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Introduction Military health education has historically been focused on conveying the consequences of risky behaviors, informing about external resources, and addressing disease through mitigation and prevention. Total Force Fitness (TFF) and Human Performance Optimization (HPO) provide a broad and holistic framework for preventing health issues and bolstering performance. The Consortium for Health and Military Performance convened a workgroup at the TFF Summit in 2021 to discuss the current state of TFF/HPO in military health education efforts and to identify areas for improvement. Methods An education workgroup of 42 attendees gathered to discuss the current state of TFF/HPO-based health education in the military. Four questions were posed to all members for discussion. Notes were taken and consolidated to obtain feedback and promote discussion from the attendees in a larger audience at the TFF Summit. Results and Discussion The education workgroup identified several education formats, goals, initiatives, and opportunities for improving the development and dissemination of TFF/HPO-based health education throughout the Services. Workgroup members reached a consensus on health education formats (development, dissemination, and audience) and that the primary goal of education is knowledge dissemination and increasing awareness. They also identified several stellar examples of existing TFF/HPO initiatives and explored how health education can increase impact and be more sustainable. The workgroup outcomes were shared with the TFF Summit audience to generate further discussion and to outline action items. Seven action items were identified to improve the development and dissemination of TFF/HPO resources and ensure productive and effective initiatives and programs throughout the Department of Defense. Conclusions The TFF Summit outlined several actionable items that would improve the development and dissemination of TFF/HPO-based health education throughout the Department of Defense's initiatives and programs. A broader approach to military health education that uses a TFF/HPO framework will directly impact the health and performance of the force. Ultimately, embedding TFF/HPO information into the fabric of military health education would shift the focus toward a holistic, proactive, preventive, and performance-based culture. [ABSTRACT FROM AUTHOR]

Many children in economically disadvantaged communities assume adult roles in their families. Negotiating the responsibilities and expectations associated with becoming what some young men describe as "man of the house" has important implications for how adolescent boys move into adulthood. In this study, we share insights from field work and life-history interviews with low-income, young African American men and Salvadoran men in the Washington, DC/Baltimore region to illustrate how adultification may deliver contradictory expectations for adolescents. The findings also show how the accelerated responsibilities that accompany the experience of adultification create difficulties in the young men's transition into adulthood. These findings indicate that the age period of emerging adulthood may begin earlier for economically disadvantaged young men.

This study examines the role of computational and Nutrition Facts Label (NFL) skills in health literacy classifications using the Newest Vital Sign (NVS). A convenience sample of 144 SNAP-eligible adults was given an original and modified version of the NVS. Responses on NVS and modified NVS (NVS-M) were compared using a paired McNemar test, while the order of administration was evaluated using a chi-square test. Overall, significant differences between the paired NVS and NVS-M responses (p < 0.001) resulted in more classifications of adequate health literacy with the NVS-M. Stratification by order of administration revealed a version-specific priming effect, but a comparison of the first administration of each assessment showed no significant difference in classifications (p = 0.955). Common incorrect responses reflected computational errors and confounding serving size and servings per container. Nutrition education may improve NFL skills, while limited numeracy may undermine their utility. Differentiation among related health literacy concepts could improve measurement and screening. [ABSTRACT FROM AUTHOR]

The Medical Monitoring Project (MMP) is an HIV surveillance system that provides national estimates of HIV-related behaviors and clinical outcomes. When first implemented, MMP excluded persons living with HIV not receiving HIV care. This analysis will describe new case-surveillance-based methods to identify and recruit persons living with HIV who are out of care and at elevated risk for mortality and ongoing HIV transmission. Stratified random samples of all persons living with HIV were selected from the National HIV Surveillance System in five public health jurisdictions from 2012–2014. Sampled persons were located and contacted through seven different data sources and five methods of contact to collect interviews and medical record abstractions. Data were weighted for non-response and case reporting delay. The modified sampling methodology yielded 1159 interviews (adjusted response rate, 44.5%) and matching medical record abstractions for 1087 (93.8%). Of persons with both interview and medical record data, 264 (24.3%) would not have been included using prior MMP methods. Significant predictors were identified for successful contact (e.g., retention in care, adjusted Odds Ratio [aOR] 5.02; 95% Confidence Interval [CI] 1.98–12.73), interview (e.g. moving out of jurisdiction, aOR 0.24; 95% CI: 0.12–0.46) and case reporting delay (e.g. rural residence, aOR 3.18; 95% CI: 2.09–4.85). Case-surveillance-based sampling resulted in a comparable response rate to existing MMP methods while providing information on an important new population. These methods have since been adopted by the nationally representative MMP surveillance system, offering a model for public health program, research and surveillance endeavors seeking inclusion of all persons living with HIV. [ABSTRACT FROM AUTHOR]

While text messages or short messaging service programs are increasingly utilized for delivering health education, few studies have explored the unique challenges of recruiting and retaining participants in such programs. This study utilizes survey and focus group data from Text2BHealthy, a short messaging service–based nutrition and physical activity promotion program, to examine barriers to enrollment and facilitators of retention among parents of elementary school students. Results show that participants were hard to reach with recruitment materials, had difficulty with self-enrollment, and were apprehensive about program costs. However, 89–90 percent of participants were retained. Results suggest that providing manual enrollment options, alternative program delivery methods (e.g. email messages), and opportunities to reenroll may facilitate participation in short messaging service–based health education and promotion programs. [ABSTRACT FROM AUTHOR]

Objective: Non-AIDS-defining cancers (NADCs) have emerged as significant contributors to cancer mortality and morbidity among persons living with HIV (PLWH). Because NADCs are also associated with many social and behavioural risk factors that underlie HIV, determining the extent to which each of these factors contributes to NADC risk is difficult. We examined cancer incidence and mortality among persons with a history of incarceration, because distributions of other cancer risk factors are likely similar between prisoners living with HIV and non-infected prisoners. Design: Registry-based retrospective cohort study. Participants: Cohort of 22 422 persons incarcerated in Georgia, USA, prisons on 30 June 1991, and still alive in 1998. Outcome measures: Cancer incidence and mortality were assessed between 1998 and 2009, using cancer and death registry data matched to prison administrative records. Age, race and sex-adjusted standardised mortality and incidence ratios, relative to the general population, were calculated for AIDS-defining cancers, viral-associated NADCs and noninfection- associated NADCs, stratified by HIV status. Results: There were no significant differences in cancer mortality relative to the general population in the cohort, regardless of HIV status. In contrast, cancer incidence was elevated among the PLWH. Furthermore, incidence of viral-associated NADCs was significantly higher among PLWH versus those without HIV infection (standardised incidence ratio=6.1, 95% CI 3.0 to 11.7, p<0.001). Conclusions: Among PLWH with a history of incarceration, cancer incidence was elevated relative to the general population, likely related to increased prevalence of oncogenic viral co-infections. Cancer prevention and screening programmes within prisons may help to reduce the cancer burden in this high-risk population. [ABSTRACT FROM AUTHOR]

Objectives. We investigated whether eventual causes of death among a cohort of inmates imprisoned in the southeastern United States differed from those in previous prisoner studies. Methods. We matched 23 510 prisoners in Georgia, a state with historically low levels of heroin consumption but moderate amounts of injection drug use, who were incarcerated on June 30, 1991, to death registries through 2010. Main exposure was 4-year time intervals over 2 decades of observation; main outcome was mortality from liver disease, HIV, and overdose. Results. Although the HIV-related mortality rate exceeded that from liver-related conditions before 2003, liver disease subsequently surpassed HIV as a cause of death. Among 3863 deaths, 22 (0.6%) occurred within 2 weeks after release from prison. Of these, only 2 were caused by accidental poisoning (likely drug overdose). Cardiovascular disease and cancer were the most frequent causes of death in this aging cohort. Conclusions. Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast. (Am J Public Health. 2015;105:e51–e57. doi:10.2105/AJPH.2014.302546) [ABSTRACT FROM AUTHOR]

Background: Annually, 10 million adults transition through prisons or jails in the United States (US) and the prevalence of HIV among entrants is three times higher than that for the country as a whole. We assessed the potential impact of increasing HIV Testing/Treatment/Retention (HIV-TTR) in the community and within the criminal justice system (CJS) facilities, coupled with sexual risk behavior change, focusing on black men-who-have-sex-with-men, 15–54 years, in Atlanta, USA. Methods: We modeled the effect of a HIV-TTR strategy on the estimated cumulative number of new (acquired) infections and mortality, and on the HIV prevalence at the end of ten years. We additionally assessed the effect of increasing condom use in all settings. Results: In the Status Quo scenario, at the end of 10 years, the cumulative number of new infections in the community, jail and prison was, respectively, 9246, 77 and 154 cases; HIV prevalence was 10815, 69 and 152 cases, respectively; and the cumulative number of deaths was 2585, 18 and 34 cases, respectively. By increasing HIV-TTR coverage, the cumulative number of new infections could decrease by 15% in the community, 19% in jail, and 8% in prison; HIV prevalence could decrease by 8%, 9% and 7%, respectively; mortality could decrease by 20%, 39% and 18%, respectively. Based on the model results, we have shown that limited use and access to condoms have contributed to the HIV incidence and prevalence in all settings. Conclusions: Aggressive implementation of a CJS-focused HIV-TTR strategy has the potential to interrupt HIV transmission and reduce mortality, with benefit to the community at large. To maximize the impact of these interventions, retention in treatment, including during the period after jail and prison release, and increased condom use was vital for decreasing the burden of the HIV epidemic in all settings. [ABSTRACT FROM AUTHOR]

Many children in economically disadvantaged communities assume adult roles in their families. Negotiating the responsibilities and expectations associated with becoming what some young men describe as 'man of the house' has important implications for how adolescent boys move into adulthood. In this study, we share insights from field work and life-history interviews with low-income, young African American men and Salvadoran men in the Washington, DC/Baltimore region to illustrate how adultification may deliver contradictory expectations for adolescents. The findings also show how the accelerated responsibilities that accompany the experience of adultification create difficulties in the young men's transition into adulthood. These findings indicate that the age period of emerging adulthood may begin earlier for economically disadvantaged young men. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Although routine HIV testing is recommended for jails, little empirical data exist describing newly diagnosed individuals in this setting. Methods: Client-level data (CLD) are available on a subset of individuals served in EnhanceLink, for the nine of the 10 sites who enrolled newly diagnosed persons in the client level evaluation. In addition to information about time of diagnosis, we analyzed data on initial CD4 count, use of antiretroviral therapy (ART), and linkage to care post discharge. Baseline data from newly diagnosed persons were compared to data from persons whose diagnoses predated jail admission. Results: CLD were available for 58 newly diagnosed and 708 previously diagnosed individuals enrolled between 9/08 and 3/ 11. Those newly diagnosed had a significantly younger median age (34 years) when compared to those previously diagnosed (41 years). In the 30 days prior to incarceration, 11% of those newly diagnosed reported injection drug use and 29% reported unprotected anal intercourse. Median CD4 count at diagnosis was 432 cells/mL (range: 22-1,453 cells/mL). A minority (21%, N = 12) of new diagnoses started antiretroviral treatment (ART) before release; 74% have evidence of linkage to community services. Conclusion: Preliminary results from a cross-sectional analysis of this cohort suggest testing in jails finds individuals early on in disease progression. Most HIV+ detainees did not start ART in jail; therefore screening may not increase pharmacy costs for jails. Detainees newly diagnosed with HIV in jails can be effectively linked to community resources. Jail-based HIV testing should be a cornerstone of "test and treat" strategies. [ABSTRACT FROM AUTHOR]

Introduction The Cardiovascular Disease (CVD) Prevention project is a VA–DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD. Materials and Methods The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar. Results Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise. Conclusions This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers. [ABSTRACT FROM AUTHOR]

The Total Force Fitness (TFF) framework was envisioned as a holistic framework of interrelated domains, whereby impact in one domain could have cascading implications for the others. For this reason, definitional clarity surrounding how to achieve fitness in the various domains is crucial. Social fitness definitions tend to focus on individual efforts and overlook the powerful impact of the social group and the social environment on the individual. In this article, various definitions of social fitness are analyzed in an effort to broaden the current understanding of the social domain. Some of the knowledge gaps in understanding social fitness and the resulting challenges are addressed before reviewing a few existing social fitness interventions. Finally, this study offers recommendations for improvement, along with future directions for the increased integration of the social domain into the TFF framework., (2023.)

Introduction: The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD., Materials and Methods: The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar., Results: Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise., Conclusions: This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers., (© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Humans are the heart of our warfighting efforts and, as such, human performance must be optimized and sustained to maintain effective and successful SOF Operators over the long haul. How do we do this? Based on the July 2018 signing of a Joint Requirements Oversight Council Memo (JROC) making Total Force Fitness (TFF) a required framework for taking care of our military Servicemembers, we propose three solutions for further optimizing the performance of SOF. The proposed solutions are human performance optimization (HPO)/TFF capability-based blueprinting (CBB), HPO integrator profession (HPO-I), and HPO-centric education and training across the total force. These solutions would potentiate the Preservation of the Force and Family (POTFF) concept by improving the targeting of resources and support of Operator and unit operational readiness. These solutions, the knowledge, skills, abilities, and experiences in HPO from a holistic perspective and the opportunity to obtain college credits through the Uniformed Services University of the Health Sciences (USU) College of Allied Health Sciences (CAHS) are described here., (2019.)

The purpose of this study was to explore the relationship between health literacy and nutrition behaviors using a low-income sample. Face-to-face surveys at 11 social services offices generated a convenience sample of 154 Supplemental Nutrition Assistance Program (SNAP)-eligible adults. We assessed health literacy, fruit and vegetable intake, food label use, consumption of healthy foods, and demographic characteristics. Thirty seven percent of the sample had adequate health literacy as measured by the Newest Vital Sign (NVS). Race and parenthood were significantly related to health literacy scores. Adequate health literacy, as measured by the NVS, was associated with frying chicken less often and eating the peels of fresh fruit more often. The findings suggest that health practitioners should ensure nutrition-related messages are accessible to all of their clients, especially those with the lowest health literacy levels.