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The workplace has been highlighted as a potential setting to deliver health promotion programs to target modifiable health behaviors that contribute to chronic disease. This review evaluated the effectiveness of interventions implemented within the workplace that targeted either smoking, nutrition, alcohol, physical activity, and/or overweight and obesity in men. A review protocol was prospectively registered through PROSPERO (CRD42021293398). Five electronic bibliographic databases were searched for randomized controlled trials conducted in the workplace assessing chronic disease risk factors in men from January 2010 to August 2021. Eleven studies were included, reporting on overweight and obesity n = 8, physical activity n = 7, nutrition n = 4, alcohol n = 3, smoking n = 3, with eight studies assessing multiple outcomes. Results were mixed. Narrative synthesis highlighted studies reporting improvements to snacking frequency, sugar sweetened beverage consumption, and physical activity (METs and Vo2 max). Meta-analysis highlighted pooled mean decrease in body weight of -0.28 kg up to 3 months; -1.38 kg for >3 months, and pooled mean decrease in body mass index 0.06 kg/m2 up to 3 months; -0.27 kg/m2 for >3 months. Despite the encouraging direction of the relationship, results were not statistically significant (p > 0.05). Findings underscore the potential of workplace health promotion programs targeting certain chronic disease risk factors in men; however, future research should consider long-term study designs to assess the efficacy of workplace health programs as a solution to the growing burden of global disease.

Introduction: Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts. Methods: The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria. Results: Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised. Discussion: CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.

This study described integrative community therapy (ICT) in the online modality as a health promotion resource in the context of COVID-19 in Latin America, characterizing the ICT circles, the ICT training centers, and the community therapists involved in this practice. It is a descriptive, observational, and cross-sectional study with a quantitative approach. Data were collected from November 2020 to July 2021 through an online questionnaire created on the Google Forms platform. The study's first stage involved the participation of ICT training centers, while the second involved community therapists. Forty-three centers participated in the first stage; 86.1% offered online ICT in the period evaluated, and 74.4% trained professionals to implement this modality. In the second stage, 66 community therapists responded to the questionnaire. Of these, 49 (74.2%) resided in Brazil, 84.8% were female, and 72.7% performed the work voluntarily, with an average of 6.1 hours per week dedicated to online circles. Community-based circles were the most cited, followed by those linked to the public sector, with an average of 20.7 participants/circle in the period. The most frequent themes were stress and negative emotions, problems with work/unemployment, and family conflicts. Strengthening self-care, participation in ICT circles, and personal empowerment stood out among the coping strategies. In conclusion, online ICT proved to be an innovative resource for health promotion during the pandemic through the articulation and engagement of community therapists and different institutions, expanding solidary social networks, and showing itself as a sustainable practice in the Latin American scenario.

Background: This study examined student and caregiver preference for school communication and explored the feasibility and acceptability of a digital tool to assist with communication about school meal program between schools and families. Methods: The study used qualitative methodology through youth focus groups and caregiver semi-structured phone interviews. The study was conducted in 4 high schools in a large, urban city. The phenomenon of interest included the exploration of preferences regarding communication around school meal programs and feasibility and acceptability of a digital tool for communication and promoting the ordering of healthful foods in the school environment. Interviews were transcribed, coded, and analyzed through NVivo qualitative software using thematic analysis approach to examine themes. Results: Forty-seven students (ages 14-21, grades 9-12) participated in 7 focus groups and 24 caregivers participated in semi-structured phone interviews. Three themes emerged around (1) communication preferences, (2) accessibility, and (3) extrinsic motivational factors for engagement in healthy eating behaviors. Conclusion: Results indicated that communication methods could potentially influence motivation and engagement in youth school meal participation.

Background: Since 2002, the Chinese Ministry of Education has conducted reform in the physical education (PE) curriculums of schools in China, with a focus on shifting from sports skills to regular participation in physical activity (PA) and promoting health. The aim of the study, therefore, is to examine the effects of school PE on the exercise habits of children and adolescents in China over time. Methods: Data based on 5941 observations of 3708 individuals aged 6 to 17 were collected from the China Health and Nutrition Survey (CHNS) for the period 2004 to 2015. The data were analyzed using the fixed-effect Logit model and the random-effect Tobit model. Results: The likelihood of exercising outside of school is 20.2% higher for students who have school PE than those who do not. Our study found that increasing the duration of PE at school by 100%, increases the duration of out-of-school PA by 22.3%. The variety of the types of sports schools offer encourages students to participate in out-of-school physical activity. The likelihood of students exercising outside of school increases by 5.6% when 1 more exercise type is provided in school PE. In addition, soccer, basketball, badminton, and volleyball education increases students' participation in after-school exercises. Soccer and basketball education, in particular, improves the duration of after-school PA. Conclusions: To form exercise habits in children and adolescents, we encourage the promotion of a variety of physical activities in schools, especially team sports such as soccer and basketball.

Background: For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. Methods: This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. Discussion: This study will provide a rigorous test of BASIS-T--a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms--to increase the yield of standard EBPP training and support strategies.

Purpose: We studied innovation processes in agriculture and nutrition to discuss a scaling approach that encompasses the technical, institutional, and behavioral dimensions of change. Approach: To understand dynamics across these dimensions, we analyzed farmers' innovation processes through two analytical lenses: farmer-centered and structural. Focus group discussions in Kapchorwa, Uganda, and Teso South, Kenya, looked at farmers' choices of innovations. Individual interviews and stakeholder workshops at both study sites increased understanding of the local innovation system. Findings: To address local challenges, strive for livelihood aspirations, and fulfill personal taste preferences, farmers selected and adapted practices promoted by a research project. A wide range of additional support providers encouraged farmers to develop innovations in agriculture, marketing, and nutrition. Practical implications: By promoting innovation as a process rather than an outcome, it is possible to address context-specific needs and enhance farmers' adaptive capacities. Scaling these processes necessitates the involvement of innovation support service providers in order to create an enabling environment for experimentation. Theoretical implications: Analytical dualism highlights the different roles of human agency and structures in innovation processes needed to design successful scaling strategies. Originality/value: This paper sets out a novel approach to understanding the increasingly discussed dimensions of scaling by linking them with concepts from innovation studies.

Objective: To evaluate the effects of a nutrition education programme conducted during health education lessons on students' adherence to the Mediterranean Diet (MD) and their body mass index (BMI). Design: Quasi-experimental pre-test/post-test research design: two study conditions (intervention and control groups). Setting: Two urban schools, the 11th and 21st primary schools in Limassol, Cyprus. Method: Two hundred and thirty-five fifth- and sixth-grade students participated in the programme. One hundred and fifteen were in the intervention group school (the 11th primary school), and 120 were in the control group school (the 21st primary school). Students in the intervention school participated in nine 80-minute lessons during the health education class. The curriculum focused on the MD and included cooking activities, food tasting and parental involvement. The primary outcomes were subsequent adherence to the MD, nutritional knowledge, self-efficacy physical activity and BMI. Results: Following the implementation of the intervention, the intervention group showed a significant increase in nutritional knowledge, self-efficacy and adherence to the MD (p < 0.001). The intervention group also had significantly higher nutritional knowledge and MD Quality Index scores than the control group (p < 0.001). However, no effect was observed on children's BMI (p > 0.05). Conclusion: The intervention successfully improved children's dietary habits in the intervention group by increasing adherence to the MD, but it did not affect their BMI. The results show some promise for addressing poor nutrition through education.

Objective: Successful university wellness programs approach wellness holistically and regularly assess for improvements to program offerings. This case-study reports five lessons learned from a university wellness program evaluation that must be considered when developing wellness programming. Participants: Faculty, staff, and students at a public university health sciences center. Methods: A 23-question electronic survey with open-ended questions was administered to measure feedback on current and future wellness programming. Responses were analyzed with an open coding approach into five themes for program improvement to more holistically address wellness. Results: The five improvements to wellness programming identified by respondents were: wellness offering awareness, workplace culture and environment, racial representation, wellness programming policy enforcement, and creating an environmentally friendly campus. Conclusions: Themes identified in this case-study require additional attention by university wellness programs to ensure they are equitably accessible and comprehensive in their offerings.

Objective: This one-year pilot study investigated the effectiveness of a multimedia campaign, Heart Healthy U (HHU), to increase awareness about the link between unhealthy behaviors and risk for heart disease among emerging adults on a college campus. This paper describes the implementation of HHU. Participants: The HHU campaign was implemented from the Fall of 2019 through Spring 2020 and during this time there were approximately 15,043 enrolled students at the south eastern U.S. college campus. Methods: The HHU campaign employed print (e.g., banners, posters, and yard signs) and electronic formats (e.g., email, Instagram). We designed the methods across three phases: (1) relationship building and formative research, (2) campaign development, and (3) the Heart Healthy U campaign launch. Results: The HHU encountered challenges when the novel coronavirus (COVID-19 or SARS-co-V2) interrupted campus life, however we relied on the electronic formats to reach students during the state-wide lockdown/quarantine mandates. In addition, there were two changes to the HHU health messages. First, we updated the health messages to illustrate that eating healthy and engaging in physical activity supports immune function. Next, we developed new health messages to address effects of physical isolation and anxiety by promoting psychological well-being during this historic public health crisis. Conclusions: We asked whether a multimedia campaign on a college campus could encourage emerging adults to consume fruits and vegetables and engage in physical activity according to the federally-recommended guidelines. It is essential that interventions intended to reach today's emerging adults be presented in formats that they use (e.g., social media platforms), supported by campus administrators, and endorsed by peer influencers. In conclusion, more intervention studies are needed to counter the unhealthy social norm behaviors common to college campus life that increase heart disease risk, particularly among marginalized populations.

Prior research about pupil welfare teams have identified problems at several levels: those of leadership, interprofessional cooperation, cooperation between the pupil welfare team and teachers, and type of work carried out. Perhaps most importantly, teams seem to work primarily with 'firefighting', i.e. acting reactively when problems already have occurred, rather than in a health promoting and preventive way. On the one hand, health promotion and prevention are endorsed as desired ways to work (e.g. SFS 2010, 800); on the other hand, reactive measures seem to dominate in practice. In order to try to bridge this gap, we carried out a study of a pupil welfare team in Sweden that we had reason to believe worked more in line with the health-promoting and preventive manner of working that is recommended. Since we could not know a priori whether the team studied worked in a qualitatively different way than other teams studied in prior research, we were led by two overarching research questions: (1) Is the studied team working in a heath promoting and preventive way? and (2) If so, how did their way of working emerge and how is it sustained? Our overriding purpose is to increase our knowledge concerning whether and how pupil welfare teams can become more health promoting and preventive in practice. More specifically, we are interested to find factors that contribute to the development and sustainability of health promoting and preventive work in pupil welfare teams.

Background: Despite recent declines, youth nicotine vaping remains seen by experts as a national public health epidemic. Few, if any, researchers have examined how related high-profile and school-based prevention programs such as LifeSkills Training (LST) are further disseminated with cooperation from research-to-practice entities as well as the tobacco industry. Purpose: Provides a systems-driven documentary analysis of efforts pertaining to prevention entities at the University of Colorado, Boulder, as well as LST, and the tobacco industry. Methods: Employs focused synthesis data collection with constant comparative analyses. Results: Likely previously unseen and related to LST, is the degree to which prevention entities with a public mission appear to cooperate among themselves and with the tobacco industry as part of a longstanding, if not elaborate, school-based drug prevention social system characterized by patterned evidence of opaque or furtive representations and/or activities. Discussion: Along with limitations, summarizes a research-to-practice social system likely compromising school-based prevention and, in turn, the health of the young people they serve. Theorizes a symbolic politics explanatory mechanism while providing recommendations toward transparency for more informed school-based prevention decision-making. Translation to Health Education Practice: Emphasizes the National Commission for Health Education Credentialing Inc. (NCHEC) critical thinking and program evaluation competencies.

Public health campaigns have the potential to correct vaping misperceptions. However, campaigns highlighting vaping harms to youth may increase misperceptions that vaping is equally/more harmful than smoking. Vaping campaigns have been implemented in the United States and Canada since 2018 and in England since 2017 but with differing focus: youth vaping prevention (United States/Canada) and smoking cessation (England). We therefore examined country differences and trends in noticing vaping campaigns among youth and, using 2022 data only, perceived valence of campaigns and associations with harm perceptions. Seven repeated cross-sectional surveys of 16-19 year-olds in United States, Canada and England (2018-2022, n = 92 339). Over half of youth reported noticing vaping campaigns, and noticing increased from August 2018 to February 2020 (United States: 55.2% to 74.6%, AOR = 1.21, 95% CI = 1.18-1.24; Canada: 52.6% to 64.5%, AOR = 1.13, 1.11-1.16; England: 48.0% to 53.0%, AOR = 1.05, 1.02-1.08) before decreasing (Canada) or plateauing (England/United States) to August 2022. Increases were most pronounced in the United States, then Canada. Noticing was most common on websites/social media, school and television/radio. In 2022 only, most campaigns were perceived to negatively portray vaping and this was associated with accurately perceiving vaping as less harmful than smoking among youth who exclusively vaped (AOR = 1.46, 1.09-1.97). Consistent with implementation of youth vaping prevention campaigns in the United States and Canada, most youth reported noticing vaping campaigns/messages, and most were perceived to negatively portray vaping.

Health literacy (HL) in children is essential for healthy decision-making from early on. At six Austrian elementary schools, all children (aged 6-11 years) received 3 years of health education (HE). The participating schools were equipped with teaching materials to convey lessons in a child-oriented way. The teachers were professionally accompanied during the implementation process and received specific training. HL and its subprocesses (obtain, understand, comprehend and apply) in children >8 years were measured with a standardized test (QUIGK-K) after 1, 2 and 3 years of education and compared with values from two comparison schools without such lessons. t-Tests showed a significant increase in HL at the end of the second year of HE. After this period, the children showed above-average values on all subprocesses of HL and performed better than children without HE. The third year did not lead to a further increase. Hence, child-oriented HE is suitable to promote HL in elementary school students within 2 years. It is therefore recommended to start HE as early as possible in order to lay the foundation for a long and healthy life.

Purpose: Whole-of-school approaches to physical activity (PA) promotion are recommended internationally, but there remains little descriptive research detailing the implementation of such approaches, especially at the secondary level. The purpose of this case study, which drew upon a social-ecological perspective, was to examine a whole-of-school approach used by one secondary school in England. Method: Participants (N = 30) included three members of the school's senior leadership team, eight teachers, 15 students, and four parents. Data were collected during 5 months using open-ended questionnaires that all participants completed, 14 staff interviews with staff, three focus groups with students, six observations, and attendance records from various PA opportunities. Results: Thematic analysis identified five key PA opportunities and uncovered four themes in relation to these opportunities--Student Autonomy, Support from Leadership, New School, and Physical Education Time. Discussion/Conclusion: This study highlights the importance of targeting multiple levels of influence when implementing whole-of-school PA programming.

Objectives: This case study examined multi-level social-ecological supports in promoting well-being through college students impacted by one of the deadliest wildfires in U.S. history. Participants: College students attending a large public university were surveyed (N = 354, M[subscript age] = 22.7, 76.2% female, 61% white).Methods: Measures included demographics, individual factors (mindfulness, sleep problems), social support (emotional support, family support, and friendship), and sense of community. Multiple linear regression models on well-being were constructed. Results: Findings indicated that mindfulness, sleep disturbances, emotional support, family support, number of close friends, and sense of community were significant predictors of well-being. Conclusion: Findings highlight the importance of universities in proactively bolstering critical social-ecological needs of college students living in communities vulnerable to climate-change accelerated environmental disasters.

Diverse approaches to the treatment of depressive disorders are necessary to improve evidence-based practice and maximize treatment outcomes. As a result, a range of behaviors and other factors associated with the onset and course of depressive disorders should be examined more comprehensively. Behavioral activation (BA) is a treatment approach to these disorders that can be tailored to address certain health behaviors within the context of depression in an attempt to promote health behaviors whose adoption and maintenance can prove complementary in the treatment of depression. We conducted a scoping review of published studies in which BA-based interventions were used to promote certain health behaviors in individuals with depression. Our search of Medline and the Web of Science identified 336 potential candidate studies. Following screening and with the application of inclusion and exclusion criteria to isolate potentially eligible full-text records, we ultimately identified and evaluated 20 papers that report the nature and efficacy of these modified interventions. Across various domains, including substance use, exercise, medication adherence, and occupational and social success, we found evidence that many--but not all--of the studies we reviewed demonstrated that BA-based interventions were efficacious in promoting the health behavior of interest as well as reducing depressive symptomatology in participants. Implications for more widespread dissemination of such interventions, especially via mobile and web-based platforms due to their accessibility and affordability, are discussed. More research on the feasibility and efficacy of BA-based interventions tailored toward various determinants of health behavior and comorbidities of depressive disorders is warranted.

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.

Background: The National School Lunch and School Breakfast programs reduce food insecurity and improve dietary intake. During the COVID-19 pandemic, school meals were provided to all children at no cost, regardless of income. This policy is known as Healthy School Meals For All (HSMFA). The purpose of the study was to examine the feasibility of a HSMFA policy in Utah. Methods: A mixed-methods approach was used, including qualitative interviews for policymakers, surveys for school foodservice directors, and financial modeling of Utah Child Nutrition Programs data. Analysis included a phenomenological analytic approach for qualitative data, descriptive statistics for surveys, and development of a cost model with 6 scenarios. Results: Qualitative data revealed themes of (1) awareness; (2) responsibility; (3) perspectives on school meals; and (4) new opportunities. Most (81%) foodservice directors believed HSMFA should continue post-pandemic. HSMFA would cost $51,341,436 to $82,358,375 per year. Implications for School Health Policy, Practice, and Equity: HSMFA would result in the equitable treatment of all children regarding access to healthy school meals. Conclusions: Given the support of foodservice directors but the lack of political consensus, considering stepwise implementation and providing cost estimates may increase feasibility of a HSMFA policy in Utah.

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = 0.21-0.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |0.16-0.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.

Objective: This study evaluated a media literacy education program designed for sexual health promotion, "Media Aware," in southeastern universities. Participants: Participants included college students from four universities in the southeastern United States (n = 457). Methods: "Media Aware" was implemented on college campuses either in a group setting, one-on-one setting, at a student event, or online only. "Media Aware" contains four sections on sexual health promotion including on how media messages influence sexual health, gender stereotypes and representations of romantic relationships, sexual violence, substance use, consent, sexual risk behaviors, contraception, STIs, and partner communication. Results: Results indicated significant changes in intention to visit a healthcare provider for sexual health services, intention to use condoms and other forms of birth control, and awareness of Long Acting Reversible Contraceptives after participation in "Media Aware." Conclusion: Future research should explore how to extend program impacts and use an experimental study design to assess between group differences.

Children and youth in contemporary western society spend less time outdoors compared to previous generations. Increased use of technology, lack of green space, and concerns for risk and safety have contributed to a generation of children spending too much time indoors. A disconnection between children and nature has occurred. Our team conducted a research synthesis review of several empirically defined non-traditional literacies (physical literacy, media literacy, health literacy, nutrition literacy, and ecological literacy) to identify common components used to conceptualize, define, and describe a new nature-based literacy. Findings included four common components: (a) Motivation, (b) Knowledge, (c) Competence, and (d) Confidence. Operationalizing nature-based literacy into a set of capability domains are described as a practical way of re-engaging children and youth with the natural world. Recommendations for future research and practice are shared.

The purpose of this study was to examine the association between perceived weight change since high school and perceived factors contributing to weight change, or lack thereof, among college students. Students from a large university in the Northeast of the United States self-reported socio-demographic characteristics, and perceived factors contributing weight change (or lack thereof) via an online survey; and, completed an objective health assessment that included the anthropometric measurements. Of all participants (n = 183), most were men (61.2%), juniors/seniors (89.5%), non-Hispanic white (65.9%). Most participants reported gaining weight since high school (n = 113, 62.1%), and these participants had significantly greater abdominal girth, weight, and body fat percentage than those who maintained their weight (p < 0.005). Perceived factors contributing to weight change explained a significant portion of the variance in perceived weight change, and perceived factors contributing to weight change differed significantly between those who perceived that they had lost or gained weight. In summary, perceived weight gain despite awareness of contributing health behaviors among some students reinforces that supporting/facilitating actual health behavior changes, rather than mere awareness of healthy behaviors, should be the focus of health promotion efforts.

Background: Despite the establishment of the Healthy, Hunger-Free Kids Act (HHFKA) in 2010, child nutrition programs continue to experience challenges impacting participation. Prior qualitative studies have explored how to reduce barriers to implementation of these programs in schools, but few studies have examined attitudes held by students, who are the ultimate stakeholders in school lunch programs and their success. Purpose: The present study explored children's attitudes about food at school and suggestions for improving the school lunch program. Methods: This qualitative study was conducted during the 2018-2019 school year in five middle schools. Students (N = 21) participating in a larger study were invited to take part in focus groups at school. Results: Qualitative analyses revealed that children were knowledgeable about healthy eating but had strong opinions about disliking some foods served at school. Children had thoughtful ideas about improving school food and recommendations to encourage healthy eating among students. Discussion: Insights from this qualitative investigation highlight the importance of considering the child's perspective when implementing food nutrition programs. Translation to Health Education Practice Health: promotion efforts to improve the school nutrition environment include engaging families in school nutrition policy decisions and improved training and resources for food service staff.

Background: Traditional workplace interventions have targeted sedentary behavior using standing desk-based interventions delivered in the physical workplace. However, little is known about standing desk interventions designed for employees in flexible positions working at home and in the workplace. Purpose: The purpose of this study was to determine factors associated with the motivation to participate in and perceived benefits of a mobile standing desk intervention. Methods: After participating in an 8-week intervention using a mobile standing desk, employees (n = 20) completed one focus group session. Focus groups were audio recorded, transcribed verbatim, and analyzed using thematic analysis in NVivo. Results: Themes associated with motivation to participate included: 1) trialability; 2) previous experience; 3) health concerns; and 4) difficulty accessing a standing desk. Themes about perceived benefits of the intervention included: 1) awareness of workday behavior; 2) productivity; and 3) usefulness in the home setting. Discussion: Employees perceived work-related and health-related benefits from the mobile standing desk intervention. Motivating factors to use a mobile standing desk should be considered when recruiting employees for workplace interventions and programs. Translation to Health Education Practice: Findings from this study may help health education specialists design standing desk-based interventions for employees with remote and flexible work schedules. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars http://portal.shapeamerica.org/trn-Webinars

Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to: (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12-14 years. Feedback from teachers and students supported the proposed program's feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings.

Children should engage in at least 60 min of physical activity daily to develop or maintain healthy habits (Centers for Disease Control and Prevention, 2021a). Previous research suggests that contingent attention is a powerful tool for increasing moderate to vigorous physical activity. In this study, the researchers examined the effects of a group game on steps per minute at recess in an inclusive classroom with preschoolers. The researcher taught the game called the T-Rex game in which the game rules (chasing students who were moving) involved contingencies for natural attention to follow moderate to vigorous physical activity. The results showed a functional relation between step count and the group game in which students engaged in higher step counts when the group game was in place than during baseline. These findings extend other work by demonstrating that contingent attention embedded in group games can increase step count.

Health education can elevate health literacy, which is associated with health knowledge, health-seeking behaviors and overall improved health outcomes. Refugees are particularly vulnerable to the effects of low health knowledge and literacy, which can exacerbate already poor health stemming from their displacement experience. Traditional learning methods including classroom-based instruction are typically how health-related information is presented to refugees. Through a series of interactive classes focused on specific health topics relevant to the resettled refugee population, this study evaluated the effectiveness of a classroom-based health education model in enhancing the health knowledge of recently resettled refugees. We used the Wilcoxon signed-rank test to evaluate differences in pre- and post-class knowledge through test performance. We found a significant improvement in health knowledge in two refugee groups: females and those who were employed. Culturally and socially sensitive considerations including language inclusiveness, class timing, transportation and childcare provisions are important when creating an educational program for individuals with refugee backgrounds. Developing focused approaches to instruction that enhance health knowledge could lead to better health literacy and ultimately improve health-related behaviors and outcomes in the refugee population.

People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n = 10), text-based materials (n = 5), films (n = 8) and radio (n = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds.

Farm to school education connects learning to the real world by helping students foster a deeper appreciation for local agriculture and healthy eating habits. Students experience and understand how nature supports life and the food they eat. Farm to school can take many forms, from classroom lessons to field trips in the school garden. Many programs include meeting farmers and farm workers to learn about the hard work that goes into growing food and about the ecosystems that support healthy crops. Educators can incorporate local food into the curriculum as a hands-on and engaging approach to teaching essential concepts about food, health, agriculture, and nutrition. When educators bring cultural relevance to farm to school education, they can create meaningful and engaging learning experiences for all students. And when this happens, students' health, attendance, participation, and academic success can all improve. The "Eating Learning Growing" guide and its framework, activities, and reflections are designed to help educators easily enrich existing lessons to include diverse topics, histories, learning styles, and customs.

Physical activity promotion is a best buy for public health because it has the potential to help individuals feel better, sleep better, and perform daily tasks more easily, in addition to providing disease prevention benefits. There is strong evidence that individual-level theory-based behavioral interventions are effective for increasing physical activity levels in adult populations but causal inference from these interventions often is unclearly articulated. A directed acyclic graph (DAG) can be, but rarely is, used to determine if the causal effect of an individual-level theory-based physical activity-promoting intervention is identifiable (e.g. stripped of any spurious association). The primary objective of the current study was to demonstrate how a DAG can be used to determine if the total causal effect of an individual randomized physical activity-promoting intervention is identifiable. The demonstration was based on the Well-Being and Physical Activity study (ClinicalTrials.gov, identifier: NCT03194854). Annotated files from DAGitty and Mplus are provided.

Purpose: Child-to-Child (C-to-C) approach is an evidence-based approach that ensures the child's participation in bringing about positive changes in healthcare. By systematically investigating the literature, the study aimed to evaluate the effectiveness of the approach and recognize associated themes, methodologies and outcomes. Design/methodology/approach: An extensive search on PubMed, ProQuest, Cochrane and Dimensions AI databases was performed for original research articles on C-to-C intervention, with no time and geographical restrictions. Following PRISMA and PICO, the Joanna Briggs Institute (JBI) critical appraisal tool assessed the studies. A data tabulation technique was used to summarize these studies. Findings: The approach shows promising results in enhancing children's understanding of health issues and their participation in community health promotion. This, in turn, encourages the adoption of better healthcare practices and shows improved health outcomes. Research limitations/implications: Further research is required to understand the long-term impact of the approach on populations from diverse socioeconomic statuses in different study settings. Practical implications: The findings will be helpful for practitioners, educators, policymakers and other stakeholders in creating more successful and effective C-to-C intervention programs to make informed decisions, achieve sustainable behavior change and improve health. Originality/value: The originality of this review paper is evident in its unique focus on the C-to-C approach, which empowers children not only as recipients of health education but also as active contributors to promoting health. Further, the present research also explores the intricacies of how children learn from each other, offering new insights into effective educational practices.

New approaches are needed when working in rural communities to identify and communicate holistic evaluation impacts related to community-based health promotion efforts of Cooperative Extension. Specifically, there is a lack of recorded long-term programmatic impacts of these programs, including behavior changes related to consuming nutritious and healthy food. The current study explored rural community members' experiences with cognitive dissonance in relation to decreased adult obesity and the adoption of healthier food consumption practices related to an extension health promotion program, as cognitive dissonance can help explain several motivational components of potential behavior change. Through a qualitative research design using a thematic analysis of focus group data, the authors observed an overall positive association between community members' experiences with cognitive dissonance, resulting in the acceptance of healthier food choices over inherited unhealthy practices, increased knowledge and awareness about nutrient-dense food, and increased physical activity. The cognitive dissonance framework revealed positive indicators of long-term programmatic impact related to food choice and consumption patterns. However, the analysis also indicated that while interventions improved access to resources, socio-economic barriers still existed that would ensure sustainability and depth of positive changes leading to long-term behavioral change in rural communities.

Although sexual and reproductive health is critically important for women with intellectual and developmental disabilities (IDD), there is limited research elucidating the role of family caregivers in assisting women with IDD access sexual and reproductive health services and information. Understanding the family caregivers' attitudes and perspectives is essential to improving access to sexual and reproductive health services and information for women with IDD. A cross-sectional online survey of family caregivers of women with IDD was administered between June and October 2018. Quantitative analysis was conducted for closed-ended responses, and qualitative analysis was conducted for open-ended responses. The analytic sample included 132 family caregivers. Most participants were parents and reported being closely involved in their family member's access to sexual and reproductive health services and information. Although most participants expressed that sexual and reproductive health services and information are essential for women with IDD, qualitative analysis of participants' open-ended responses revealed both supportive and restrictive attitudes and perspectives on sexual and reproductive health services and information for women with IDD. Supportive attitudes and perspectives included (1) "knowledge is power;" (2) supported decision-making; and (3) protection against sexual abuse. Restrictive attitudes and perspectives included (1) dependent on the individual; (2) lack of autonomy; and (3) placing responsibility on disability. Greater attention from policymakers and practitioners to systems-level changes, including universal and accessible sexual education for women with IDD, supported decision-making, and sexual abuse prevention measures, are urgently needed.

This original teaching idea for a semester-long course encompasses a team-based project in which students worked together to create persuasive campaign materials for a local community health organization. The purpose of this project was for students to apply learned concepts related to theories and principles of persuasion to a real-world situation. As a team, students engaged in working sessions to develop persuasive messages related to a health issue and create campaign materials that could be used by the organization to reach target audiences. Students produced a comprehensive final report and presentation documenting the development process and showcasing their work. Overall, while there are opportunities to shrink, expand, and otherwise customize this type of project, it produced an exciting and engaging experience for students. They reported development of their small-group communication skills, greater confidence in their unique leadership capabilities, and a greater understanding of how to connect communication theory to professional experiences. Courses: Persuasion or related graduate or upper-level undergraduate courses focusing on message design, social influence, or public communication campaigns. Objectives: This semester-long, team-based project, designed for a seminar on persuasion, required a graduate class to partner with a local community health center to: identify a specific, relevant community health concern; develop theoretically grounded, evidence-based persuasive campaign materials suitable for the organization to use on social media platforms and/or in print format; and deliver a comprehensive project report and presentation of the materials to the community organization at the end of the semester.

Aim: This study aims to evaluate the impact of a novel multicomponent nutrition education program (United for Healthier Kids; U4HK) on the diet consumed during school lunch among preschool children. Methods: The program comprised four tools: hero plates, hero content, hero menus, and hero books and stickers. The program was implemented for 16 weeks. Food consumption and the quality of the menus were examined pre- and post-intervention. Results: The lunch nutrient profiling scores for fat and vitamin C improved from moderate (9.95) to good (10.87) and moderate (9.50) to very good (13.83), respectively. Vegetable and fruit consumption also increased significantly by 127.2% (6.0 (3.2, 12.9) grams to 13.7 (6.7, 18.9) grams, p<0.001) and 44.8% (8.1 (3.9, 12.4) grams to 11.7 (5.4, 21.8) grams, p<0.001), respectively. Compared to those in the Thai school lunch guidelines, the percentages of vegetable and fruit consumed increased by 16.0% (12.1% (6.4, 25.9) to 28.1% (13.4, 43.4)) and 8.8% (14.0% (6.8, 28.3) to 22.8% (8.5, 33.4)), respectively. Energy, carbohydrate, and fat intake increased significantly by 13.2% (179.1 (137.9, 220.8) to 202.7 (163.0, 243.2) kcal), 18.9% (18.1 (14.3, 21.7) to 21.6 (17.2, 25.6) grams), and 23.2% (6.7 (4.9, 9.9) to 8.2 (6.7, 10.2) grams), respectively. Conclusions: The U4HK program adopted all aspects that foster healthy eating, including a healthy environment, an attractive role model and increased repeatability of the exposure to healthy foods.

Public health education is a powerful tool for improving communicable disease awareness and prevention protocols. Despite the fact that health education is crucial for the advancement of COVID-19 awareness and vaccination decisions, how a teacher approaches students to learn about health education during COVID-19 vaccination is a challenging issue. This study aimed to assess the preferences for public health education during COVID-19 vaccination intervention and compare the predictors of preferences between science and non-science university students in Bangladesh. A multi-item questionnaire was developed and an online link was conveniently sent to the encounters between 31st May, 2023 and 15th August, 2023. Binary logistic regression analysis was applied to rationalize the research objective. The pooled preference for public health education was 71.3% (95% Confidence Interval [CI] 67.7-74.3) vs. 81.5% (95% CI 79.3-84.7) between science and non-science students. Out of twelve predictors "vaccine agreement", "bio-safety behavior", and "disease awareness" were significantly associated (p < 0.01, p < 0.05) with the preference for public health education in both groups. Varied effects were also observed for some predictors: vaccine "safety" and "side effects" were significant (p < 0.05, p < 0.01) in science and non-science students, respectively. To address the conflict in decisions, non-science students significantly preferred "prevention alliance" whereas science students preferred "environmental health" issues (p < 0.05).Public health education was more preferred by non-science university students than by science students in making COVID-19 vaccine decisions. The focus of transformative public health education should be interdisciplinary, including information on communicable diseases, public health measures, and prevention alliances, as well as information about vaccines' side effects and safety.

Adults with autism spectrum disorder and intellectual disability often do not engage in healthy levels of physical activity despite its many benefits. We conducted a randomized control trial to evaluate the effectiveness and feasibility of the Step It Up program, which used supported self-management strategies, on daily step counts, health measures, and perceived quality of life for adults with autism spectrum disorder and intellectual disability. Forty participants, ages 18 to 57, were randomly assigned to a control or intervention group. Males accounted for 70.6% of participant gender. Both groups received Fitbits and Fitbit training, and they participated in pre- and post-assessments. The intervention group participated in the Step It Up program. Participants in the intervention group had significantly higher step counts and lost more weight. Feasibility and acceptability were also high. This study provides valuable data on using a supported self-managed exercise program as well as insight into its feasibility in home settings.

The Youth Enjoy Science -Teach To Beat Cancer program funded by the National Cancer Institute utilizes the resources of the Case Western Reserve University School of Medicine and Case Comprehensive Cancer Center to provide experiences and training for grade 6-12 teachers so that they are expertly equipped to develop curricular approaches to take back to their classrooms to enhance science education, introduce concepts of cancer biology, encourage cancer risk reduction activities, foster disparity elimination and to motivate middle and high school students to pursue careers in biomedical sciences and cancer research. The program focuses on four aspects of teacher engagement and education: (1) Research Engagement, (2) Curriculum Development, (3) Risk Reduction and Disparity Elimination, and (4) Advocacy for Cancer Research and Cancer Research Careers. This program has been crucial to achieve the National Cancer Institute's goal of educating students from diverse backgrounds underrepresented in biomedical research in the Cleveland area as each teacher influences a significant number of students in their classrooms each year, and are introducing students to cancer biology, exciting them to consider careers in cancer prevention, diagnosis, control, treatment, and research. This article provides an overview of the program including its impact on the teachers and their students.

Background: Adolescents are considered to be vulnerable to particulate matter (PM). This study aims to develop and verify the effectiveness of the "school-based education program for coping with particulate matter (SEPC_PM)." This program was designed by employing the health belief model. Methods: High school students between the ages of 15 and 18 in South Korea participated in the program. This study employed a nonequivalent control group pretest-posttest design. A total of 113 students participated in the study; of these, 56 students participated in the intervention group, and 57 in the control group. The intervention group received 8 intervention sessions the SEPC_PM over the course of 4 weeks. Results: After the completion of the program, the intervention group's knowledge about PM showed a statistically significant increase (t = 4.79, p < 0.001). The practice of engaging in health-managing behaviors to protect against PM also showed statistically significant improvement in the intervention group, with the greatest progress in practicing precaution when outdoors (t = 2.22, p = 0.029). No statistically significant changes were observed regarding other dependent variables. However, a subdomain of the variable of perceived self-efficacy for engaging in health-managing behaviors to protect against PM (degree of body cleansing after returning home) demonstrated a statistically significant increase in the intervention group (t = 1.99, p = 0.049). Conclusions: The SEPC_PM may be proposed for incorporation into regular high school curricula to improve students' health by encouraging them to take necessary actions against PM.

The delivery of comprehensive sexuality education to adolescents at school is recognized as a long-term strategy to support adolescent health. Suboptimal sexual and reproductive health (SRH) outcomes among South African adolescents necessitate the ongoing development and optimization of SRH education and promotion models. We conducted a cluster-randomized controlled trial amongst secondary schools (n = 38) in Cape Town, South Africa, to evaluate a sport-based, near-peer-led SRH curriculum, SKILLZ, amongst female learners (n = 2791). Biomedical (sexually transmitted infections [STIs], human immunodeficiency virus [HIV] and pregnancy) and socio-behavioural (social support, gender norms and self-concept) outcomes were assessed pre and post intervention. Attendance at SKILLZ was low and intervention participants did not show an improvement in SRH outcomes, with HIV and pregnancy incidence remaining stable and STI prevalence remaining high and increasing in both control and intervention arms. Although evidence of positive socio-behavioural measures was present at baseline, participants with high attendance showed further improvement in positive gender norms. SKILLZ did not demonstrate the capacity to significantly impact clinical SRH outcomes. Modest improvements in outcomes amongst high attenders suggest that the impact may be possible with improved attendance; however, in the absence of optimal attendance, alternative intervention strategies may be required to improve SRH outcomes amongst adolescents.

The restriction measures put in place during the COVID-19 pandemic posed notable challenges for formal teaching-learning processes because they had to be adapted to ensure health security. An active learning programme applied to three environments (indoors, outdoors, and online) was tested with 273 undergraduate university students in a within-subjects experimental study. Each student was assigned to two indoor and two outdoor seminars, with a subsample (n = 30) also participating in online seminars implemented in response to the university's lockdown protocols. The learning experience and learning conditions were evaluated through six dimensions: learning, evaluative impact, hedonic experience, technical conditions, environmental conditions, and health security. Outdoor seminars were more effective than indoor seminars in terms of the learning experience, with greater differences in hedonic experience, while the indoor seminars were rated more highly than the outdoor seminars in terms of learning conditions, with a larger difference in the environmental conditions. No differences were found between online and face-to-face environments in terms of the learning experience, even though the online environment yielded better scores in the learning conditions. Apparently, this adaptation to both outdoor and online contexts through active methodologies allows overcoming of technical, environmental, and teaching limitations and improves health security, while ensuring a good learning experience and added flexibility to teaching-learning processes.

In 2021, guidelines for early childhood education and care were released recommending children are provided access to outdoor areas during all free play sessions to reduce the risk of coronavirus disease of 2019 transmission, aligning with the existing recommendations to increase children's physical activity. There is a need to understand how to disseminate guidelines in this setting as dissemination is a prerequisite of adoption and implementation. This randomized controlled trial explored the impact of a video-based strategy to disseminate guidelines on family day care educators' intentions to adopt outdoor free play guidelines. Educators (N = 255) were randomized to receive a video (intervention) or text-based (usual care) resource via email describing recommendations. Educators were invited to participate in a post-intervention survey at 5-week follow-up assessing intentions to adopt guidelines. The secondary outcomes included knowledge, beliefs about capabilities, beliefs about consequences, social/professional role and identity, goals, implementation of guidelines, acceptability of resource and intervention reach. There was no statistically significant difference between groups in intentions to adopt guidelines [[Beta] = 0.01 (95% confidence interval -0.50 to 0.52), P = 0.97], nor for any secondary outcomes. Further investigation is needed to identify effective dissemination strategies in the family day care setting to increase the adoption of public health guidelines.