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BackgroundBaby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information. ObjectiveThe intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults. MethodsA random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information. ResultsAlmost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t217.60=−2.98, P=.003. Younger age (b=−0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R2 =.17, R2adj =.14, F9,229=5.277, P

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. ObjectiveThe purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. MethodsA multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). ResultsThe majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype’s information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. ConclusionsPatient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education.

Background: Although receiving the HPV vaccine can help to prevent the development of cancer and HPV-related diseases, many individuals are not vaccinated in adolescence. Purpose: To examine knowledge about changes to the FDA's approval of the HPV vaccine for adults ages 26-45 years and to utilize the Integrated Behavioral Model (IBM) constructs to understand the relationship between beliefs and HPV vaccine intention. Methods: An online survey was used to examine HPV vaccine-related beliefs, knowledge, and uptake among a sample of 421 U.S. adults 18-45 years old in April 2019. Results: Perceived norms, perceived control, sex, and provider recommendation were significantly related to vaccine intention. Perceived norms, age, and healthcare provider recommendation were significantly related to receiving the full dose of the vaccine. Fewer than half of the participants indicated having at least one dose of the HPV vaccine or having had a provider recommend the vaccine. Less than 4% knew the vaccine had been approved by the FDA for up to 45 years old. Discussion: Results highlight the importance of social norms and patient education on HPV vaccine uptake and intention. Translation to Health Education Practice: Findings can inform future interventions and instrument development

Founded in 1950, the Society for Public Health Education (SOPHE) provides leadership to the health education profession and promotes the health of all people through six strategic commitments: developing and promoting standards for professional preparation and credentialing of community and school health educators; stimulating research on the theory, practice, and teaching of health education; supporting elimination of health disparities and the achievement of health equity; providing continuing education of the health education workforce; advocating for policy and legislation affecting public health and health promotion; and supporting a network of local chapters. This article describes how SOPHE has pursued these strategic commitments during the past 70 years and discusses challenges that will influence the future of SOPHE and the contours of the research and practice agendas of the field going forward.

Background: The Internet is an important tool for empowering patients with chronic obstructive pulmonary disease (COPD) to learn about and self-manage their condition. Purpose: The purpose of this study was to understand which aspects of the online experience facilitates or hinders the perceived ability of patients with COPD to achieve their information and self-management goals. Methods: Semistructured interviews were conducted with medically underserved patients with COPD (N = 25) who access the Internet for health. A conventional content analysis approach was applied and data were analyzed with the constant comparative method. Results: The following themes were derived: (1) desire to associate with "in-group" members; (2) relationship building with other online users; (3) security of information and identity; (4) source and channel credibility appraisal; (5) user assistance and tutorials; and (6) strategies to adapt technological functions. Discussion: Success in using the Internet was dependent on the functional use of technology and the ability and resilience to engage with similar online users to build meaningful and trustworthy connections. Translation to Health Education Practice: Prior to directing patients with COPD to a disease-specific online support platform, Certified Health Education Specialists must assess patients' information goals and their skills to critically appraise and communicate with other online users.

Many female health education pioneers made seminal contributions to public health and social justice, yet these examples are not well documented in textbooks or integrated into public health curricula as pedagogical learning opportunities. Providing biographies and lessons learned from the past leaders within undergraduate health education curricula can help develop students' skills as future leaders and address gender inequities in the field. Gender inequities in higher education as well as many public health practice settings result in lower salaries, slower career advancement opportunities, fewer supervisory positions, increased work-life conflicts, and heavier workloads. Developing women's competencies in leadership and professionalism early in their careers is critical to meeting public health challenges such as COVID-19. We present four female health education trailblazers from different historical eras and various workforce sectors who exemplify leadership attributes (i.e., courage/risk taking, vision, advocacy, mentorship) and can be highlighted as a part of future health education curriculum. Innovative methods and approaches are provided for integrating these leadership lessons into undergraduate public health courses, in alignment with the HESPA II 2020 competencies. Learning from the past to inform the future is critical to inspiring and shaping the careers of emerging health educators. [ABSTRACT FROM AUTHOR]

Public health messages can be used to increase awareness about colorectal cancer screenings. Free or inexpensive images for creating health messages are readily available, yet little is known about how a pictured individual's engagement in the behavior of interest affects message outcomes. Participants (N = 360), aged 50 to 75 years, completed an online survey in which they viewed a colorectal cancer screening message and were then randomly assigned to view one of four different messages about the pictured individual's screening status. Analyses revealed no significant differences in message credibility, message effectiveness, or screening intention among the four conditions. The pictured individual's level of knowledge was rated significantly lower among those participants who were told the screening status of the pictured individual was unknown, compared with those who received no screening status information, U = 3574.50, p = 0.005. Future studies could build on the design of this study to examine the effects of using free or purchased images on intent to screen and other message outcomes over time.

For over six decades, the Society for Public Health Education (SOPHE) has been a leading professional organization for the field of health education (HE). This historical research extends the work of Cissell and Bloom by investigating the recent history of SOPHE. The aims of this historical study were to (1) identify key SOPHE and HE events from 2000 to 2015, (2) describe key contributions of SOPHE to the HE field during this time period, and (3) identify potential future directions for SOPHE. Johnson and Christensen's five steps for historical research were followed to conduct an eDelphi study and one-on-one interviews. During the three-round eDelphi study, SOPHE officers (n = 16) and senior staff (n = 5), who served between 2000 and 2015, identified significant SOPHE's leaders and rated the importance of SOPHE's recent events. Key leaders (n = 25) participated in semistructured interviews to describe their involvement in SOPHE, specific SOPHE activities, and future directions for SOPHE. Brief, structured intercept interviews were also conducted with student (n = 10) and professional SOPHE members (n = 11). Data collected during the eDelphi study were analyzed to determine central tendency statistics and percent agreement on each event evaluated in the second- and third-round surveys. Qualitative interview data were analyzed with NVivo using thematic analysis. Data from the eDelphi study revealed 29 SOPHE and 17 HE events that occurred between 2000 and 2015 as being "important" or "very important." Results from the thematic analysis revealed several themes in three areas: SOPHE accomplishments, benefits of SOPHE membership, and possible future directions for SOPHE to explore.

Background: College students actively seek online health information and use Instagram, an image- and video-based social networking website, to build social networks grounded in trust and behavioral norms (social capital), which have the potential to prevent chronic disease. Purpose: This study aimed to (1) examine how intensity of Instagram use moderates the relationship between eHealth Literacy and online social capital in college students and (2) discuss how Instagram can be used as a social awareness platform for chronic disease prevention among college students. Methods: Hierarchical regression analyses were conducted to analyze web-based survey data from a random sample of college students (N = 327). Results: Online bridging social capital was associated with greater ehealth literacy (P < 0.05) and intensity of Instagram use (P < 0.001), when controlling for sociodemographic variables. The relationship between ehealth literacy and online bridging social capital was strongest among respondents with average-intensity (P < 0.01) and high-intensity (P < 0.01) Instagram use compared to low Instagram intensity. Discussion: High intensity of Instagram use may strengthen college students' low ehealth literacy, especially when interacting with heterogeneous connections with weaker ties. Translation to Health Education Practice: Health Education Specialists should continue to explore how college students' intensity of Instagram use can be strengthened to build bridging online social capital and ultimately prevent chronic disease.

Various surface modification strategies are being developed to endow dental titanium implant surfaces with micro- and nano-structures to improve their biocompatibility, and first of all their osseointegration. These modifications have the potential to address clinical concerns by stimulating different biological processes. This study aims to evaluate the biological responses of ananatase-modified blasted/etched titanium (SLA-anatase) surfaces compared to blasted/acid etched (SLA) and machined titanium surfaces. Using unipolar pulsed direct current (DC) sputtering, a nanocrystalline anatase layer was fabricated. In vitro experiments have shown that SLA-anatase discs can effectively promote osteoblast adhesion and proliferation, which are regarded as important features of a successful dental implant with bone contact. Furthermore, anatase surface modification has been shown to partially enhance osteoblast mineralization in vitro, while not significantly affecting bacterial colonization. Consequently, the recently created anatase coating holds significant potential as a promising candidate for future advancements in dental implant surface modification for improving the initial stages of osseointegration. [ABSTRACT FROM AUTHOR]

"The Belmont Report" was written in 1979 to address the abuse of human participants in biomedical research. In the report, three ethical principles were described: (1) "beneficence," which describes an act of charity or kindness that maximizes possible benefits while minimizing possible harms; (2) "justice," described as a method of just and fair decision making where individuals are treated equally and fairly; and (3) "respect for persons," which recognizes the power of an individual to make independent decisions through ensuring their rights to receive protection if they are unable to do so. These ethical principles led to federal regulations that are almost universally adopted today by researchers and used by institutional review boards (IRBs) to maximize the benefits and minimize the risks of research participation for potential human participants. These principles are epitomized by concepts such as informed consent, risk-benefit analysis, and fair inclusion of all potential participants. With the rising popularity of community-driven research initiatives, some have questioned the applicability of "Belmont Report" principles in modern-day behavioral science research. Following a discussion on the response by the National Bioethics Advisory Commission (responsible for establishing ethical research practice standards in the United States) to this discord, the IRB process, and the role of community advisory boards (CABs) in community-engaged research (CEnR), the authors conclude that the field of health education needs clear ethical practice standards to effectively foster important attributes of community engagement. Though the field of health education has a designated code of ethics to guide professional conduct, as well as a core set of responsibilities and competencies for Certified Health Education Specialists and master Certified Health Education Specialists, health education researchers often do not adhere to specific, competency-based ethical practice standards for strengthening community action through inclusive stakeholder engagement. Therefore, they propose using the "strengthening community action" element of the expanded chronic care model (ECCM) to begin establishing discrete ethical practice standards for CEnR in health education research. The ECCM provides a comprehensive, multifaceted framework for chronic disease prevention and management that fosters community partnerships between health professionals, individuals, and communities. Additionally, the authors propose 8 competency-based ethical practice standards for health education researchers to follow during CEnR.

This special issue provides real-world examples of the diverse methods health education researchers are using to expand existing applications of information and communication technologies (ICTs) for health promotion and chronic disease management. The original and review articles presented in this special issue investigate eHealth, mHealth, and social media use in health education and community engagement research that supports wellness, healthy eating, and active living among individuals living with or at risk for one or more chronic conditions(s). Challenges and opportunities stemming from the results of these studies are discussed within seven papers published in the special issue.

Purpose: The purpose of this study was to explore how Pinterest group pinboards are used to communicate health information on chronic obstructive pulmonary disease (COPD). Method A nonprobability census sampling method retrieved 399 pins from the 10 most followed COPD group pinboards. Pins were coded according to COPD information categories, visual communication tools, and sources of self-efficacy. Chi-square analyses explored whether COPD information categories varied by visual communication tools and sources of self-efficacy. Mann-Whitney Wilcoxon tests determined whether or not differences existed in the number of repins/likes of visual communication tools by COPD information categories. Results: Half of the pins included COPD self-management information (n = 214; 45.92%). Photographs of real people included more women than men (P = 0.032), more patients than providers (P = 0.001), and more self-management information than general COPD information (P = 0.021). Infographics were repinned (Mdn = 107.8; P = 0.03) and photographs of real people were liked (Mdn = 76.54; P = 0.04) more than other visual communication tools. Self-management pins incorporated verbal persuasion (P = 0.001) and social modeling (P = 0.001). Discussion: Pinterest may be a useful social networking website to disseminate COPD patient education targeted at women living with or at high risk for COPD. Translation to Health Education Practice: Health educators can refer female users of social media to Pinterest for literacy-sensitive information on COPD.

Name changes of university departments that have professional preparation health education programs have been ongoing and significant. This study analyzes changes in the names of health education degree-offering departments between 1974 and 2009. It also discusses the implications for the health education discipline going forward with respect to personal and professional identification, as well as credentialing and employment opportunities for health educators. A large change was seen in many of the department names between 1974 and 2009. The greatest changes were seen in the increasing use of "community health," kinds of health, "public health," and "health" and something else. A large decrease was noted in the use of "health education." Name changes present potential challenges for the professional and educational development of the field, employment opportunities, and personal and professional identification. This article does not purport to provide a prescription or solution but rather suggests that health education professionals and organizations should consider this concern.

This study examined prevention and coping content related to COVID-19 on social media. Publicly available social media posts were examined by levels of the social ecological model (SEM) and by platform (Instagram, TikTok, Twitter). Using systematic random sampling, 1579 public posts were collected from March 2020 to June 2020 using COVID-19 hashtags. Of these, 663 posts written in English about COVID-19 were included. Content was coded by platform, strategies for reducing risk, strategies for coping with stress, and SEM level(s). In total, 41.18% of the posts mentioned a strategy for reducing risk. Few posts mentioned coping strategies (5%). Slightly less than half of the posts focused on the individual level (42.1%). Both the strategies mentioned for reducing risk and SEM levels referenced in each post varied significantly by platform. Results suggest that social media may provide insight into the type of health information the public receives as well as the public's strategies for reducing risk and coping; however, there is variation among platforms. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to prospectively examine the effect of state stay‐at‐home mandates on weight of US adults by BMI over 3 months during COVID‐19. Methods: US adults completed an online questionnaire containing demographics, weight, physical activity, sedentary time, fruit/vegetable intake, depressive symptoms, stress, and sleep at baseline (May 2020) and after 3 months (August 2020). Results: Participants gained 0.6 kg (76.7‐77.3 kg, p = 0.002). A total of 26% of those with obesity gained > 2 kg compared with 14.8% of those with normal weight (p < 0.001). A total of 53.3% of individuals with obesity maintained weight within 2 kg compared with 72.5% of those with normal weight (p < 0.001). Greater weight gain was related to longer stay‐at‐home mandates (β = 0.078, p = 0.010), lower baseline minutes of physical activity per day (β = −0.107, p = 0.004), greater declines in minutes of physical activity per day (β = −0.076, p = 0.026), depressive symptoms (β = 0.098, p = 0.034), and greater increases in time preparing food (β = 0.075, p = 0.031). Conclusions: US adults gained weight, and stay‐at‐home mandates were associated with atypical weight gain and greater reported weight gain in individuals with obesity over 3 months. [ABSTRACT FROM AUTHOR]

Purpose: This study examined attitudes, perceived control, perceived norms, intention, and policy support before and after the peak of E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) cases among 2 independent samples of U.S. adults. Design: This study used a successive independent samples design. Setting: Data was collected through online surveys in July 2019 (n = 521) and October 2019 (n = 536). Subjects: Participants were recruited through the Qualtrics Survey Panel. Eligibility criteria included: 1) 18 years or older, and 2) currently living in the U.S. Measures: The 2 surveys were collected from 2 separate samples examined e-cigarette attitudes, perceived control, perceived norms, intention, and policy support. Analysis: Linear regressions were used to examine the association between time, attitudinal, and belief factors associated with intention and policy support. Results: Participants in the October sample (n = 521) were significantly more likely to have negative attitudes towards e-cigarettes when compared to the July sample (n = 536), F(8,1047) = 52.671, p <.01, R2 = 0.287. Lower perceived social acceptance towards e-cigarettes and negative attitudes were related to higher support for restricting where e-cigarettes could be used, F(11, 1042) = 63.218, p <.010, R2 =.401. Higher perceived control over accessing e-cigarettes, but lower social acceptance of e-cigarettes and negative beliefs were associated with higher support for limiting places where e-cigarettes could be purchased, F(11,1039) = 36.200, p <.01, R2 =.277. Conclusion: Results indicate that EVALI cases may have had an immediate negative effect on attitudes but did not appear to decrease intention to use e-cigarettes. Results could inform future public health campaigns' programming and research. More research is needed to understand the long-term impact of EVALI on e-cigarette use. [ABSTRACT FROM AUTHOR]

Insufficient scientific evidence about electronic cigarettes (e-cigarettes) has led to conflicting recommendations (CRs) by credible scientific organizations, creating a public health debate that could prove especially difficult to reconcile as current and former smokers make decisions about whether to use e-cigarettes. To investigate how CRs about e-cigarettes may affect intentions to engage in healthy behaviors, 717 former and current smokers were randomly exposed to one of five conditions (varying in the level of conflict in recommendations) in this between-subject experiment. Our results indicated a significant interaction between the message level of conflict and individuals' information avoidance, employed to maintain hope and deniability. These results suggest the effects of CRs stemming from scientific uncertainty vary with subgroups of people, pointing to several pressing theoretical and practical implications. [ABSTRACT FROM AUTHOR]

We sought to develop and evaluate a health literacy measure in a multi-national study and to examine demographic characteristics associated with health literacy. Data were obtained from Demographic Health Surveys conducted between 2006–15 in 14 countries in Sub-Saharan Africa. Surveys were the same in all countries but translated to local languages as appropriate. We identified eight questions that corresponded to the National Academy of Medicine (NAM) definition of health literacy. Factor analysis was used to extract one measure of health literacy. Logistic regression was employed to examine the relationship between demographic characteristics and health literacy. A total of 224 751 individuals between the ages of 15 and 49 years were included. The derived health literacy measure demonstrated good internal consistency (Cronbach's α  = 0.72) and good content validity. The prevalence of high health literacy overall was 35.77%; females 34.08% and males 39.17%; less than or equal to primary education 8.93%, some secondary education 69.40% and ≥complete secondary 84.35%. High health literacy varied across nations, from 8.51% in Niger to 63.89% in Namibia. This is the first known study to evaluate a measure of health literacy relying on the NAM definition utilizing a large sample from 14 countries in Sub-Saharan Africa. Our study derived a robust indicator of NAM-defined health literacy. This indicator could be used to examine determinants and outcomes of health literacy in additional countries. [ABSTRACT FROM AUTHOR]

Objectives: Indoor tanning, which is most common among 18-25-year-old white women, increases the risk of skin cancer. To address this problem, we developed and tested messages with a national sample of indoor tanners to determine beliefs that would encourage them to quit. Methods: Messages discouraging indoor tanning using different persuasive themes (skin cancer risk, appearance risk, well-being enhancement) were developed based on formative research and a review of intervention efforts. We conducted an online experiment to test the final messages with a national sample of 480 indoor tanners. Results: Messages that emphasized skin cancer risk out-performed messages that focused on well-being enhancement or damage to appearance in terms of intention to quit indoor tanning. Analyses revealed 2 key mediators: perceived argument strength and beliefs related to the effects of indoor tanning. Conclusions: Theory- and evidence-informed public health communications can contribute to improving health-related behaviors. Focusing on the risk of skin cancer may be the most effective strategy to reduce indoor tanning among young white women. [ABSTRACT FROM AUTHOR]

In the United States, Asian Americans account for 50-60% of hepatitis B virus infections, leading to higher rates of liver cancer in this population. While some city-wide data have reported hepatitis B infection rates among young adults as high as 10-20%, little research has examined factors that impact hepatitis B beliefs, or the most effective strategies for reaching this particular population to promote hepatitis B awareness. An online survey was conducted with young Asian American adults (n = 418), aged 18-29 years old, to better understand their health information seeking, social media usage, and hepatitis B-related behaviors and beliefs. Results indicated that doctors and health organizations were the most trusted sources of health information, while the Internet was the most common source of health information. The majority of participants (99.8%) reported using social media and indicated they engaged in health-related behaviors on social media. Several factors, including non-receipt of hepatitis B vaccine, engaging in more health-related social media activities, and a higher mean score for difficulty with health information seeking, were significantly related to higher perceived susceptibility to hepatitis B. Future research should explore the effectiveness of using social media to reach young Asian American adults to promote hepatitis B awareness. [ABSTRACT FROM AUTHOR]

Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients’ eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation’s National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = −0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients benefit from web-based self-management support resources. [ABSTRACT FROM AUTHOR]

Introduction: This study examines relationships between perceived and observed nutrition environments, diet, and BMI, in order to examine the criterion validity of the Nutrition Environment Measures Survey-Perceived (NEMS-P).Methods: In a cross-sectional study, perceived nutrition environments were assessed (NEMS-P) among 221 adults from four neighborhoods in the Philadelphia area in 2010 and 2011. A total of 158 food store environments were observed using the NEMS-Stores. Data analyses were conducted in 2016. Bivariate Spearman rank correlations were used to examine relationships between perceived and observed availability, quality, and price of fruits and vegetables in respondents' neighborhoods. Linear regression models were used to examine relationships between perceived neighborhood and home food environments and daily fruit and vegetable consumption and BMI.Results: A significant, positive relationship was found between perceived and observed availability of fruits and vegetables in the neighborhood (r = 0.36, p<0.001). A similar relationship was seen between perceived and observed quality of fruits and vegetables (r = 0.34, p<0.001). Perceived availability and quality of fruits and vegetables in the neighborhood, and availability and accessibility of fruits and vegetables in the home, were significantly related to daily fruit and vegetable consumption. Perceived price of food in the neighborhood was significantly associated with BMI.Conclusions: Responses to a self-reported survey to assess perceived food environments related to fruits and vegetables were significantly associated with observed nutrition environments, fruit and vegetable consumption, and BMI. The perceived prices of fruits and vegetables were modestly associated with BMI and warrant further testing in prospective studies. When observations of food environments are not feasible, residents' survey responses are an acceptable indicator, with reasonable criterion validity. [ABSTRACT FROM AUTHOR]

Previous research has shown the use of electronic video games as an effective method for increasing content knowledge about the risks of drugs and alcohol use for adolescents. Although best practice suggests that theory, health communication strategies, and game appeal are important characteristics for developing games, no instruments are currently available to examine the quality and content of tobacco prevention and cessation electronic games. This study presents the systematic development of a coding instrument to measure the quality, use of theory, and health communication strategies of tobacco cessation and prevention electronic games. Using previous research and expert review, a content analysis coding instrument measuring 67 characteristics was developed with three overarching categories: type and quality of games, theory and approach, and type and format of messages. Two trained coders applied the instrument to 88 games on four platforms (personal computer, Nintendo DS, iPhone, and Android phone) to field test the instrument. Cohen's kappa for each item ranged from 0.66 to 1.00, with an average kappa value of 0.97. Future research can adapt this coding instrument to games addressing other health issues. In addition, the instrument questions can serve as a useful guide for evidence-based game development. [ABSTRACT FROM AUTHOR]

Obesity is now recognized as one of the most significant health concerns among adults and children in the United States and is regarded as a genuine epidemic among public health professionals. As obesity prevalence among both adults and children has increased, a national imperative to create public policies to address this problem from a public health perspective has correspondingly gained momentum. In response to this growing obesity epidemic, federal, state, and local governments have developed numerous obesity policies. Numerous determinants of health influence the social, physical, personal, and social resources of an individual and their ability to make choices conducive to health. It is to this issue that this research is concerned, namely, to what extent and how are the current obesity policies using the socio-ecological approach and what are the potential impacts of these policies on target populations. Data were collected on state obesity policies and categorized by level of the socio-ecological. The majority of policies identified were at the interpersonal level. A significant relation was found between community level policies and obesity rates. Because some of these policies are relatively new, further research is needed to evaluate the impact of obesity policies. [ABSTRACT FROM AUTHOR]

Background: Despite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy-related skills that can uniquely influence patients' health-related quality of life (HRQoL) outcomes.Objective: The aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD.Methods: Adults from the COPD Foundation's National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables.Results: After adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R2=21%; F9,164=6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R2=26.4%; F8,161=8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=-.56, SE 0.29, 95% CI -1.22 to -0.004, P<.05) was inversely associated with lung-specific HRQoL.Conclusions: Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL. [ABSTRACT FROM AUTHOR]

Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone.Objective: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone.Methods: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data.Results: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than -2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable.Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations. [ABSTRACT FROM AUTHOR]

Background: Social media can promote healthy behaviors by facilitating engagement and collaboration among health professionals and the public. Thus, social media is quickly becoming a vital tool for health promotion. While guidelines and trainings exist for public health professionals, there are currently no standardized measures to assess individual social media competency among Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES).Objective: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES.Methods: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines.Results: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r<.30), high interitem correlations (Ρ>.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|.Conclusions: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES. [ABSTRACT FROM AUTHOR]

University wellness programs often employ health campaigns to promote awareness and engagement in health behaviors. However, with limited resources, it is challenging to develop and test health campaign materials in a timely manner. The Design Thinking Approach (DTA) provides a promising strategy for developing materials in a quicker, less expensive way compared to traditional methods. This pilot study examined the feasibility and short-term impact of implementing the DTA to develop a self-care campaign at a university to reach students on campus. University peer health educators and staff completed a 5-session DTA workshop to learn how to apply the DTA to develop and test a self-care campaign. Feasibility of the approach was conducted by having workshop participants rate the acceptability and practicality of the process. To examine the short-term impact, the self-care campaign was compared to an existing mental health campaign. Results from the feasibility analysis indicated that the participants responded well to the approach and found it to be overall beneficial. Results also revealed that the self-care campaign had a greater number of event attendees compared to the existing mental health campaign. However, the reach on social media was similar, but slightly higher, for the existing mental health campaign. No significant difference in perceived effectiveness score was found. Results provide evidence for the potential for the DTA to be a feasible and efficient tool for testing health campaign ideas. However, more extensive testing is needed to understand its impact long-term and which feedback methods (e.g., interviews and surveys) are most useful.

Objective: Although the prevalence of adolescent smoking has declined over the past two decades, the rate of decline has slowed. Electronic videogames show promise as an effective tool for health behavior change; however, the current state of tobacco prevention and cessation games has not been previously reviewed or evaluated., Methods and Materials: Currently available tobacco-related videogames were identified through online searches and in smartphone application stores. In total, 88 games were systematically coded for characteristics, content, and quality using a reliable and valid coding instrument developed for this research., Results: The majority of games included at least two components of interactivity (75.0 percent) and at least one mechanism for rewarding (69.3 percent). However, most games lacked a story line (97.7 percent) and components for sense of control (25.0 percent). There were an average of 3.54 (standard deviation = 2.20) theoretical constructs in the games, with attitudes (83.0 percent), knowledge (78.4 percent), and perceived severity (55.7 percent) being the most common. The most common educational approach used was the affective education model (83.0 percent). Most games included at least one tobacco message (90.9 percent), with a majority of messages being loss-framed (63.6 percent) and/or one-sided (75.0 percent)., Conclusions: Although today's anti-tobacco videogames contain many effective features, numerous qualities and best practices for changing behaviors through games are not present. Future games should seek to address these best practices in their development and evaluation to increase the likelihood they will be effective.