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Ethnic minority healthcare workers (EMHCW) are at high risk of COVID-19 infection and adverse health outcomes, but vaccine uptake is low among ethnic minority communities, including EMHCW. We explored the views of EMHCW towards COVID-19 Vaccine Education (CoVE), a digital training resource to improve knowledge and confidence for promoting the COVID-19 vaccine. Thirty EMHCW completed CoVE, then participated in a semi-structured qualitative interview. Principles of framework analysis were used to deductively analyse data using concepts from the Kirkpatrick New World Model of training evaluation. CoVE was viewed to be engaging, accessible and relevant to EMHCW. This training increased EMHCW perceived knowledge and confidence to provide evidence-based information to others, dispel myths, and reduce vaccine hesitancy. Participants reported changes in vaccine promotion behaviours and vaccine uptake. CoVE could be used to help improve vaccine literacy among EMHCW, enhance health communications about vaccines, and ultimately help facilitate uptake of occupational vaccination programs., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Seven of the top ten leading causes of death in the United States are due to chronic diseases and treating these accounts for 86 percent of our nation's health care costs. The workplace offers an environment to implement chronic disease prevention strategies, such as worksite wellness programs, due to the large amount of time spent at the worksite daily by employees. As a result of COVID-19, many organizations began to change their workdays (i.e., working from home). This research sought to understand what, if any, implications the COVID-19 epidemic had on worksite wellness programming. Semistructured interviews were employed and recorded via Zoom conferencing to gather qualitative data. Four themes were identified: (a) relationship building among remote employees, (b) creativity in how to carry out program components, (c) increased physical activity and work-life balance, and (d) increased knowledge of health issues and mental health resources. Both challenges and successes were reported within themes. The main finding from this research indicates a mostly positive experience for worksite wellness programs during the COVID-19 epidemic. Many organizations have continued nontraditional work environments and the lessons learned from this study can both encourage and provide ideas for how to create and continue a worksite wellness program outside of the normal face-to-face working environment.

Through Substance Abuse and Mental Health Services Administration funding, Michigan State University (MSU) Extension partnered with MSU's Family Medicine and Health Department of Northwest Michigan to implement trainings for community members and health care providers to increase awareness and improve prevention efforts addressing opioid use disorder (OUD) in rural areas. We formed the Michigan Substance Use Prevention, Education and Recovery (MiSUPER) project to design and evaluate opioid misuse prevention trainings. A socio-ecological prevention model was an underlying conceptual framework for this project and drove strategies used in trainings, products created, and measurement. The purpose of this study is to determine the effectiveness of one-time online educational training events for rural community members and health care providers on community OUD issues, treatment options, and supports for those in recovery. Between 2020 and 2022, rural participants completed pre- and posttraining, and 30-day follow-up evaluation surveys. We report the demographic characteristics of community ( n = 451) and provider ( n = 59) participants, self-reported knowledge gained, and overall perceptions of the trainings. Findings show community members' knowledge increased from pre- to posttraining ( p < .001) and was maintained at 3 months, while providers' knowledge was unchanged over time. Posttraining, community participants felt more comfortable speaking about addiction with family and friends ( p < .001), and providers had better knowledge of local resources for patients who could not afford opioid misuse treatments ( p < .05). All participants reported gaining knowledge of community resources for opioid misuse prevention, treatment, and recovery ( p < .01). Opioid misuse prevention trainings may be most effective when adapted to leverage local resources.

Introduction: Early Head Start (EHS) and Head Start (HS) staff comprise a large segment of the public sector workforce and experience numerous risk and chronic factors for medical conditions or symptoms. Few health and wellness workplace interventions, however, specifically focus on EHS/HS staff., Methods: A train-the-trainer (TTT) approach was used to build capacity among directors and staff from 57 EHS/HS programs on how to strategically plan and implement a health promoting worksite program focusing on improving nutrition and physical activity practices among EHS/HS staff. Baseline and 3-month post-training questionnaires assessed EHS/HS staff changes on knowledge and practices related to nutrition and physical activity. Paired t-tests or chi 2 statistics assessed changes in questionnaire responses over time., Results: 1,363 staff from 57 programs completed baseline and follow-up surveys. Staff had high knowledge regarding healthful dietary patterns at baseline. Over one-third of staff reported drinking soda with meals and almost 50% identified soda as their most common drink. Roughly one-third of staff also reported no physical activity in the prior week at baseline. Staff demonstrated significant improvements in dietary, nutrition, and physical activity practices. Staff also improved grocery shopping behaviors., Implications for Practice: The TTT approach to disseminate an EHS/HS staff-focused health promotion program, "Eat Healthy, Stay Active!' provides a potentially promising strategy to build upon and disseminate more broadly to reach the over >300,000 EHS/HS staff workforce.

Clinical education programs are positioned to train future health care professionals to provide excellent health care for transgender and gender-diverse patients. The purpose of this resource, Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators, is to facilitate critical inquiry among clinical educators regarding their approach to teaching about sex, gender, the historical and sociopolitical context of transgender health, and how to prepare their students to apply standards of care and clinical care guidelines set forth by national and international professional organizations.

Introduction . Research suggests that awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) among adolescents is associated with increased harm perception of e-cigarettes. The depiction of EVALI on three primetime medical dramas offers an opportunity to examine the use of these storylines for tobacco prevention education. Methods. We conducted four focus groups with seventh- and eighth-grade students at an urban middle school. Participants viewed three clips of scenes followed by a facilitated discussion as to the influence of the clips on knowledge and perceptions of e-cigarettes and the use of clips for tobacco prevention education. Two research assistants double-coded notes from the focus groups using a qualitative content analysis approach. Results. Our final sample included 78 adolescents; we obtained self-reported demographic information for 75. The majority of participants were 13 to 14 years of age (82.7%) and identified as cisgender female (52.0%) and Black (52.0%). No participants had knowledge of EVALI prior to viewing the clips. Comments made both during and after watching suggest the clips may have reinforced knowledge and perceptions of harm; participants stated that the clips could be a useful intervention tool. Viewing the clips also generated unprompted discussion about flavored products, tobacco advertising, other television programs, and marijuana. Conclusions. Clips featuring the depiction of EVALI on medical dramas may be an effective tool for raising awareness of e-cigarette use-related harms. These results offer a promising first step for future collaborative research between public health, adolescents, and schools to develop tobacco prevention education utilizing these clips.

Objectives: To review the effect of telemedicine interventions on cardiovascular risk factors control in people with arterial hypertension (AH), type 2 diabetes (T2D), or both in primary care., Methods: We conducted a systematic review in February 2024 using PubMed/MEDLINE, Cochrane Library, and EMBASE databases. We included randomised controlled trials from 2010 onwards, lasting ≥3 months, comparing telemedicine to standard care for managing cardiovascular risk factors in adults with AH, T2D, or both., Results: Among 1803 records, 54 were included. Telemonitoring with teleconsultations showed the best outcomes. For AH, systolic blood pressure decreased by -5.63 mmHg (95% CI -9.13 to -2.13) at 6 months and -5.59 mmHg (95% CI -10.03 to -1.14) at 12 months compared to standard care. For T2D, HbA1c decreased by -0.45% (95% CI -0.90 to 0.00) at 6 months and -0.18% (95% CI -0.41 to 0.05) at 12 months compared to standard care. Blood glucose self-monitoring was as effective as telemonitoring for T2D at 6 months. The effect on diastolic blood pressure, low-density lipoprotein, triglycerides, and body mass index was non-significant., Discussion: Telemedicine offers short-term benefits but lacks long-term effectiveness. Optimal outcomes require a combined telemedicine approach, health education co-intervention, ≥12-month follow-up, and careful patient selection., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Recruiting women participants with criminal legal system involvement (CLSI) has always presented challenges, whether gaining access to them in prisons and jails or locating them after release. This research brief describes how the COVID-19 pandemic required us to change our recruitment strategies from previously successful approaches to a hybrid strategy using techniques from respondent-driven sampling (RDS) to recruit CLSI women. The RDS techniques, with internet social media, enabled us to capitalize on the community-based social networks of CLSI women to recruit 255 into our clinical trial of a health education intervention. This new avenue for recruitment can be useful beyond pandemic conditions.

Background: As health education robots may potentially become a significant support force in nursing practice in the future, it is imperative to adhere to the European Union's concept of "Responsible Research and Innovation" (RRI) and deeply reflect on the ethical risks hidden in the process of intelligent robotic health education., Aim: This study explores the perceptions of professional nursing professionals regarding the potential ethical risks associated with the clinical practice of intelligent robotic health education., Research Design: This study adopts a descriptive phenomenological approach, employing Colaizzi's seven-step method for data analysis., Participants and Research Context: We conducted semi-structured interviews with 17 nursing professionals from tertiary comprehensive hospitals in China., Ethical Considerations: This study has been approved by the Ethics Committee of the Second Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Second Chinese Medicine Hospital., Findings: Nursing personnel, adhering to the principles of RRI and the concept of "person-centered" care, have critically reflected on the potential ethical risks inherent in robotic health education. This reflection has primarily identified six themes: (a) threats to human dignity, (b) concerns about patient safety, (c) apprehensions about privacy disclosure, (d) worries about implicit burdens, (e) concerns about responsibility attribution, and (f) expectations for social support., Conclusions: This study focuses on health education robots, which are perceived to have minimal ethical risks, and provides rich and detailed insights into the ethical risks associated with robotic health education. Even seemingly safe health education robots elicit significant concerns among professionals regarding their safety and ethics in clinical practice. As we move forward, it is essential to remain attentive to the potential negative impacts of robots and actively address them., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Nurses are at the forefront of providing health education for the general public and are leaders in developing health education programs for all ages. Research has shown that the pediatric population often experience anxiety surrounding common medical procedures. However, evidence-based health education has been shown to enhance self-management, increase knowledge, and decrease anxiety in the pediatric population. One such successful evidence-based health education approach designed for the pediatric population is the Teddy Bear Clinic. The purpose of this article is to report on the efficacy of a nursing student-led Teddy Bear Clinic designed to increase the awareness of common medical equipment and procedures in the pre-school pediatric population. This quality improvement project used a program evaluation design to assess the children's knowledge of common medical procedures and equipment. Participants were a convenience sample of 16 children aged 3-5 years old, attending one daycare center in a large city in Atlantic Canada. Findings showed that after participation in the clinic, the pre-schoolers reported a high level of knowledge of common medical equipment and procedures. This project shows that a Teddy Bear Clinic run by senior nursing students can promote community partnerships and enhance health knowledge in pre-school children., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents ( n = 781) were randomized to the control group ( n = 394) and the health game intervention group ( n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study aimed to describe the profile and practices of school nurses working at a network of educational centers in Spain. This was a descriptive study of the documented actions of 107 school nurses between September 2018 and June 2021 in 54 educational centers (55.6% private and 44.4% subsidized). The profile of the school nurses was young (average age 33.8 [standard deviation (SD) = 7.7] years) and predominantly female (91.6%) with a diverse and multidisciplinary education, primarily at the postgraduate level (specialized mainly in emergency care, nursing/school health, and pediatrics/neonatology). They carried out 256,499 interventions. The most frequent types of incidents they treated were accidents (30.4%) and disease-related episodes (22.2%). The interventions were usually brief (average time 7.7 min) and were resolved by the school nurse (99.1%), and the main recipients were students (87.3%). The highest incidence of interventions occurs during breaks between classes. Acute interventions occupied most of the school nurses' time, leaving little opportunity for health education (0.3%). School nurses played an important role in preserving and promoting the health of school populations and cost-savings to healthcare systems with the actions that they performed. Descriptions of these actions are essential when advocating for the continuation and expansion of school nursing services., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Health literate self-management education is at stake for the prevention and management of non-communicable diseases in low resources settings and countries. Here we describe the Learning Nest in Ordinary Context (NA-CO in French, Nids d'Apprentissage en Contexte Ordinaire) aiming at the structuring of health education programs at the micro- (education sessions) and the meso-levels (adapted to context). The Learning Nest model was designed based on a combination on health literacy principles and on studies conducted with vulnerable people with non-communicable diseases. Observation of NA-CO active-learning sessions found them to be operational and relevant as they center on access, understanding, and use of health information while integrating the ordinary context of learners. The Learning Nest packages (including several adapted thematic sessions, training of trainers and development in context) were shown to be feasible and realistic in diverse locations (Reunion, Mali, Mayotte, Mauritius, Burundi). Qualitative and intervention studies have documented the potential usefulness of the Learning Nest model for context- and setting-specific health literacy interventions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The National Commission of Health Education Credentialing, Inc. (NCHEC) created the Category 1 COVID-19 Claim Form Opportunity to document how Certified Health Education Specialists (CHES ® ) and Master Certified Health Education Specialists (MCHES ® ) assisted communities during the COVID-19 pandemic. Using data submitted by CHES ® /MCHES ® ( n = 3,098 claim forms), the purpose of this study was to (a) describe the settings where CHES ® and MCHES ® completed their pandemic work and (b) assess differences in the type of pandemic work completed by CHES ® compared with MCHES ® based on specific Areas of Responsibility (AOR) for Health Education Specialists. Findings showed that CHES ® and MCHES ® engaged in seven AOR during the pandemic, with the largest proportion of CHES ® ( n = 859; 33%) and MCHES ® ( n = 105; 21.9%, documenting COVID-19-related activities in health departments. CHES ® reported higher engagement than MCHES ® in activities such as COVID-19 reporting/tracking, χ 2 (1, N = 3,098) = 27.3, p < .001; outbreak response, χ 2 (1, N = 3,098) = 4.3, p = .039; and vaccination, χ 2 (1, N = 3,098) = 5.2, p = .023. Conversely, MCHES ® reported higher participation than CHES ® in screening/testing, χ 2 (1, N = 3,098) = 174.2, p < .001; administration of budgets/operations, χ 2 (1, N = 3,098) = 30.1, p < .001; and adapting educational activities at college/universities, χ 2 (1, N = 3,098) = 46.1, p < .001. CHES ® were more likely than MCHES ® to indicate working in all AOR except for Area 2-Plan Health Education/Promotion. Results support that employer-verified health education skills in all AOR were transferable during COVID-19, especially for CHES ® employed within state/county health departments.

This study examined the relationships between current anxiety problems and school engagement, community service or volunteer work, and paid work among U.S. adolescents. The 2018-2019 National Survey of Children's Health (NSCH) dataset was analyzed and included 24,609 adolescents ages 12-17 years. We conducted unadjusted and adjusted logistic regression analyzes. A total of 12.6% of adolescents had healthcare provider-confirmed current anxiety problems. Adolescents with current anxiety were at decreased odds of engaging in school (aOR = 0.35, 95%CI = 0.29, 0.41) and participating in community service or volunteer work (aOR = 0.72, 95%CI = 0.59, 0.86) compared to adolescents without current anxiety. Adolescents with current anxiety were at increased odds of participating in paid work (OR = 1.18, 95%CI = 1.01, 1.38). This study reports that U.S. adolescents with anxiety were less likely to engage in school and participate in community service or volunteer work, but were more likely to participate in paid work compared to their peers without anxiety. Results should inform future interventions targeting adolescents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Community health workers (CHWs) are increasingly being required to perform complex health care activities, especially in community cardiovascular disease and stroke prevention. However, currently, there are no psychometrically validated instruments for assessing CHW competencies in these roles. This article describes the development and validation of the stroke literacy assessment test (SLAT)-pertaining to the Life's Simple Seven (LS7) risk factors for stroke-for evaluating CHWs' competencies in the context of education and training programs. The SLAT was developed using an iterative instrument design protocol, followed by empirically testing the instrument in 68 CHWs from the Columbia University Institute for Training Outreach and Community Health (InTOuCH) in New York. Data collection began in March 2021 and continued through May 2021. The evaluation was based on four types of validity evidence: (a) content validation with expert reviews of items and overall domain, (b) validation on examinee response processes with cognitive interviews, (c) item validation and diagnostic analysis, and (d) validity evidence based on expected directional group differences. In addition, the internal consistency reliability of the total test scores, with the best functioning items, were evaluated. Two such iterative cycles yielded a 34-item, written structured response test that assesses the factual knowledge and application levels of cognition, and demonstrates sufficient validity and reliability (Cronbach's α = .69) for use with CHWs specializing in stroke prevention efforts. The SLAT is a novel, valid, and reliable instrument that contributes to filling a critical gap in rigorous competency assessments for CHWs deployed in chronic disease prevention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Early recognition of the warning signs of pregnancy-related complications and provision of timely, quality care could prevent many maternal deaths. We piloted a maternal warning signs education intervention with five Maryland-based maternal, infant, and early childhood home visiting programs serving populations disproportionately affected by adverse maternal outcomes. The intervention included a 1.5-hr online training for home visitors, monthly collaborative calls with program managers, and a client education toolkit with a 3-min video, illustrated handout of 15 urgent maternal warning signs, magnet with the same, and discussion guide for home visitor-client interactions. A mixed-methods formative evaluation assessed the acceptability, feasibility, and utilization of different components of the intervention. Home visiting program staff reported that the materials were highly acceptable and easily understood by diverse client populations. They valued the illustrations, simple language, and translation of materials in multiple languages. Program managers found implementation a relatively simple process, feasible for in-person and remote visits. Despite positive reception, not all components of the toolkit were used consistently. Program managers and staff also identified the need for more guidance and tools to help clients communicate with health care providers and advocate for their health care needs. Feedback from pilot sites was used to adapt the training and tools, including adding content on patient self-advocacy. Home visiting programs have a unique ability to engage families during pregnancy and the postpartum period. This pilot offers lessons learned on strategies and tools that home visiting programs can use to improve early recognition and care-seeking for urgent maternal warning signs.

Background: The use of measurement instruments to assess the use of Evidence-Based Practice by health professionals has been frequently reported in studies., Aims: This systematic review aimed to summarize, describe, and evaluate the measurement properties of the instruments that evaluate the use of Evidence-Based Practice in health professionals., Methods: The search was carried out in four databases considering three groups of search terms: evidence-based practice, evaluation, and measurement proprieties. Studies were included that described the use of instruments to assess Evidence-Based Practice in health professionals, with the full-text publication, which analyzed the measurement properties, in English. The methodological quality of the studies was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments., Results: In total, 6,429 were found and only 92 were eligible for data analysis. Forty new instruments were identified most were developed for nursing and physical therapist. The investigators performed at least 1 type of validity test on 73% of the instruments. Reliability was tested at 90%, through internal consistency. Responsiveness was tested on less than half of the instruments (30%). Most of the instruments identified are reliable and valid to measure evidence-based practice in health professionals., Conclusion: Although the Fresno Test remains the most complete instrument, and adequate for use. The COnsensus-based Standards for the selection of health Measurement INstruments checklist classified 7 (seven) instruments as suitable for the target audience., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

School nurses are uniquely positioned to support lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) students. One approach is involvement in Gender and Sexuality Alliances (GSAs). GSAs have been found to improve outcomes for LGBTQ students. The purposes of this quality improvement project were to build infrastructure for GSAs by implementing a GSA Support Plan including a digital resource binder, GSA advisor trainings, and establishment of an Advisor Leadership Committee and increase the number of schools with a GSA. The binder was distributed electronically to 95 advisors. Forty-nine participants attending virtual trainings. A statistically significant increase in all measures of participant confidence occurred between the pre- and post-training surveys. The Advisor Leadership Committee was established. This paper adds to the literature by showing that support for GSAs is important to aiding LGBTQ students. Further, authors suggest ways in which school nurses can harness their expertise to be involved with GSAs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: While vaccines have reduced the incidence of vaccine-preventable diseases, vaccine hesitancy threatens the re-emergence of childhood infectious diseases. Purpose: This randomized controlled study evaluated an online vaccine education program to advance vaccine acceptance among middle-school students. Methodology: Study participants were randomly assigned to an intervention group who viewed the VEP videos or to a comparison group who viewed a science-based video unrelated to vaccines. Results: Knowledge scores improved in both groups and more favorable shifts in vaccine-related beliefs and attitudes occurred in the intervention than in the comparison group. Conclusions: This program can be feasibly delivered via an online platform to middle school students, resulting in shifts in vaccine-related knowledge, beliefs and attitudes. Implications: Delivering evidence-based content to instruct about vaccine effectiveness and safety is an area in which school nurses have demonstrated an important role as a resource for patient education to promote vaccine advocacy.

Background: The field of lactation currently uses breastfeeding rates to measure effectiveness. While monitoring breastfeeding outcomes can provide insight into the successes of lactation consulting as a profession, the improvement of breastfeeding outcomes is a multifactorial issue. In order to facilitate the growth of lactation education processes, understanding experiences during training and perceptions of readiness of current International Board Certified Lactation Consultants (IBCLC) for clinical practice is necessary., Research Aim: The aim of this survey was to provide a baseline assessment of the current landscape of the lactation profession through data related to certification, job market, practice confidence after passing the International Board of Lactation Consultant Examiners (IBLCE) certifying examination, and perceptions of specializations., Methods: A cross-sectional study design was used to assess the experiences of practicing IBCLCs. Non-probability convenience sampling was implemented from December 2021 through January 2022. A total of 281 unique responses were recorded with complete data on variables of interest., Results: The majority of respondents were white females under age 50 located in the United States. The majority of respondents were certified through a Pathway 1. The largest barrier to certification was reported to be a lack of clinical/mentorship opportunities. Respondents were significantly more confident in providing entry-level support to dyads when mentored by four or more preceptors., Conclusion: Diversification of the field of lactation is necessary to provide appropriate support to lactating families in the United States. Additionally, addressing the barrier of accessing clinical/mentorship opportunities is essential for continued growth of the field of lactation., Competing Interests: Disclosures and Conflicts of InterestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Ineffective health communication can drive health disparities and limit the effectiveness of interventions to reduce them. Stock photo libraries are a critical tool for developers of patient education, health education, and intervention materials. It is not clear how well stock photo libraries represent communities bearing disproportionate burdens of disease., Method: We conducted a search using five popular stock image libraries (Adobe Stock Images, Canva, Getty Images, Microsoft Office Image Library, and Pixabay) in November 2021 to evaluate diversity and representation in health-related stock photos. We searched for the following five key preventive health topics: healthy eating, exercising, quitting smoking, vaccination, and pregnancy. The images ( N = 495 ) were coded for age, gender presentation, representation of perceived minoritized racial/ethnic identity, skin color using the Massey-Martin skin color scale, markers of high socioeconomic status (SES), and access costs. Results. The representation of perceived minoritized people, darker skin color, and inclusion of markers of high SES varied greatly by the search term and library. Images predominately portrayed young adults and adults, with limited representation of other age groups. Images in libraries with any paywall were significantly more likely to depict a person of perceived minoritized racial/ethnic identity and depict darker skin colors, and were significantly less likely to contain markers of high SES identity than images in libraries that were free to use., Discussion: We found that it costs more to develop culturally relevant health education materials for minoritized populations and groups that do not represent high SES populations. This may hinder the development of effective communication interventions.

Background: Unacceptably high levels of e-cigarette use among youth paired with growing research about the dangers of vaping demonstrate a critical need to develop interventions that educate young people to reject e-cigarette use and promote cessation for current users. Vaping: Know the Truth (VKT) is a free digital learning experience prioritizing middle and high school students that aims to improve students' knowledge about the dangers of using e-cigarettes and provide quitting resources for those who already vape. The current study was designed to evaluate whether students receiving the curriculum increased knowledge of the dangers of vaping., Methods: The outcome measures were calculated as the change in the number of correct responses from the pre- to post-module assessments among middle and high school students who completed four modules of the VKT curriculum ( N = 103,522). Linear regression was performed to determine the association between the student's pre-module assessment score and the knowledge change score after completion of the four modules., Results: Students' e-cigarette knowledge significantly improved by an average of 3.24 points ( SD = 3.54), following implementation of the VKT curriculum. This indicates that participants answered more than 3 additional questions correctly, on average, after the intervention., Conclusion: Findings demonstrate that the Vaping: Know the Truth curriculum is an effective resource for increasing knowledge among youth about the harms associated with e-cigarette use. Further research is needed to evaluate whether the intervention is associated with behavioral outcomes over time.

The use of Critical Race Theory, Photovoice, and Community-Based Participatory Research has helped uncover the root causes of issues such as systemic racism in the fields of public health and health promotion. Often, we see studies using traditional research methods to investigate potential causal factors of disparities in minoritized communities report only quantitative data. While these data are imperative for understanding the severity of disparities, quantitative-only approaches cannot address nor can they improve the critical root causes of these disparities. As a team of BIPOC graduate students in public health, we conducted a community-based participatory research project using Photovoice methodology to explore inequities in Black and Brown communities exacerbated during the COVID-19 pandemic. The participatory nature of this research revealed cumulative challenges across the social determinants of health in New Haven and Bridgeport, Connecticut. It allowed us to engage in local-level advocacy to promote health equity as our findings illuminated the need for community-led and community-engaged action. Health and racial inequities cannot be effectively addressed if public health research and programming do not collaborate with the community to build community capacity, empowerment, and trust. We describe our experiences doing community-based participatory research to investigate inequities and provide reflections on their value for public health students. As responses to health inequities and disparities become more politically polarized in the United States, it is critical for public health and health education students to use research methodologies that elevate communities that have been historically marginalized and neglected. Together, we can catalyze equitable change.

Background: Disparities in advance care planning (ACP) among older Latinos necessitate targeted interventions to enhance engagement and knowledge in end-of-life care. This study aimed to evaluate the effectiveness of a resource-efficient, culturally tailored educational intervention in improving ACP readiness and knowledge among older Latino adults in the community., Methods: A quasi-experimental pretest-posttest design was used to assess the impact of the intervention. The study involved community-dwelling older Latinos (aged 61-94) in the U.S. attending community wellness centers. Measures included participants' knowledge of ACP, care options, familiarity with hospice and palliative care, and attitudes toward hospice, assessed using pre- and post-intervention surveys., Results: Statistically significant improvements were observed in ACP knowledge, understanding of care options, and attitudes towards hospice and palliative care post-intervention. Demographic factors influenced knowledge scores, with no significant gender differences in the intervention's efficacy., Conclusions: The educational intervention effectively enhanced end-of-life care planning readiness and knowledge among older Latinos. The study highlights the potential for sustainable, accessible, and culturally sensitive educational strategies to reduce disparities in ACP knowledge and possibly engagement., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Cadres play an important part in providing community-based education. This study developed and assessed an education program for cadres in Malang, Indonesia, as 'change agents' to promote rational antibiotic use., Methods: In-depth-interviews with stakeholders ( N = 55) and a subsequent group discussion with key personnel ( N = 5) were conducted to develop a relevant education tool for cadres. This was followed with a pilot study with cadres ( N = 40) to assess the effectiveness and acceptability of the new tool., Results: Consensus was reached on the education tool media: an audio-recording (containing full information) with a pocketbook (containing key information) as a supplement. A pilot study on the new tool reported its effectiveness in improving knowledge ( p < 0.001) and demonstrated a high acceptability (all respondents stated 'Strongly Agree' or 'Agree' on all statements)., Conclusion: This study has created a model for an education tool which can potentially be implemented for cadres to educate their communities about antibiotics in the Indonesian context., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

There is a public health epidemic in adolescents' use of Electronic Nicotine Delivery Systems (ENDSs), also known as electronic cigarettes, vaping products, or JUULs. However, little is known about the level of knowledge school staff have about ENDS. The purpose of this study is to examine outcomes of a nurse-led educational intervention designed to increase school staff knowledge about ENDS. A descriptive, nonrandomly selected pre-test/post-test design was used with 125 Wisconsin school staff. Results revealed further educational needs of school staff in content areas including advertising to youth and flavoring of ENDS. Following the educational intervention, post-test results showed a significant overall improvement in participant knowledge scores. Recommendations include implementing nurse-led education about ENDS to a more diverse population of school staff. Providing nurse-led ENDS education to school staff offers an upstream, proactive approach for school nurses to help address this public health epidemic., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Concussion education is widely mandated and largely ineffective. Recent consensus guidance on concussion education asserts the importance of (1) theory-driven programming that targets the team as a system and (2) working with end users throughout the development process, and considering issues such as feasibility, acceptability, and sustainability. Consistent with this guidance, and in collaboration with youth sport stakeholders in two regions of the United States, we developed a novel approach to concussion education: Pre-game safety huddles. Safety huddles have the following two core components: (1) athletes, coaches, and other stakeholders come together before the start of each game and (2) opinion leaders (coaches, referees) affirm the importance of care seeking for suspected concussion. The aim of this article is to provide an overview of the collaborative process through which we refined the safety huddle concept into an acceptable and feasible intervention with potential for sustainable implementation in diverse youth sports settings with minimal resource demands. In describing our process and discussing challenges and opportunities, we hope to provide an example for others seeking to develop and implement injury prevention interventions in youth sports settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The present qualitative study is a part of the process evaluation of a complex intervention, the randomized controlled trial, "Prevention of human papillomavirus (HPV) in a school-based setting." We aimed to explore participating school nurses' perceptions and experiences of delivering the educational HPV intervention to adolescents aged 16. Focus group interviews were conducted with school nurses ( n  = 20) and analyzed with inductive qualitative content analysis. The overall theme Easily adapted into the existing role as a school nurse permeated the participants' views. The nurses were in favor of delivering an intervention that increased the HPV vaccination rates and improved beliefs and awareness about HPV prevention. It suits their work and health-promoting aspect of their role well and can easily be adapted into the current school health consultant curriculum. Having material in different languages to share with adolescents and their parents to promote equal health was deemed important., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Motivational interviewing is an evidence-based counseling approach. However, its learning processes and their influencing factors are understudied, failing to address the suboptimal use of motivational interviewing in clinical practice. A participatory action research was conducted in collaboration with 16 primary care clinicians, who encountered similar challenges through their previous counseling approaches. The study aimed to facilitate and describe the clinicians' professional transformation through interprofessional communities of practice on motivational interviewing (ICP-MI). Data were collected using the principal investigator's research journal and participant observation of four independent ICP-MIs (76 h) followed by focus groups (8 h). The co-participants performed inductive qualitative data analysis. Results report that learning motivational interviewing requires a paradigm shift from health experts to health guides. The learning processes were initiated by the creation of an openness to the MI spirit and rapidly evolved into iterative processes of MI spirit embodiment and MI skill building. The intrinsic influencing factors involved the clinician's personal traits and professional background; the extrinsic influencing factor was the shared culture disseminating the expert care model. Previously described in a fragmented manner, motivational interviewing learning processes, and its influencing factors were presented as integrated findings. Considerations in elaborating effective MI training/implementation programs are discussed for clinicians, trainers, and decision-makers. Future areas of investigation are also highlighted calling forth the research community to contribute to knowledge advancement on health education in primary care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The American Public Health Association's Public Health Education and Health Promotion (APHA PHEHP) Section celebrates its 100th anniversary by reflecting on its humble beginnings and early contributions to the field of health education. This article highlights the often-unsung history of our field and its fledgling beginnings, which is important to scholars and students alike. First codified as the Health Education and Publicity Section in the early 1920s, we trace the history and challenges of using new modes of publicity such as motion pictures and innovative exhibits to help curb the spread of infectious diseases (e.g., tuberculosis, venereal disease). Evart G. Routzahn, credited as the Section's father, worked tirelessly to increase the Section's visibility (renamed the Health Education Section in 1927 and the Public Health Education and Health Promotion Section in 1990) and in advancing the professionalization of health education during a time when there were no formal professional preparation programs in health education. Over the years, the Section has played significant roles in strengthening the practice of health education and communication; advancing APHA's overall leadership, infrastructure, and governance; and contributing to the unified voice and advocacy for the health education profession and health equity. We conclude by describing contemporary initiatives that reflect the continued spirit and vibrancy of the Section in setting the stage for the next 100 years.

Although suicide prevention trainings (SPT) have been a standard approach for suicide prevention for years, researchers have noted a need for more clarity in the definition of core competencies for SPTs, particularly in the areas of diversity and culture. Recent research has identified key theoretically- and empirically-based cultural considerations for suicide prevention, but translation is needed to infuse these standards for culture-related competencies into SPTs. This study performed a systematic literature review with a thematic synthesis analytic approach to establish a set of curricular guidelines for infusion of cultural considerations into SPTs. The study also examined the extent to which existing community trainings already incorporate cultural components. Based on the thematic synthesis of 39 SPT studies from 2010 to 2020 and seminal reviews of the cultural and suicide literature, results identified three overarching categories of cultural curricular competencies (suicide knowledge and awareness, suicide intervention skills, and curriculum delivery) and 14 core cultural curricular subthemes for community trainings (e.g., culturally informed risk factors and warning signs, systemic inequities, etc.). These three categories with 14 core cultural curricular competencies comprise the Culturally Infused Curricular Framework (CICF) for Suicide Prevention Trainings. The majority of trainings (62%) included five or less out of 14 total possible core cultural competencies in their training curricula, pointing to insufficient integration of cultural components in existing community trainings. This study's research-based guideline establishes a culture-inclusive framework to strengthen content and approach of community trainings and suicide prevention across cultural groups.

A SWOT (strengths, weaknesses, opportunities, and threats) analysis is a strategic planning and management technique used for project planning. It is sometimes called situational assessment or situational analysis. We applied this tool (with some adaptations) effectively in a health promotion/public health education intervention project in the Paso del Norte region. This region is composed of a predominantly Hispanic population and is marked by a dynamic flow of residents across the border. In this milieu, COVID-19 has disproportionately impacted communities of color and individuals who are economically and socially marginalized. The University of Texas at El Paso (UTEP) has partnered with the National COVID-19 Resilience Network (NCRN) to mitigate the impact of COVID-19 among farm and food production workers (i.e., farmworkers, dairy, and meat packing workers) in El Paso, Doña Ana, and Moore counties. Intervention strategies include: (1) providing culturally and linguistically appropriate COVID-19 information, (2) disseminating protective equipment, and (3) ensuring access to COVID-19 vaccines. After completing year 1 of the project, we conducted a multiple-level SWOT analysis to evaluate, gather insights, and develop actionable strategies that would allow better service delivery to our priority population. We provide this case study to illustrate how a SWOT analysis can be a useful tool for practitioners engaged in the practice of evaluating health promotion and disease prevention programs. Even when attention and energy is absorbed in the immediate course of action, a SWOT analysis can help to achieve positive and effective collaborations resulting in strong service levels.

The menarche age in girls with intellectual disability and high support needs (HSN) is approximately the same as in girls with typical development. However, there is no clear teaching procedure for menstrual hygiene management (MHM) skills before menarche. This study examined whether a menstrual education program that focuses on visual support affects the MHM skills of girls with intellectual disability/HSN. The study comprised 11 preadolescent girls with intellectual disability/HSN in their pre-menarche age. They were asked to change napkins on a doll three times: before, immediately following, and one month after attending the program. Fifteen MHM items were measured. The participants' scores were significantly higher after attending the program. There was no significant difference in the mean scores for each of the 15 items among the levels of intellectual disability. The program that utilized visual materials was effective, and the effect was not influenced by age or intellectual level., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This article describes the use of play therapy in a school-based health clinic on an American Indian Reservation. The project used the play therapy model, a nursing intervention focused on using play materials in a therapeutic manner as a form of communication and self-expression for children, enhancing the development of social, emotional, and behavioral skills through the nursing process. The purpose of the Teddy Bear Clinic was to establish relationships among non-Native student nurses and Native American children and their community on a Northern Plains Indian Reservation. A discussion of the potential benefits addresses opportunities for school nurses and student nurses to enhance their understanding of children's perceptions of the health care clinic and the effects of historical trauma on the health and wellbeing of Native American children while offering an opportunity for young children to engage in the health care setting in a fun way, without fear or discomfort is provided.

The COVID-19 pandemic continues to disproportionately impact communities of color and expose health inequities. Minoritized communities experience disparities in chronic diseases, premature death, and cancer, and gaps continue to widen; systemic injustice in housing, nutrition, and environment are major contributors. At the height of the COVID-19 pandemic and racial justice movement, students at the University of Louisville School of Medicine created Grow502 to speak truth to the challenges of health disparities in Louisville, Kentucky. The goal was to pursue a healthier community by raising awareness. Community leaders and health professionals provided expert consultation. This partnership led to the co-creation of a curriculum focused on education, advocacy, community engagement, and creative media. Grow502 sought to support communities impacted by injustices due to racism, limited health literacy, redlining, and limited green space by creating programming centered on education and empowerment. Effective strategies to reduce disparities involve creating interventions with authentic engagement and context. Grow502 involves community stakeholders as active partners. We continue to intentionally seek effective collaborations and interventions that merge our mission and our diverse communities impacted by health disparities.

Background: Vaccine misinformation has been widely spread on social media, but attempts to combat it have not taken advantage of the attributes of social media platforms for health education., Methods: The objective was to test the efficacy of moderated social media discussions about COVID-19 vaccines in private Facebook groups. Unvaccinated U.S. adults were recruited using Amazon's Mechanical Turk and randomized. In the intervention group, moderators posted two informational posts per day for 4 weeks and engaged in relationship-building interactions with group members. In the control group, participants received a referral to Facebook's COVID-19 Information Center. Follow-up surveys with participants ( N = 478) were conducted 6 weeks post-enrollment., Results: At 6 weeks follow-up, no differences were found in vaccination rates. Intervention participants were more likely to show improvements in their COVID-19 vaccination intentions (vs. stay same or decline) compared with control ( p = .03). They also improved more in their intentions to encourage others to vaccinate for COVID-19. There were no differences in COVID-19 vaccine confidence or intentions between groups. General vaccine and responsibility to vaccinate were higher in the intervention compared with control. Most participants in the intervention group reported high levels of satisfaction. Participants engaged with content (e.g., commented, reacted) 11.8 times on average over the course of 4 weeks., Conclusions: Engaging with vaccine-hesitant individuals in private Facebook groups improved some COVID-19 vaccine-related beliefs and represents a promising strategy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: L.A. receives royalties for the sale of Text2Quit. DAB has received consulting fees from Merck & Co. for participating in the 2021 Merck Global Vaccine Confidence Expert Input Forum, and has received a speaking honorarium from the United Nations Shot@Life Foundation.

The Black Men's Health Forum, a 6-week online health education intervention for African American men and accountability partners of African American men, was conducted to increase awareness of health issues that disproportionately affect African American men. In this article, we describe the intervention and report on the immediate benefits of the intervention, including changes in health knowledge and perception of research participation. Participants completed a pre-evaluation prior to participating in the forum and a post-evaluation after each session to capture data on sociodemographic information, medical history, health knowledge, and health behaviors. A total of 60 participants (30 African American men and 30 accountability partners) completed the forum. African American men had a mean age of 61.1 years while accountability partners had a mean age of 57.6 years. Overall health knowledge increased by 6.9 points for African American men and 2.8 points for accountability partners. Before the forum began, nine African American men reported ever participating in a research study. The proportion of African American men who reported that they would definitely participate in research in the next 12 months after participating in the forum increased by 40%. Through culturally tailored programming, the Black Men's Health Forum increased access to health information as well as African American male medical professionals and health researchers for African American men in the community. Exposure to health information resulted in significant increases in health knowledge and willingness to participate in health research among African American men., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs)., Methods: Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance., Results: Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%., Conclusions: Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations., Competing Interests: Author Conflict of InterestThe authors declare that they have no potential, perceived, or real conflicts of interest.

Background: Black women are diagnosed, disabled, and die from obesity and associated chronic diseases at higher rates than any other sex or race. Advanced practice registered nurses (APRN) can potentially improve culturally relevant health education and counseling by using health literacy communication tools., Objective: Explore individualized barriers and APRNs' role in providing obesity prevention education and counseling by assessing the efficacy of the Teach-Back Method (TBM) to understand health habits and attitudes., Methods: Black women aged 18-45, previously diagnosed as overweight or obese, and identified with perceived barriers were recruited from a predominantly Black church in Atlanta. They engaged in weekly, 1-hour educational sessions via Zoom, addressing four common barriers identified in the literature. Sessions ended with a 5-10 minute Teach-Back session. Pre- and post-intervention Readiness to Change Questionnaire (RCQ) were completed. Descriptive statistics and quantitative data from surveys and pre- and post-RCQ were analyzed., Results: Twenty women completed the intervention. Paired sample t -test revealed no statistical significance or correlation between pre- and post-RCQ scores after using TBM in educational sessions. However, Pearson's correlation showed positive associations between elevated body mass index levels as one advances their education and annual income, with a p -value of 0.05., Discussion: Increased rates of obesity are experienced despite higher educational attainment or pay. Stress and high-coping mechanisms contributed to disordered eating, decreased physical activity engagement, and decreased motivation toward habit change. Clinicians should be held accountable for delivering culturally sensitive care using the TBM, addressing social determinants of health, performing routine stress assessments, and checking their implicit biases.

The Coalition of National Health Education Organizations (CNHEO) has existed since 1972, with a mission of bringing together national and international health education organizations who serve within the United States to seek joint actions in support of the health education profession. Much success and collaboration have occurred over the last 50 years, including developing and implementing the 2018-2025 strategic plan. The nine member organizations of the Coalition paused to review individual and collaborative work in addressing shared goals and objectives around policy and mandates, preparation and professional development, credentialing, identity and value of health education, health education workforce and diversity, and research and practice. Findings of this mid-progress strategic plan review suggest that great value is provided to the profession via the collaborative work of organizations (sharing of advocacy alerts and work, supporting training and certification efforts, etc.), but areas for improvement exist (more joint policy statements, better study and support for the profession, etc.). This article outlines important Coalition history for the profession, describes goal and objective accomplishments related to the CNHEO 2018-2025 strategic plan, and makes suggestions for future improvement designed to affect the health of the public and the health education profession.

Sexual health education in the United States continues to be a controversial topic of discussion with no federal regulations. Due to this, the sex education students receive before college varies greatly. Our team discovered that no mandatory, comprehensive sexual health education is required for students once they enter the California State University system. At Cal Poly specifically, it was found that students were engaging in risky sexual behaviors. For example, the 2021 American College Health Association-National College Health Assessment III Fall 2021 Data Report revealed that less than half (42.1%) of students reported regularly using condoms during vaginal sex, and a mere 5.1% of students reported barrier method use during oral sex. To fill in the noticed gaps in our students' sexual health education, our team developed a set of 10 comprehensive sexual health educational learning modules. The modules cover topics ranging from condom use and STIs to pleasure, porn literacy, and having difficult conversations with a partner. This anonymous online resource provides students with easy-to-read written material and engaging graphics. Future research will focus on user engagement and the effect of the resource on sexual health best practices across our campus.

Introduction: Differences in availability and choices of contraceptive methods among postpartum women have been found to influence their quality of life as the fertility rate is very high, and the contraceptive usage rate persistently remains low in Nigeria., Objectives: This study assessed the determinants of contraceptive options among postpartum women in Nigeria., Methods: Two Local Governments were randomly selected from the four Local Governments. Within these two local governments, five health facilities were selected. A multistage sampling technique was used to select the 240 respondents, while a structured questionnaire was used to collect data., Results: Findings from the study indicated that 81.7% of the respondents have planned to have their current baby, and about 65.4% of the women have resumed sexual activities since delivery. Of those who have resumed sexual activities, the majority, 91.1% did so 6 weeks after delivery. Some form of contraceptive usage was prominent among 59.2% of the respondents, as the most common contraceptive method used was withdrawal (24.8%). Contraceptive prevalence was slightly lower for urban respondents than rural respondents, although the relationship was not significant. Also, there was a statistically significant relationship between the current use of contraceptives and resumption of sexual activities since delivery ( p  = .001), resumption of menstruation ( p  = .001), and information received about postpartum family planning ( p  = 0.013)., Conclusion: Findings from this study emphasize the urgent need for enhanced accessibility and availability of contraceptive methods, with a parallel emphasis on targeted interventions and effective communication strategies to promote contraceptive uptake and family planning. Addressing these determinants is vital in improving postpartum women's overall quality of life in the study area., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The use of hormonal contraceptives is decreasing in the United States alongside a growing interest in nonhormonal contraceptive options. Social media messaging may be contributing to this trend. TikTok thus offers a novel opportunity to understand how people share information about risks and alternatives for pregnancy prevention. To describe the availability and content of information about hormonal contraceptive side effects and nonhormonal contraceptive options on TikTok, we conducted a content analysis of 100 videos using the hashtags #birthcontrolsideeffects and #nonhormonalcontraception. We found that these videos were popular and often framed hormonal contraceptives and patient-provider interactions negatively, with users frequently discussing discontinuation of hormonal contraception and no plans for uptake of another contraceptive. When uptake of a new contraceptive method is mentioned, creators typically mention a fertility awareness-based method, which requires specialized knowledge to use safely and effectively. The risks and side effects of hormonal options were often overemphasized compared with the possible risks and side effects of nonhormonal options. This framing may suggest opportunities for providers and health educators to reassess how they counsel about contraceptive options. We conclude with recommendations for future research on TikTok and consider the policy implications of these findings.

Firearm-related injuries are the leading cause of death among youth in the United States, and rates of firearm-related suicide in rural youth are more than double those in urban youth. Although safe firearm storage has been shown to reduce firearm injuries, little is known about how to culturally tailor such interventions for rural families in the United States. Informed by community-based participatory methods, focus groups and key informant interviews were conducted to design a safe storage prevention strategy for rural families. Participants included a broad array of community stakeholders ( n = 40; 60% male, 40% female; age 15-72, M = 36.9, SD = 18.9) who were asked to identify acceptable messengers, message content, and delivery mechanisms that were perceived as respectful to the strengths of rural culture. Independent coders analyzed qualitative data using an open coding technique. Emerging themes included (1) community norms, values, and beliefs about firearms; (2) reasons for ownership; (3) firearm safety; (4) storage practices; (5) barriers to safe storage; and (6) suggested intervention components. Firearms were described as a "way of life" and family tradition in rural areas. Owning firearms for hunting and protection influenced family storage decisions. Intervention strategies that use respected firearm experts as messengers, refer to locally derived data, and that reflect community pride in firearm safety and responsible ownership may improve the acceptability of prevention messages in rural areas.

Objective: To evaluate the efficacy of ADHD medication adherence interventions and explore the pathways to effectiveness., Methods: A systematic review was conducted using multiple databases to identify relevant randomized controlled trials (RCTs). Pooled effect sizes were calculated for medication adherence and ADHD symptom outcomes. Qualitative Comparative Analysis (QCA) was used to identify pathways to effectiveness., Results: Six RCTs were included. The interventions significantly improved medication adherence (OR = 2.39, 95% CI [1.19, 4.79]) and ADHD symptoms (Hedges' g  = -0.96, 95% CI [-1.38, -0.54]). Multi-regression analysis showed a positive relationship between medication adherence and ADHD symptom reduction. QCA revealed two paths for effectiveness: (1) Presence of ADHD drug education and absence of reminder and (2) Presence of tracking and absence of reminder., Conclusion: ADHD medication adherence interventions have a positive impact on both medication adherence and ADHD symptoms. Interventions should consider including ADHD drug education or tracking to maximize effectiveness., Competing Interests: Declaration of Competing InterestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background: Upper limb exercise has long been considered to be the main means to promote autogenous arteriovenous fistula (AVF) maturation, but in practice exercise intensity and compliance are both typically lacking. Several randomized controlled trials (RCTs) have demonstrated the good effects of functional resistance or pressure exercise in patients with AVF. However, many patients' have difficulty complying with upper limb exercise programs without systematic health education. Therefore, we argue that resistance and pressure exercise supported by health education is actually the most beneficial for AVF patients., Methods: We randomly divided 114 patients into a control group and an experimental group of 57 patients each. In the control group, conventional care was used, and in the experimental group, online health education based on the IMB (Information-Motivation-Behavior skills) model and functional resistance and pressure upper limb exercises was implemented with the AVF side arm. The failure rate of AVF maturation, clinical maturation time, cephalic venous blood flow, vessel diameter, and vessel skin thickness were compared between the two groups., Results: Fifty-five cases were included for each in the final study. The primary outcome of this study was the failure rate of AVF maturation. Secondary outcomes included clinical maturation time, cephalic vein flow, vessel diameter, and vessel thickness. The failure rate of AVF maturation in the experimental group was significantly lower than that in the control group, and the clinical maturation time in the experimental group was significantly shorter than that in the control group. For the remaining three indicators, there were between-group effects, time effects, and interaction effects in both groups. Comparison between groups showed that there was no statistical difference in the observed indicators of cephalic vein flow, vessel diameter, or vessel thickness between the two groups before the intervention but that there was a statistical difference at the end of the 4th, 8th, and 12th weeks of the intervention. A 2 × 2 comparison also showed that there was a statistical difference between the three indicators at each time point within the two groups., Conclusion: IMB model-based online health education combined with functional resistance and pressure exercises can improve AVF maturation status and accelerate AVF maturation within 12 weeks of surgery., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.