016/j.cct.2022.106711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
The strategic use of media is a common approach to promote health. A large body of evidence identifies specific features that increase message efficacy, including tailoring messages to the target audience and using a storytelling format. Yet most message testing research has focused on individual-level outcomes, ignoring the social and environmental determinants of health behaviors, which require collective action and political will to change. Grounded in an ecological approach to communication, we will carry out two double-blinded randomized experiments to test the relative effectiveness of message tailoring (culturally-tailored vs. standard) and format (narrative vs. didactic) to increase the intention to reduce individual sugar-sweetened beverage consumption, the understanding of social and commercial determinants of health, and the sense of empowerment among young adult Latinas. Based on power analyses (80% power at alpha = 0.05), we will randomize 438 participants to two groups (traditional standard infographic and culturally-tailored infographic) in the first study, and 662 participants to two groups (culturally-tailored infographic and culturally-tailored comic book) in the second study. All participants will be measured by a pre-treatment test and an immediate post-treatment test. We hypothesize that culturally-tailored comic book will be most effective, and traditional standard infographic will be least effective, on all levels of outcomes. This study will provide empirical evidence in communication strategies to help young Latinos or other racial/ethnic minority young people to pursue positive dietary behaviors that both benefit themselves and contribute to change of social norms.
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Affiliation(s)
- Mi Zhou
- University of California Merced, Merced, United States.
| | | | - Sandie Ha
- University of California Merced, Merced, United States
| | - Dean Schillinger
- University of California San Francisco, San Francisco, United States
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Machado SS, Schillinger D, Avina L, Cortez G, Daniels R, Thompson HR. Seeing "The Bigger Picture:" Impact of an Arts-Focused Type 2 Diabetes Education Program in High Schools. JOURNAL OF HEALTH COMMUNICATION 2021; 26:696-707. [PMID: 34781852 PMCID: PMC9029009 DOI: 10.1080/10810730.2021.1998845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Traditional health education efforts rarely align with youth social justice values. The Bigger Picture (TBP), a spoken word arts campaign, leverages a social justice approach to activate youth around the social determinants of type 2 diabetes (T2D). This quasi-experimental study examines the impact of embedding TBP in urban, low-income high schools (3 intervention schools received TBP; 3 comparison schools received a non-health related spoken word program) with respect to (1) health-related mind-sets and expectations; (2) sense of belonging; and (3) civic engagement among youth. Adults and youth who participated in programming at all 6 schools were interviewed, and a content analysis of students' poems was performed. TBP was well-received by adults and students. While students in both TBP and comparison programs described multiple social determinants of T2D, intervention students more frequently articulated the connections between race/ethnicity and T2D as a social justice issue. Further, all comparison students explicitly mentioned individual dietary behavior as a T2D determinant while most, yet not all, intervention students did. Students in both programs reported a high sense of belonging at school and confidence in civic engagement. Content analysis of TBP students' poems revealed youth's detailed understanding of T2D determinants. Future studies might explore program scalability, and how the integration of civic engagement opportunities into TBP curriculum might impact students' capacity to create positive social change.
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Affiliation(s)
- Stephanie S Machado
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco (UCSF), San Francisco, California, USA
- Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Lizette Avina
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | - Ryane Daniels
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco (UCSF), San Francisco, California, USA
- Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Hannah R Thompson
- School of Public Health, University of California Berkeley, Berkeley, California, USA
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Alonzo D, Popescu M. Utilizing social media platforms to promote mental health awareness and help seeking in underserved communities during the COVID-19 pandemic. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:156. [PMID: 34222531 PMCID: PMC8224506 DOI: 10.4103/jehp.jehp_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND COVID-19 virus has resulted in significant psychological distress for many individuals, particularly, those in underserved communities. Social media have the potential to be one of the most effective tools for mental health campaigns, reaching wide audiences in the shortest amount of time. In this paper, the potential of harnessing social media platforms to address mental health needs in underserved populations is presented. In addition, description of the preliminary implementation of a social media mental health campaign, the 5 × 5 campaign, is described as an example of the feasibility and benefits of such efforts. Key implications gleaned from the implementation process are also presented. MATERIALS AND METHODS Utilizing a participatory approach, the 5 × 5 campaign aimed to improve recognition of mental health symptoms, promote help seeking, and provide immediate strategies for self-care for individuals experiencing psychological distress related to the COVID-19 pandemic in low-income, high-risk communities in and around Guatemala City. Campaign content was promoted on Facebook, Instagram, and WhatsApp from April 2020 to June 2020. RESULTS Preliminary analysis of the 5 × 5 campaign demonstrated feasibility and substantial impact with over 84,000 individuals reached by the campaigns through initial messaging and shares. CONCLUSION The 5 × 5 highlights the feasibility of using social media campaigns for mental health promotion and key factors that should be incorporated in the planning of social media mental health campaigns aimed at promoting awareness, engaging underserved communities, and encouraging help seeking.
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Affiliation(s)
- Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
| | - Marciana Popescu
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
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Abbs E, Daniels R, Schillinger D. Type 2 Diabetes as a Socioecological Disease: Can Youth Poets of Color Become Messengers of Truth and Catalysts for Change? Health Promot Pract 2021; 23:583-593. [PMID: 33989074 DOI: 10.1177/15248399211007818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Efforts to confront the type 2 diabetes (T2D) epidemic have been stymied by an absence of effective communication on policy fronts. Whether art can be harnessed to reframe the T2D discourse from an individual, biomedical problem to a multilevel, communal and social problem is not known. METHOD We explored whether spoken word workshops enable young artists of color to convey a critical consciousness about T2D. The Bigger Picture fosters creation and dissemination of art to shift from the narrow biomedical model toward a comprehensive socioecological model (SEM). Workshops offer (1) public health content, (2) writing exercises, and (3) feedback on drafts. Based on Freire and Boal's participatory pedagogy, workshops encourage youth to tap into their lived experiences when creating poetry. We analyzed changes in public health literary and activation among participants and mapped poems onto the SEM to assess whether their poetry conveyed the multilevel perspective critical to public health literacy. RESULTS Participants reported significant increases in personal relevance of T2D prevention, T2D discussions with peers, concern about corporations' targeted marketing, and interest in community organizing to confront the epidemic. Across stanzas, nearly all poems (95%) featured >three of five SEM levels (systemic forces, sectors of influence, societal norms, behavioral settings, individual factors); three-quarters (78%) featured >four levels. CONCLUSIONS Engaging youth poets of color to develop artistic content to combat T2D can increase their public health literary and social activation and foster compelling art that communicates how complex, multilevel forces interact to generate disease and disease disparities.
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Affiliation(s)
- Elizabeth Abbs
- University of California San Francisco, San Francisco, CA, USA
| | - Ryane Daniels
- University of California San Francisco, San Francisco, CA, USA
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Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents. Public Health Nutr 2021; 24:3242-3252. [PMID: 33427154 PMCID: PMC8272722 DOI: 10.1017/s1368980021000069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents’ sugar-sweetened beverage (SSB) intake. Design: This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake – step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver’s SSB behaviours, caregiver’s SSB rules) and step 4: environmental (i.e., home SSB availability) level variables. Setting: Eight middle schools across four rural southwest Virginia counties in Appalachia. Participants: Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years). Results: Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent’s SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001). Conclusions: SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.
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Ogunleye C, Farnan JM, Martin SK, Tanksley A, Ngooi S, Venable LR, Anderson S, Marte J, Meltzer DO, Arora VM. A Peer-Led Social Media Intervention to Improve Interest in Research Careers Among Urban Youth: Mixed Methods Study. JMIR MEDICAL EDUCATION 2020; 6:e16392. [PMID: 32406859 PMCID: PMC7256755 DOI: 10.2196/16392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Novel methods to boost interest in scientific research careers among minority youth are largely unexplored. Social media offers a unique avenue toward influencing teen behavior and attitudes, and can therefore be utilized to stimulate interest in clinical research. OBJECTIVE The aim of this study was to engage high-achieving minority youth enrolled in a science pipeline program to develop a targeted social media marketing campaign for boosting interest in clinical research careers among their peers. METHODS Students enrolled in the Training Early Achievers for Careers in Health program conducted focus groups in their communities to inform themes that best promote clinical research. They then scripted, storyboarded, and filmed a short video to share on social media with a campaign hashtag. Additionally, each student enrolled peers from their social circle to be subjects of the study. Subjects were sent a Career Orientation Survey at baseline to assess preliminary interest in clinical research careers and again after the campaign to assess how they saw the video, their perceptions of the video, and interest in clinical research careers after watching the video. Subjects who did not see the video through the online campaign were invited to watch the video via a link on the postsurvey. Interest change scores were calculated using differences in Likert-scale responses to the question "how interested are you in a career in clinical research?" An ordinal logistic regression model was used to test the association between watching a peer-shared video, perception of entertainment, and interest change score controlling for underrepresented minorities in medicine status (Black, American Indian/Alaska Native, Native Hawaiian, or Pacific Islander), gender, and baseline interest in medical or clinical research careers. RESULTS From 2014 to 2017, 325 subjects were enrolled as part of 4 distinct campaigns: #WhereScienceMeetsReality, #RedefiningResearch, #DoYourResearch, and #LifeWithoutResearch. Over half (n=180) of the subjects watched the video via the campaign, 227/295 (76.9%) found the video entertaining, and 92/325 (28.3%) demonstrated baseline interest in clinical research. The ordinal logistic regression model showed that subjects who viewed the video from a peer (odds ratio [OR] 1.56, 95% CI 1.00-2.44, P=.05) or found the video entertaining (OR 1.36, 95% CI 1.01-1.82, P=.04) had greater odds of increasing interest in a clinical research career. Subjects with a higher baseline interest in medicine (OR 1.55, 95% CI 1.28-1.87, P<.001) also had greater odds of increasing their interest in clinical research. CONCLUSIONS The spread of authentic and relevant peer-created messages via social media can increase interest in clinical research careers among diverse teens. Peer-driven social media campaigns should be explored as a way to effectively recruit minority youth into scientific research careers.
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Affiliation(s)
| | - Jeanne M Farnan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Shannon K Martin
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Audrey Tanksley
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Samantha Ngooi
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Laura Ruth Venable
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Samantha Anderson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jhonatan Marte
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - David O Meltzer
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Zoellner JM, Porter KJ, You W, Chow PI, Ritterband LM, Yuhas M, Loyd A, McCormick BA, Brock DJP. Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods. Contemp Clin Trials 2019; 83:64-80. [PMID: 31233859 PMCID: PMC6713199 DOI: 10.1016/j.cct.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
Abstract
The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. Unfortunately, there is insufficient evidence for effective strategies targeting SSB behaviors among Appalachian youth in real-world settings, including rural schools. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy program aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short message service (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior and health literacy, media literacy, numeracy, and public health literacy concepts. Guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. Secondary outcomes include other changes in students (e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed, along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine how teachers implement Kids SIPsmartER and the potential for institutionalization within schools. This paper discusses the rationale for implementing and evaluating a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors in Appalachia. Clincialtrials.gov: NCT03740113.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Kathleen J Porter
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 321A Hutcheson Hall, 24060, USA
| | - Phillip I Chow
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Lee M Ritterband
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Maryam Yuhas
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Annie Loyd
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Brittany A McCormick
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Donna-Jean P Brock
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
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Lane HG, Porter KJ, Hecht E, Harris P, Zoellner JM. A Participatory Process to Engage Appalachian Youth in Reducing Sugar-Sweetened Beverage Consumption. Health Promot Pract 2019; 20:258-268. [PMID: 29577771 PMCID: PMC6119513 DOI: 10.1177/1524839918762123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Children and adolescents consume excessive amounts of sugar-sweetened beverages (SSBs), which are associated with adverse health outcomes. We describe a yearlong participatory research study to reduce SSBs in Central Appalachia, where excessive consumption is particularly prevalent. This study was conducted in partnership with a community advisory board in Southwest Virginia. Nine "youth ambassadors," aged 10 to 13 years helped to systematically adapt SIPsmartER, an effective theory-based program for Appalachian adults, to be age and culturally appropriate and meet desired theoretical objectives. They then assisted with delivering the curriculum during a school-based feasibility study and led an advocacy event in their community. Satisfaction surveys and feedback sessions indicate that ambassadors found the program acceptable and important for other students. Validated surveys and focus groups suggested that theoretical objectives were met. Findings from these mixed methods sources informed curricular changes to further enhance acceptability and refine theoretical objectives. Participation in follow-up advocacy activities was tracked and described. Following the yearlong study, ambassadors reported having advocacy skills and motivation to continue reducing SSB intake in their community. Results, challenges, and lessons learned are presented to inform larger efforts to enhance acceptability of programs and inspire youth to take action to reduce health disparities in Appalachian communities.
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Affiliation(s)
- Hannah G. Lane
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Erin Hecht
- University of Virginia School of Medicine, Charlottesville, VA, USA
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Lane HG, Deitch R, Wang Y, Black MM, Dunton GF, Aldoory L, Turner L, Parker EA, Henley SC, Saksvig B, Song HJ, Hager ER. "Wellness Champions for Change," a multi-level intervention to improve school-level implementation of local wellness policies: Study protocol for a cluster randomized trial. Contemp Clin Trials 2018; 75:29-39. [PMID: 30342257 PMCID: PMC6594543 DOI: 10.1016/j.cct.2018.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 12/01/2022]
Abstract
Schools are a recommended place for childhood obesity prevention. Local Wellness Policies (LWPs) establish guidelines for schools to provide opportunities for students to access nutritious foods and be physically active. Little is known about the impact of LWPs, when implemented, on students' behavior and body mass index (BMI). The Wellness Champions for Change trial assesses the student-level impact of providing theory-based training and technical assistance to help schools implement LWPs. This 3-arm, cluster randomized controlled trial will take place in 30 low- or middle-income schools (15 elementary and 15 middle) in five Maryland school districts. Ten schools will receive both Wellness Champions for Change (WCC), which involves training teacher-led wellness teams, and Wellness Champions for Change-Student (WCC-S), which engages students as wellness team members. Ten schools will receive WCC only, and ten control schools will receive a delayed intervention. The RE-AIM framework will guide evaluation. Student Effectiveness measures will include BMI z-scores, self-reported diet patterns, and objectively-measured physical activity. The sample size (1080 students across 30 schools, followed for 2.5 years) will enable power (>0.8) to detect BMI z-score differences. A three-level linear mixed model that accounts for clustering will be used to assess Effectiveness. A mixed methods approach will assess school- and district-level Reach, Adoption, and Implementation. If effective, this approach will represent a sustainable, multi-level, school-based strategy to prevent childhood obesity. The evaluation framework will allow for the description of factors necessary to broadly disseminate this approach for obesity prevention on a large scale.
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Affiliation(s)
- Hannah G Lane
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Rachel Deitch
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Yan Wang
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Epidemiology and Public Health, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Epidemiology and Public Health, 737 West Lombard Street, Baltimore, MD 21201, USA; RTI International, Research Triangle Park, NC 27709, USA.
| | - Genevieve F Dunton
- University of Southern California, Departments of Preventive Medicine and Psychology, 2001 N. Soto St., Los Angeles, CA 90032, USA.
| | - Linda Aldoory
- University of Maryland College Park, Department of Communication, College of Arts and Humanities, College Park, MD 20742, USA.
| | - Lindsey Turner
- Boise State University, College of Education, 1910 University Drive, #1740, Boise, ID 83725, USA.
| | - Elizabeth A Parker
- University of Maryland School of Medicine, Department of Family and Community Medicine, Center for Integrative Medicine, 520 W. Lombard Street, East Hall, Baltimore, MD 21201, USA.
| | - Shauna C Henley
- University of Maryland Extension, Department of Agriculture and Natural Resources, 1114 Shawan Road, Cockeysville, MD 21030, USA.
| | - Brit Saksvig
- University of Maryland College Park, Department of Epidemiology and Biostatistics, School of Public Health, College Park, MD 20742, USA.
| | - Hee-Jung Song
- University of Maryland College Park, Department of Nutrition and Food Science, College of Agriculture and Natural Resources, College Park, MD 20742, USA.
| | - Erin R Hager
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Epidemiology and Public Health, 737 West Lombard Street, Baltimore, MD 21201, USA.
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The Health Literacy of U.S. Immigrant Adolescents: A Neglected Research Priority in a Changing World. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102108. [PMID: 30257475 PMCID: PMC6209953 DOI: 10.3390/ijerph15102108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 09/18/2018] [Indexed: 11/16/2022]
Abstract
Immigrant adolescents are the fastest-growing sector among U.S. youth, but they receive little attention in health literacy research. Immigrant adolescents are a diverse population tasked with mastering new literacies while also navigating new social systems. Many immigrant adolescents serve as important linguistic and cultural resources in their families and local communities, and yet their contributions (and struggles) as new navigators of our health care system remain invisible. In this commentary article, we argue that health literacy researchers need to devote more attention to immigrant adolescents and the pathways by which they learn new language and literacy skills while also developing their own health habits and behaviors. We contend that the study of immigrant adolescents provides a critical window into health literacy as a socially and historically situated practice, specifically how immigrant adolescents' transnational experiences shape their learning of new health literacy practices. With a coordinated interdisciplinary research agenda on immigrant adolescents, the health literacy field will expand its empirical base for what becoming "health literate" looks like in today's globalizing world.
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Barquera S, Schillinger D, Aguilar-Salinas CA, Schenker M, Rodríguez LA, Hernández-Alcaraz C, Sepúlveda-Amor J. Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin. Global Health 2018; 14:84. [PMID: 30134925 PMCID: PMC6104005 DOI: 10.1186/s12992-018-0390-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) is now a massive epidemic in both California and Mexico, with serious consequences for social and economic well-being. A large proportion of these populations share common ethnic backgrounds. Yet diverse environmental and social conditions across regions create unique opportunities to explore the ways that T2D risk, incidence, management and outcomes manifest. MAIN TEXT An action-oriented research consortium headed up by the University of California and Universidad Nacional Autónoma de Mexico was constituted to set priorities for bi-national translational research, in an attempt to implement and evaluate clinical, public health and policy actions to decrease the burden of T2D for people of Mexican origin. In this paper, we describe the epidemiology of T2D in Mexico and California, review current efforts to combat the epidemic, highlight gaps in knowledge and identify urgent areas of opportunity for collaboration. The group has developed a common research agenda and funding has been obtained to evaluate biological samples from the 2016 Mexican Health Survey, collaborate in a telemedicine-based retinopathy project, implement interventions in food banks, promote a communications campaign, and design a large-scale diabetes prevention effectiveness trial. CONCLUSIONS T2D has caused a state of emergency in Mexico and is a major health problem among Mexican populations on both sides of the border. Understanding the commonalities and differences between California and Mexico for those of Mexican origin with respect to T2D, when combined with a sharing of knowledge and advances, can produce a bi-national translational research agenda to inform relevant policy and practice. Amidst economic and political uncertainty and limited healthcare budgets, this collaboration can contribute to the development of scientific evidence to inform policies and interventions. This may provide a promising collaborative model that could be expanded to other health conditions and regions of the world.
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Affiliation(s)
- Simón Barquera
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Dean Schillinger
- UCSF Division of General Internal Medicine at San Francisco General Hospital, 1545 Divisadero St., First and Second Floors, San Francisco, CA 94115 USA
- UCSF Center for Vulnerable Populations, School of Medicine, Department of Medicine, 1001 Potrero Ave, San Francisco, CA 94110 USA
| | - Carlos A. Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P, 14080 Ciudad de Mexico, Mexico
| | - Marc Schenker
- UC Davis School of Medicine, Department of Public Health Sciences, University of California Davis Medical Sciences 1-C, One Shields Avenue, Davis, CA 95616 USA
| | - Luis A. Rodríguez
- UCSF School of Medicine, Department of Epidemiology & Biostatistics, 550 16th St, San Francisco, CA 94158 USA
| | - Cesar Hernández-Alcaraz
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Jaime Sepúlveda-Amor
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- UCSF School of Medicine, Department of Epidemiology & Biostatistics, 550 16th St, San Francisco, CA 94158 USA
- UCSF Institute for Global Health Sciences, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
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Lane H, Porter KJ, Hecht E, Harris P, Kraak V, Zoellner J. Kids SIP smartER: A Feasibility Study to Reduce Sugar-Sweetened Beverage Consumption Among Middle School Youth in Central Appalachia. Am J Health Promot 2018; 32:1386-1401. [PMID: 28731385 PMCID: PMC5993639 DOI: 10.1177/0890117117715052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To test the feasibility of Kids SIP smartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs). DESIGN Matched-contact randomized crossover study with mixed-methods analysis. SETTING One middle school in rural, Appalachian Virginia. PARTICIPANTS Seventy-four sixth and seventh graders (5 classrooms) received Kids SIP smartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers. INTERVENTION Kids SIP smartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity. MEASURES Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance). ANALYSIS Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data. RESULTS During the first intervention period, students receiving Kids SIP smartER (n = 43) significantly reduced SSBs by 11 ounces/day ( P = .01) and improved media ( P < .001) and public health literacy ( P < .01) understanding; however, only media literacy showed between-group differences ( P < .01). Students and teachers found Kids SIP smartER acceptable, in-demand, practical, and implementable within existing resources. CONCLUSION Kids SIP smartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIP smartER to reduce SSBs among rural adolescents.
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Affiliation(s)
- Hannah Lane
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen J. Porter
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Erin Hecht
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - Vivica Kraak
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic and State University, Blacksburg, VA, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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Do Low Income Youth of Color See " The Bigger Picture" When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050840. [PMID: 29695114 PMCID: PMC5981879 DOI: 10.3390/ijerph15050840] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 01/02/2023]
Abstract
As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. Methods: We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Results: Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Conclusion: Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Practice Implications: Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors.
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Pan SW, Stein G, Bayus B, Tang W, Mathews A, Wang C, Wei C, Tucker JD. Systematic review of innovation design contests for health: spurring innovation and mass engagement. ACTA ACUST UNITED AC 2017; 3:227-237. [PMID: 29576873 DOI: 10.1136/bmjinnov-2017-000203] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We undertook a systematic review evaluating the effectiveness and cost of health-focused innovation design contests. We followed Cochrane guidance and systematically searched eight databases. Articles were included if they reported an open contest focused on improving health, required participants submit finished design solutions and contained a prize structure. We searched 3579 citations, identifying 29 health-focused innovation design contests which collectively received 15494 contest submissions. Contests solicited submissions worldwide (7) and exclusively from North America (13), Asia (4), Africa (2), Australia (2) and Europe (1). Submissions per contest ranged from 3 to 11354 (median of 73). Contest entrants were tasked with helping develop health promotion messages (HPM) (25) and improve predictive clinical models, protocols and/or algorithms (4). Two types of contests emerged-those focused on high-quality, innovative outcomes and those focused on the process of mass community engagement. All outcome-oriented contests had innovation design contest solutions equivalent or superior to the comparator (100%; 7/7). Two of two studies found that innovation design contests saved money (100%; 2/2). Five of seven process-oriented contests concluded the contest improved at least one health indicator (71%; 5/7). Innovation design contests are an effective way to solicit innovative solutions to health problems and spur mass community engagement.
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Affiliation(s)
- Stephen W Pan
- Social Entrepreneurship for Sexual Health, University of North Carolina Project-China Office, Guangzhou, China
| | - Gabriella Stein
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry Bayus
- Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Weiming Tang
- Social Entrepreneurship for Sexual Health, University of North Carolina Project-China Office, Guangzhou, China
| | - Allison Mathews
- Institute for Global Health and Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cheng Wang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Chongyi Wei
- Department of Epidemiology, Biostatistics and Global Health, University of California, San Francisco, California, USA
| | - Joseph D Tucker
- Social Entrepreneurship for Sexual Health, University of North Carolina Project-China Office, Guangzhou, China
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Schillinger D, Ling PM, Fine S, Boyer CB, Rogers E, Vargas RA, Bibbins-Domingo K, Chou WYS. Reducing Cancer and Cancer Disparities: Lessons From a Youth-Generated Diabetes Prevention Campaign. Am J Prev Med 2017; 53:S103-S113. [PMID: 28818240 PMCID: PMC8491805 DOI: 10.1016/j.amepre.2017.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 01/28/2023]
Abstract
Adolescence and young adulthood, a period essential for determining exposures over the life-course, is an ideal time to intervene to lower cancer risk. This demographic group can be viewed as both the target audience and generator of messages for cancer prevention, such as skin cancer, obesity-, tobacco-, and human papillomavirus-related cancers. The purpose of this paper is to encourage innovative health communications that target youth; youth behavior; and the structural, environmental, and social determinants of youth behavior as critical areas of focus for cancer prevention and disparities reduction. The authors describe the rationale, processes, products, and early impacts of an award-winning youth diabetes prevention communication campaign model (The Bigger Picture) that harnesses spoken-word messages in school-based and social media presentations. The campaign supports minority adolescent and young adult artists to create content that aligns with values held closely by youth-values likely to resonate and affect change, such as defiance against authority, inclusion, and social justice. This campaign can be leveraged to prevent obesity, which is a cancer risk factor. Then, the authors propose concrete ways that The Bigger Picture's pedagogical model could be adapted for broader cancer prevention messaging for youth of color and youth stakeholders regarding tobacco-related cancers, skin cancers, and human papillomavirus-related cancers. The goal is to demonstrate how a youth-generated and youth-targeted prevention campaign can: (1) reframe conversations about cancer prevention, (2) increase awareness that cancer prevention is about social justice and health equity, and (3) catalyze action to change social norms and confront the social and environmental drivers of cancer disparities.
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Affiliation(s)
- Dean Schillinger
- University of California San Francisco Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California; Division of General Internal Medicine, University of California San Francisco, San Francisco, California.
| | - Pamela M Ling
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California; University of California San Francisco Center for Tobacco Control Research and Education, San Francisco, California
| | - Sarah Fine
- University of California San Francisco Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California; Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Cherrie B Boyer
- Department of Medicine and Division of Adolescent Medicine, University of California San Francisco, San Francisco, California
| | - Elizabeth Rogers
- Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Roberto Ariel Vargas
- Community Engagement and Health Policy Program, University of California San Francisco, San Francisco, California
| | - Kirsten Bibbins-Domingo
- University of California San Francisco Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California; Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, National Cancer Institute, NIH, Rockville, Maryland
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Nutbeam D, McGill B, Premkumar P. Improving health literacy in community populations: a review of progress. Health Promot Int 2017; 33:901-911. [DOI: 10.1093/heapro/dax015] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Don Nutbeam
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Bronwyn McGill
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Pav Premkumar
- Southampton Education School, University of Southampton, Southampton, UK
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A Systematic Study of Dysregulated MicroRNA in Type 2 Diabetes Mellitus. Int J Mol Sci 2017; 18:ijms18030456. [PMID: 28264477 DOI: 10.3390/ijms18030456] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 02/07/2023] Open
Abstract
MicroRNAs (miRNAs) are small noncoding RNAs that modulate the cellular transcriptome at the post-transcriptional level. miRNA plays important roles in different disease manifestation, including type 2 diabetes mellitus (T2DM). Many studies have characterized the changes of miRNAs in T2DM, a complex systematic disease; however, few studies have integrated these findings and explored the functional effects of the dysregulated miRNAs identified. To investigate the involvement of miRNAs in T2DM, we obtained and analyzed all relevant studies published prior to 18 October 2016 from various literature databases. From 59 independent studies that met the inclusion criteria, we identified 158 dysregulated miRNAs in seven different major sample types. To understand the functional impact of these deregulated miRNAs, we performed targets prediction and pathway enrichment analysis. Results from our analysis suggested that the altered miRNAs are involved in the core processes associated with T2DM, such as carbohydrate and lipid metabolisms, insulin signaling pathway and the adipocytokine signaling pathway. This systematic survey of dysregulated miRNAs provides molecular insights on the effect of deregulated miRNAs in different tissues during the development of diabetes. Some of these miRNAs and their mRNA targets may have diagnostic and/or therapeutic utilities in T2DM.
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Shi M, Xu MY, Liu ZL, Duan XY, Zhu YB, Shi HM, Jiang B, Zhang XM, Yu XH. Effectiveness of family involvement in newly diagnosed type 2 diabetes patients: a follow-up study. PATIENT EDUCATION AND COUNSELING 2016; 99:776-782. [PMID: 26763869 DOI: 10.1016/j.pec.2015.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the effects of family-involvement on health education for T2DM from the aspects of knowledge, attitude and practice (KAP), health-related quality of life (HRQoL), body mass index (BMI) and glucose control. METHODS A follow-up study was performed and patients with newly diagnosed T2DM were divided into family-involved group (FIG, n=60) and single-involved group (SIG, n=60). Hierarchical linear models were used to assess within-group changes and between-group differences in the glycosylated hemoglobin A1c (HbA1c), KAP, SF-36 and BMI. RESULTS Significant improvements in FIG along with significant differences between-group were seen for HbA1c levels (9.73, 8.92, 5.55, 5.79, 5.30 vs. 10.05, 9.53, 6.36, 8.41, 6.58) in baseline, M3, M6, M12, M24 compared with SIG, respectively (all P≤0.001). Significant improvements in FIG along with significant differences between-group were seen for KAP (16.23, 46.98, 48.93 vs. 16.65, 29.07, 37.62), SF-36 (78.04, 92.68, 92.34 vs. 74.96, 77.03, 78.25), and BMI (24.74, 23.46, 22.96 vs. 24.00, 23.45, 23.50) in baseline, M12 and M24, respectively (all P≤0.05). CONCLUSION Family involvement is beneficial to the control of T2DM and should be suggested for T2DM newly diagnosed. PRACTICE IMPLICATIONS Health education should encourage the family to participate in the whole process to improve the efficacy of education.
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Affiliation(s)
- Mai Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China; Department of Clinical Nutrition, China-Japan Friendship Hospital, Beijing 100029, China
| | - Mei-Yan Xu
- Department of Clinical Nutrition, The Central Hospital of China Aerospace Corporation, Beijing 100049, China
| | - Zhao-Lan Liu
- Centre for Evidence-based Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue-Ying Duan
- Department of Clinical Nutrition, Yan-Hua Hospital, Beijing 100250, China
| | - Yan-Bo Zhu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Hui-Mei Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Bo Jiang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Mei Zhang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Han Yu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
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Rogers EA, Fine SC, Handley MA, Davis HB, Kass J, Schillinger D. Engaging Minority Youth in Diabetes Prevention Efforts Through a Participatory, Spoken-Word Social Marketing Campaign. Am J Health Promot 2016; 31:336-339. [PMID: 26730553 DOI: 10.4278/ajhp.141215-arb-624] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the reach, efficacy, and adoption of The Bigger Picture, a type 2 diabetes (T2DM) social marketing campaign that uses spoken-word public service announcements (PSAs) to teach youth about socioenvironmental conditions influencing T2DM risk. DESIGN A nonexperimental pilot dissemination evaluation through high school assemblies and a Web-based platform were used. SETTING The study took place in San Francisco Bay Area high schools during 2013. SUBJECTS In the study, 885 students were sampled from 13 high schools. INTERVENTION A 1-hour assembly provided data, poet performances, video PSAs, and Web-based platform information. A Web-based platform featured the campaign Web site and social media. MEASURES Student surveys preassembly and postassembly (knowledge, attitudes), assembly observations, school demographics, counts of Web-based utilization, and adoption were measured. ANALYSIS Descriptive statistics, McNemar's χ2 test, and mixed modeling accounting for clustering were used to analyze data. RESULTS The campaign included 23 youth poet-created PSAs. It reached >2400 students (93% self-identified non-white) through school assemblies and has garnered >1,000,000 views of Web-based video PSAs. School participants demonstrated increased short-term knowledge of T2DM as preventable, with risk driven by socioenvironmental factors (34% preassembly identified environmental causes as influencing T2DM risk compared to 83% postassembly), and perceived greater personal salience of T2DM risk reduction (p < .001 for all). The campaign has been adopted by regional public health departments. CONCLUSION The Bigger Picture campaign showed its potential for reaching and engaging diverse youth. Campaign messaging is being adopted by stakeholders.
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Key Words
- Health focus: prevention and health literacy
- Outcome measure: cognitive, descriptive
- Research purpose: program evaluation
- Setting: Web-based platform, school
- Strategy: education
- Study design: nonexperimental
- Target population age: youth
- Target population circumstances: income level, geographic location, race/ethnicity
- Type 2 Diabetes Mellitus, Prevention, Adolescent, Social Marketing, Health Campaigns, Health Literacy, Prevention Research. Manuscript format: research
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Affiliation(s)
- Elizabeth A Rogers
- 1 Departments of Internal Medicine and Pediatrics, and the Department of Medicine's Applied Clinical Research Program, University of Minnesota, Minneapolis, Minnesota.,2 Departments of Internal Medicine and Pediatrics, University of California, San Francisco, California
| | - Sarah C Fine
- 3 Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, California
| | - Margaret A Handley
- 4 Department of Epidemiology and Biostatistics and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, San Francisco General Hospital and Trauma Center, San Francisco, California
| | | | - James Kass
- 5 Youth Speaks, San Francisco, California
| | - Dean Schillinger
- 3 Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, California
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Bailey SC, McCormack LA, Rush SR, Paasche-Orlow MK. Highlighting progress in the field of health literacy research. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:5-9. [PMID: 25315578 DOI: 10.1080/10810730.2014.946116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Stacy Cooper Bailey
- a Division of Pharmaceutical Outcomes and Policy , UNC Eshelman School of Pharmacy, University of North Carolina , Chapel Hill , North Carolina , USA
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