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OBJECTIVE: To provide readers with information on various techniques to improve future health behavior EFA research. METHODS: Data from a health education questionnaire development study are analyzed to make the discussion of techniques concrete. RESULTS: There are numerous strategies to use when making a factor retention decision. CONCLUSIONS: The informed health-behavior researcher should use sophisticated factor retention techniques during EFAs. [ABSTRACT FROM AUTHOR]

A pilot study (n = 41) was conducted to test the effects of three educational treatments (DVD vs. Pamphlet vs. DVD + Pamphlet) on health-related quality of life (HRQoL), COPD information needs and self-efficacy among a referred sample of Certified Federal Rural Health Clinic patients (mean age = 61.51 years ± 6.29 years; ~61% female) suffering from COPD using a randomly-assigned, multiple-group pretest-posttest design with a control group. A MANCOVA testing planned multivariate contrasts determined patients receiving a DVD reported statistically significant higher levels of lung-specific physical functioning as compared to patients receiving a Pamphlet. Additionally, DVD patients reported clinically significant improvements on two dimensions of lung-specific HRQoL. No such improvements occurred within the Pamphlet and Control groups. The provision of self-management education as compared to usual care, however, did not improve the outcome variables examined. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management., Methods: A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States., Results: Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia., Conclusions: Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills., Competing Interests: Conflicts of InterestThe authors have no conflicts of interest to report.

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.

Objective: Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs)., Participants: College students with STBs in the 2018-2020 Healthy Minds Study., Methods: Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions., Results: Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress., Conclusions: Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Purpose: This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D)., Design: A qualitative, phenomenological approach using semi-structured, one-on-one interviews., Setting: Interviews conducted on Zoom (n = 28) and in-person (n = 3)., Participants: Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States., Method: This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis., Results: Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management., Conclusion: Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D., 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.

Objective: In clinical and athlete populations, research has found that experiencing a concussion (or traumatic brain injury) is correlated with experiencing other psychiatric conditions, including depression and alcohol problems. However, less is known about concussion comorbidity in other population segments. The purpose of this study is to examine the relationships between concussions and depression symptoms, anxiety symptoms, and hazardous drinking among a large sample of college students ( N  = 1776) enrolled in a mandatory health course. Methods: This study used an online health survey to examine concussion frequency (informal and formal diagnoses), sports-related concussions, depression symptoms, anxiety symptoms, and hazardous drinking in the sample. Bivariate and multivariate analyses were conducted to examine comorbid relationships between concussion frequency and the dependent variables of interest (anxiety symptoms, depression symptoms, and hazardous drinking). Results: We found that 691 (39.1%) participants indicated having at least one concussion. Analyses indicated that concussion frequency scores of both formal or informal diagnoses were significantly associated with scores of depression symptoms, anxiety symptoms, and hazardous drinking. When examining concussion frequency scores of only formal diagnoses, only hazardous drinking evidenced a statistically significant relationship. In addition, participants who had a sports concussion had significantly higher concussion frequency scores and hazardous drinking scores than those who have had a concussion that was not sport-related. Conclusions: The comorbid concussion relationships found in this study are consistent with those observed in clinical and athlete populations. It is important for college health professionals to be aware that concussion comorbidity is not limited to the athlete population and can impact the entire student body.

Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

The quality of patient education materials is an important issue for health educators, clinicians, and community health workers. We describe a challenge achieving reliable scores between coders when using the Patient Educational Materials Assessment Tool (PEMAT) to evaluate farmworker health materials in spring 2020. Four coders were unable to achieve reliability after three attempts at coding calibration. Further investigation identified improvements to the PEMAT codebook and evidence of the difficulty of achieving traditional interrater reliability in the form of Krippendorff's alpha. Our solution was to use multiple raters and average ratings to achieve an acceptable score with an intraclass correlation coefficient. Practitioners using the PEMAT to evaluate materials should consider averaging the scores of multiple raters as PEMAT results otherwise may be highly sensitive to who is doing the rating. Not doing so may inadvertently result in the use of suboptimal patient education materials.

The data presented in this data article were collected at three points in the 2012-2013 academic year; Fall 2012, Spring 2013, and Summer 2013 from undergraduate students enrolled in an introductory health education course at a large university in the United States. The data regarding undergraduate students' perceptions of and experiences with the campus emergency notification system were ascertained using a self-administered online-delivered survey instrument. The data included in the Mendeley Data repository affiliated with this data article encompass closed- and open-ended responses from 746 undergraduate students. Closed-ended questions included items based on central constructs from Technology Acceptance Model research-perceived usefulness, perceived ease of use, attitudes toward use, and behavioral intention. Survey questions also assessed students' actual use of emergency notification messages, students' perceived self-efficacy to respond to future potential emergency notifications, and demographics and technology use characteristics. This research team asked open-ended questions to collect students' ideas for systematic improvement in their own words. Descriptive statistics for demographic variables, participant characteristic variables, and scale variables were conducted in SPSS 27 and are provided in tables. The open-ended question response frequencies were also calculated in SPSS 27 and are provided within a supplemental PDF. To date, no data pertaining to an institution of higher education's emergency notification system are published for open access use. This article provides open access data and surveys that campus emergency planners, researchers, and health education specialists can use to inform emergency communication plans, improve the content of critical campus alert messages, structure future emergency notification studies, and frame future emergency notification system evaluations. This research team anticipates these data will help campus emergency personnel craft more effective messages and optimize their channel mixture to make emergency notifications reach and resonate with students in situations when minutes matter. The data for this article are hosted in a .csv file for widespread access in the following Mendeley Data repository: https://data.mendeley.com/datasets/6jdwfbwzk5/1., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships, which have, or could be perceived to have, influenced the work reported in this article., (© 2021 The Authors. Published by Elsevier Inc.)

The use of social media in public health education has been increasing due to its ability to remove physical barriers that traditionally impede access to healthcare support and resources. As health promotion becomes more deeply rooted in Internet-based programming, health education specialists are tasked with becoming more competent in computer-mediated contexts that optimize both online and offline consumer health experiences. Generating a better understanding of the benefits and drawbacks to using social media in the field is important, since health education specialists continue to weigh its advantages against potential concerns and barriers to use. Accordingly, this Special Issue aims to explore social media as a translational health promotion tool by bridging principles of health education and health communication that examine (1) the method with which social media users access, negotiate, and create health information that is both actionable and impactful for diverse audiences; (2) strategies for overcoming challenges to using social media in health promotion; and (3) best practices for designing, implementing, and evaluating social media forums in public health. In this commentary, we discuss the updated communication and advocacy roles and responsibilities of health education specialists in the context of social media research and practice., Competing Interests: The authors declare no conflict of interest.

Undergraduate subject pools are prevalent across disciplines in the United States. The Health Education Research Experience (HERE) Program was the first known course-based subject pool entirely managed and conducted online for online students enrolled in an introductory health education/health promotion course. The program was conducted within five semesters from Spring 2012 through Summer 2013. The HERE Program encompassed 13 studies embedded in two sections of an undergraduate online course at the University of Florida. The studies were all related to course topics and current research topics in health education/promotion (as identified through the Healthy People 2020 Framework). The topics ranged from the relatively less sensitive health aspects of college life (i.e., technology use) to studies assessing more sensitive health topics (i.e., intimate partner violence and sexual assault). In alignment with a best practice in survey design, the HERE Program's survey instruments included one metadata item embedded in each survey to identify which devices students used to complete the surveys. Understanding which devices students used for survey completion has ramifications for survey designers and survey researchers. In contrast to the relative uniformity of pen and paper surveys and control of the survey completion environment, online surveys may not look identical across personal devices and may be completed in increasingly varied environments. All studies, study procedures and protocols, and metadata collection procedures were approved by the university's Institutional Review Board. The data presented here were extracted from each survey's data files and aggregated. The aggregated metadata are available through Mendeley Data in a.csv file for widespread access. Descriptive statistics are presented in tables. The data provided in this article will benefit researchers interested in survey methodology, questionnaire design, modes of survey collection, and survey metadata. The data are hosted in the following Mendeley Data repository: https://data.mendeley.com/datasets/ht9jmd3cdt/2., (© 2020 The Author(s).)

Facebook Groups facilitate information exchange and engagement for patients with chronic conditions, including those living with Chronic Obstructive Pulmonary Disease (COPD); however, little is known about how knowledge is diffused throughout these communities. This study aimed to evaluate the content that is available on COPD-related Facebook Groups, as well as the communication (self-disclosures, social support) and engagement (agreement, emotional reaction) strategies used by members to facilitate these resources. Two researchers independently searched the "Groups" category using the terms "COPD", "emphysema", and "chronic bronchitis". Twenty-six closed ( n = 23) and public ( n = 3) COPD Facebook Groups were identified with 87,082 total members. The vast majority of Group members belonged to closed ( n = 84,684; 97.25%) as compared to open ( n = 2398; 2.75%) groups. Medications were the most commonly addressed self-management topic ( n = 48; 26.7%). While overall engagement with wall posts was low, the number of "likes" (an indicator of agreement) was significantly greater for wall posts that demonstrated social support as compared to posts that did not ( p < 0.001). Findings from this study showed that COPD Facebook group members share specific disease-related experiences and request information about select self-management topics. This information can be used to improve the quality of self-management support provided to members of popular COPD Facebook groups.

Background: Despite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy-related skills that can uniquely influence patients' health-related quality of life (HRQoL) outcomes., Objective: The aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD., Methods: Adults from the COPD Foundation's National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables., Results: After adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R 2 =21%; F 9,164 =6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R 2 =26.4%; F 8,161 =8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=-.56, SE 0.29, 95% CI -1.22 to -0.004, P<.05) was inversely associated with lung-specific HRQoL., Conclusions: Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL., (©Michael Stellefson, Samantha R Paige, Julia M Alber, Beth H Chaney, Don Chaney, Avery Apperson, Arjun Mohan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.06.2019.)

Background: Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC)., Objectives: The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker., Methods: 548 bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior., Results: After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R 2  = .323) of the variance of BrAC levels (F(12) = 21.162, p < .001), with 4.30% of the variance explained solely by pregaming (β = 0.014; p < .001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R 2  = .312) of the variance of pregaming behavior (F(18) = 13.276, p < .001), with 4.2% of the variance explained solely by AUDIT-C scores (β = 0.280; p < .001)., Conclusion: Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication.

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

While the association between current smoking and alcohol consumption is well known, the relationship between social smoking and alcohol consumption is less understood. The purpose of this study was to examine the association between smoking status and two alcohol consumption measures in a sample of college student bar patrons. The data used in this study was collected in fall 2015. Study participants (N = 415) were college student bar patrons who agreed to complete an interview that assessed smoking status (i.e., regular smoker, social smoker, non-smoker) and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels (using a handheld breathalyzer device) and (2) hazardous drinking scores (using the AUDIT-C scale). We conducted one-way ANOVAs with Bonferroni correction to examine differences in BrAC levels and hazardous drinking scores by smoking status. Among sample participants, 25.3% were regular smokers, 14.7% were social smokers, and 60.0% were non-smokers. Smokers had significantly higher BrAC levels than social smokers and non-smokers. Regular smokers also had significantly higher hazardous drinking scores than social smokers and non-smokers. The BrAC levels and hazardous drinking scores of social smokers and non-smokers were not significantly different. The drinking habits of social smokers reflected those of non-smokers and being a regular smoker was associated with higher drinking levels than the rest of the sample. Because of the association found between alcohol consumption and regular smoking, combining efforts to reduce these behaviors in college students might be advantageous.

Background: Alcohol consumption and experiencing a concussion are positively correlated. Concussion history has not been examined previously in any alcohol field study (i.e., conducted in a natural setting)., Objective: To better understand the relationship between concussion history and alcohol consumption., Methods: We conducted two anonymous field studies among a 2015 sample of bar patrons (N = 544; 62.5% males) in a college town to assess concussion history and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels and (2) hazardous drinking scores (based on the AUDIT-C). Next, we conducted a logistic regression analysis to predict concussion history using the two alcohol consumption measures and other potential covariates (i.e., age, gender, race, college student status)., Results: Among participants in our sample, the average BrAC level was.070 (SD =.053) and the average hazardous drinking score was 4.7 (SD = 2.5). Less than half of participants indicated that they had experienced a concussion in their lifetime (235; 43.2%). The logistic regression model indicated that hazardous drinking scores were significantly, positively associated with having experienced a concussion, whereas other covariates (i.e., BrAC, age, gender, race, college student status) did not significantly predict concussion history. Conclusions/Importance: Hazardous drinkers were more likely to have experienced a concussion. Therefore, the relationship found in this sample, between hazardous drinking behavior and concussion history, points to hazardous drinking as a possible risk factor for having had a concussion in the past.

Objective: Hazardous drinking is associated with other risky behaviors and negative health-related outcomes. This study examined covariation between hazardous drinking scores and the following risky driving behaviors: Falling asleep while driving, texting (receiving and sending) while driving, and driving after consuming alcohol., Methods: The participants in this study were a sample of undergraduate students (N = 1,298) who were enrolled in an introductory health course at a large Southeastern university in spring 2016 and completed an online health survey that assessed hazardous drinking, falling asleep while driving, texting while driving, and driving after consuming alcohol. We conducted a series of 2-step regression analyses to examine covariation between hazardous drinking scores (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and the risky driving behaviors of interest., Results: We found that the majority of participants did not drink and drive (91.8%), nor did they fall asleep while driving (80.4%); however, the majority did read a text while driving (81.7%) and sent a text while driving (75.3%). In the full multivariable model, hazardous drinking score was positively associated with drinking and driving (step 2 odds ratio [OR] = 1.28, 95% confidence interval [CI], 1.18, 1.38) and sending a text message while driving (step 2 b = 0.19, P = .01). Hazardous drinking score was also positively associated with reading a text while driving (step 1 b = 0.14, P < .001) and falling asleep while driving (step 1 b = 0.02, P = .02) in the model only controlling for demographic characteristics. The analyses also indicated covariability between the following risky driving behaviors: (1) drinking and driving/reading a text message while driving, (2) drinking and driving/falling asleep and driving, (3) reading a text while driving/sending a text while driving, and (4) sending a text while driving/sleeping and driving., Conclusion: The findings of this study indicate a need for interventions discouraging both hazardous drinking and risky driving behaviors in college student populations; recommendations to reduce risky driving and hazardous drinking are discussed.

Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone., Objective: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone., Methods: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data., Results: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than -2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable., Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations., (©Michael Stellefson, Samantha R Paige, Bethany Tennant, Julia M Alber, Beth H Chaney, Don Chaney, Suzanne Grossman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.10.2017.)

The objective of this study was to examine how different ways of describing a hypothetical tobacco-free campus policy would impact college students' perceived level of support from the college. In the spring of 2016, we randomized 1885 undergraduate students in a required course to three message conditions in an online survey: control (no message), wellness (emphasizing promoting health and quitting support), and punitive (emphasizing consequences for violating the policy). The dependent variable was perceived organizational support. We selected items previously shown to be relevant for college students (alpha = 0.92 in our data). Given significant non-normality, we used non-parametric Kruskal-Wallis tests with pairwise comparisons to examine differences in perceived organizational support across the three conditions. We examined results by smoking status and if the participant correctly reported the message they received. We found no significant difference in perceived organizational support among students exposed to different tobacco-free campus policy announcements ( p = 0.75). We also found no significant difference among smokers ( p = 0.66). However, among smokers who correctly reported the message they received, we found significantly lower perceived university support ( p = 0.01). Messages about tobacco-free campus policies should focus on the role of policy in supporting a healthy environment instead of punitive enforcement. Campus administrators should use caution when using message frames focusing on consequences of violating newly adopted policies., Competing Interests: The authors declare no conflict of interest.

Many noted difficulties of farmworker life result in increased risk for stress and depression. To date, limited research has focused primarily on seasonal farmworkers; much of the prior research examines migrant farmworkers or both groups collectively. This study aims to: (1) describe levels of stress and depression among a sample of seasonal farmworkers ; and (2) identify if covariates (age, gender, marital status, education level, years of residency, problems obtaining healthcare due to documentation, language barriers, transportation, costs, medical insurance, and stress level) are significant predictors of depressive symptoms. Survey data were collected from 150 Latino seasonal farmworkers. A hierarchical binary logistic regression was conducted to identify significant covariates. The results indicated that the only statistically significant covariates were health insurance coverage ( p = 0.025) and stress ( p = 0.008). Those farmworkers without health insurance were 1.8 times more likely than those with health insurance to possess depressive symptoms, while those demonstrating higher stress levels were over 7 times more likely to demonstrate symptoms of depression. The implications of the results are discussed in the manuscript., Competing Interests: The authors declare no conflict of interest. East Carolina University’s research office, who handles start-up funds for faculty, had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Background: College students actively seek online health information and use Instagram, an image- and video-based social networking website, to build social networks grounded in trust and behavioral norms (social capital), which have the potential to prevent chronic disease., Purpose: This study aimed to: (1) examine how intensity of Instagram use moderates the relationship between eHealth Literacy and online social capital in college students, and (2) discuss how Instagram can be used as a social awareness platform for chronic disease prevention among college students., Methods: Hierarchical regression analyses were conducted to analyze web-based survey data from a random sample of college students ( N =327)., Results: Online bridging social capital was associated with greater eHealth Literacy ( P <.05) and intensity of Instagram use ( P <.001), when controlling for socio-demographic variables. The relationship between eHealth Literacy and online bridging social capital was strongest among respondents' with average ( P <.01) and high ( P <.01) intensity Instagram use, as compared to low Instagram intensity., Discussion: High intensity of Instagram may strengthen college students' low eHealth Literacy, especially when interacting with heterogeneous connections with weaker ties., Translation to Health Education Practice: Health education specialists should continue to explore how college students' intensity of Instagram use can be strengthened to build bridging online social capital, and ultimately prevent chronic disease.

Breath alcohol concentration (BrAC) is a commonly used measure of alcohol intoxication. Because of the potential negative consequences of excessive alcohol consumption, it is important to examine how accurately intoxicated individuals can estimate their BrAC values, especially individuals over the legal BrAC driving threshold (i.e., 0.08%). To better understand perceptions of BrAC values among intoxicated individuals, this field study examined actual BrAC values and BrAC range estimates (0.08% and above, 0.02-0.07%, less than 0.02%) among a sample of bar patrons (N = 454) with BrAC levels at 0.08% or higher. Bivariate and multivariate analyses were conducted to examine the relationship between actual BrAC values and perceived BrAC levels. We also examined whether the following demographic and drinking variables were associated with underestimating BrAC in this sample: gender, age, race, college student status, plans to get home, and hazardous drinking. Results indicated that the majority (60.4%) of participants underestimated their BrAC (i.e., less than 0.08%) and lower BrAC values correlated with underestimating BrAC ranges (p < .001, 95% CI[0.2, 0.6]). Further, females (p = .001, 95% CI[1.3, 3.3]) and participants under 21 (p = .039, 95% CI = 1.0, 2.6) were significantly more likely to estimate their BrAC to be less than 0.08%, which is concerning given that young (less than 21) intoxicated females are a group at high risk for sexual assault on college campuses. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Purpose: The current study seeks to: 1) assess the relationship between alcohol consumption and intentions to engage in unprotected sex in an uncontrolled environment, and 2) to identify if covariates (race, age, sex, breath alcohol content (BrAC), intentions to engage in sex, hazardous drinking rates) are significant predictors of condom possession during time of uncontrolled alcohol consumption., Methods: Data were collected from 917 bar patrons to assess alcohol use using the Alcohol Use Disorders Identification Test (AUDIT-C), BrAC levels, intentions to engage in risky sex, and condom possession. Correlational analysis and hierarchical binary logistic regression was conducted using SPSS., Results: Correlational analyses indicated a negative relationship between AUDIT-C scores (r=-0.115, p=0.001), BrAC (r=-0.08, p=0.015), and intentions to use a condom. Over 70% of participants intended to use a condom if they engaged in sex; however, only 28.4% had a condom to use. The regression analysis indicated the predictive model (χ(2)=114.5, df=8, p<0.001) was statistically significant, and correctly classified 72.9% of those in possession of a condom., Conclusions: Alcohol consumption was associated with intentions to have unprotected sex; however, intentions to engage in protected sex and condom possession were higher for males and those with higher BrAC levels., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: "Weight-conscious drinking" refers to behaviors to restrict calories in conjunction with consuming alcohol and is associated with numerous negative consequences. This behavior has been observed in the college student population but has not been examined among college student athletes., Methods: This cross-sectional study assessed drinking, hazardous drinking levels (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C] sum score), and weight-conscious drinking behaviors (for weight loss purposes and for intoxication purposes) using a paper-and-pencil survey that was completed by students at a large, private university in the Southwest United States. The sample for this study included college student nonathletes (n = 482; 212 males and 270 females) who completed the survey in 1 of 34 classes and college student athletes (n = 201; 79 males and 122 females) who completed the survey during practice. These analyses examined whether hazardous drinking level and other personal covariates (gender, race, and athlete status) predicted the 2 weight-conscious drinking behaviors of interest., Results: Among the subsample of students who drank, the same proportion of participants indicated weight-conscious drinking behavior for weight loss and weight-conscious drinking behavior for intoxication (both 24.9%; n = 122). In the multivariate analyses, students with higher hazardous drinking scores and females were significantly more likely to report engaging in both weight-conscious drinking behaviors. In those analyses, neither weight-conscious drinking behavior varied by athlete status., Conclusions: In this sample of college students, hazardous drinking most predicted weight-conscious drinking behavior and superseded gender and athlete status. In response, college health professionals should consider evidenced-based approaches to address hazardous drinking.

Background: Alcohol-related injuries are a serious public health issue and research has found that alcohol consumption is positively correlated with injury risk., Objective: To better understand the association between alcohol consumption and injury risk., Methods: We conducted four anonymous cross-sectional field studies among a sample of bar patrons (N = 917) to assess breath alcohol concentration (BrAC) levels, hazardous drinking levels (based on AUDIT-C score), and past year alcohol-related injuries in Fall 2014. Next, we conducted two logistic regression analyses to predict alcohol-related injuries: one model used hazardous drinking level as a predictor variable and the other model used BrAC., Results: Among participants in our sample, the average BrAC% was .076 (SD =.055) and the average hazardous drinking score (based on the AUDIT-C) was 5.0 (SD = 2.6). The majority of participants indicated that they had not experienced an alcohol-related injury in the past year (859; 93.7%). Our regression analyses found that each incremental increase in a participants' hazardous drinking score increased the odds of experiencing a self-reported alcohol-related injury by 1.4 times and as BrAC increased one unit of change (percentage), the odds of a past-year alcohol related injury increased twofold (OR = 2.2). Other covariates (ie, age, gender, race, college student status) did not significantly predict alcohol-related injuries in either model., Discussion and Conclusions: High-risk drinking behaviors, including higher BrAC levels, greatly influenced experiencing an alcohol-related injury., Scientific Significance: This is the first examination of BrAC levels and alcohol-related injuries in a primarily college student sample., (© American Academy of Addiction Psychiatry.)

Background and Objectives: In March 2015, the Alcohol and Tobacco Tax and Trade Bureau approved the sale of Palcohol, the first powdered alcohol product to be marketed and sold in the U.S. Powdered alcohol is freeze-dried, and one individual-serving size packet added to 6 ounces of liquid is equivalent to a standard drink. This study assessed awareness of powered alcohol and likelihood to use and/or misuse powdered alcohol among college students., Methods: Surveys were administered to a convenience sample of 1,841 undergraduate students., Results: Only 16.4% of respondents had heard of powdered alcohol. After being provided a brief description of powdered alcohol, 23% indicated that they would use the product if available, and of those, 62.1% also indicated likelihood of misusing the product (eg, snorting it, mixing it with alcohol). Caucasian students (OR = 1.5) and hazardous drinkers (based on AUDIT-C scores; OR = 4.7) were significantly more likely to indicate likelihood of use. Hazardous drinkers were also six times more likely to indicate likelihood to misuse the product., Discussion and Conclusions: These findings can inform upstream prevention efforts in states debating bans on powdered alcohol. In states where powdered alcohol will soon be available, alcohol education initiatives should be updated to include information on the potential risks of use and be targeted to those populations most likely to misuse., Scientific Significance: This is the first peer-reviewed study to assess the awareness of and likelihood to use and/or misuse powdered alcohol, a potentially emerging form of alcohol., (© American Academy of Addiction Psychiatry.)

Background and Objective: The college student population is one of the heaviest drinking demographic groups in the US and impaired driving is a serious alcohol-related problem. The objective of this study is to better understand the relationship between alcohol-related behaviors and "plans to get home" among a sample of college students., Methods: We conducted four anonymous field studies to examine associations between breath alcohol concentration (BrAC) levels, Alcohol Use Disorders Identification Test (AUDIT-C) classification, and plans for getting home among a sample of bar-attending college students (N = 713)., Results, Discussion and Conclusions: The vast majority of participants in our sample (approximately 95%) were not intending to drive and the average BrAC% of those intending to drive was .041. Our one-way ANOVAs indicated that (1) participants classified by the AUDIT-C as not having an alcohol problem had a significantly lower BrAC% than those classified as having a potential problem and (2) participants planning to drive had a significantly lower BrAC% than those with a plan that did not involve them driving and those without a plan to get home. Although it is encouraging that most of our sample was not intending to drive, it is important to continue to attempt to reduce impaired driving in this population., Scientific Significance: This study helps college health professionals and administrators to better understand the relationship between alcohol-related behaviors and plans to get home among college students., (© American Academy of Addiction Psychiatry.)

Objectives: To describe how a community academic partnership (CAP) created a cardiovascular disease (CVD) prevention program for firefighters., Methods: Principles of community based participatory research (CBPR) were integrated with intervention mapping (IM) to guide the development of a physical activity program., Results: Key elements of the CAP program include instituting annual CVD screenings; creating a department-wide program and a pilot intervention for high-risk firefighters; training firefighters to become peer health mentors; improving access to physical activity equipment; instituting policy to promote physical activity, and validating instrumentation for assessing cardiorespiratory fitness., Conclusions: Integrating CBPR with IM was an efficacious approach for engaging firefighters in research for developing an ecological approach to cardiovascular health in firefighters.

Background: To simplify the screening process to identify problem drinking, researchers have developed single-item, quantity-based instruments. Quantity-based items, however, suffer from several limitations., Objective: Determine whether a non-quantity-based single item assessing drunkenness would be able to identify those who exhibited signs of hazardous alcohol use, as determined by Alcohol Use Disorders Identification Test (AUDIT)-C scores., Methods: Between September and November of 2011, the alcohol-related behaviors of 1062 self-identified current drinkers were assessed with self-report measures (i.e. AUDIT-C and one item assessing frequency of drunkenness) in addition to corresponding biologic samples (i.e. breath alcohol concentration (BrAC) samples). We assessed the concurrent validity of the single item to identify hazardous alcohol use established via gender-based AUDIT-C thresholds. Convergent validity of the single-item was assessed by determining its relationship to BrAC levels., Results: The single item accounted for 0.791 of the area under the received operating characteristics curve for hazardous alcohol use (p < 0.001). When employing a cut-off of 1, the single-item question was 95.9% sensitive in identifying hazardous alcohol use., Conclusion: The results reported herein highlight the validity (both concurrent and convergent) and potential utility of a non-quantity-based single-item alcohol screen for assessing drunkenness. Additional research is warranted to confirm the utility of this one-item drunkenness measure to capture risk of injury and hazardous drinking.

Pregaming has been highlighted as an especially deleterious college drinking ritual. The present study assessed (a) event-level associations between pregaming and biologic samples of blood alcohol concentration (BrAC) and (b) the impact of one's alcohol-related behaviors (measured by AUDIT-C scores) on the likelihood that respondents would report pregaming prior to a night out drinking. The sample included adult (n=1029; collegiate and non-college-affiliated) bar patrons in a southeastern college community. Multiple and linear regressions were conducted to determine the association between pregaming and BrAC levels, and pregaming and the presence of an alcohol use disorder, respectively. After controlling for the influence of time of data collection, gender, age, college student status, and ethnicity, the linear regression model explained 15.5% (R2=.155) of the variance in BrAC levels (F (10, 915)=16.838, p<0.001), of which 10.8% was accounted for by self-reported pregaming alone. Furthermore, pregamers exhibited significantly higher BrACs compared to non-pregamers (β=.332, p<.001). Logistic regression analyses indicated that AUDIT-C scores were the only significant predictor of pregaming status (OR=1.305, Wald=64.843), such that respondents with higher AUDIT-C scores (B=0.266) were more likely to pregame. This event-level study highlights the practice of pregaming as an insidious behavior associated with enhanced levels of drinking behavior and overall intoxication., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: This study established breath alcohol concentrations (BrACs) and alcohol-related behaviors of designated drivers (DDs) to determine (a) whether DDs are abstaining from drinking, (b) whether alcohol-related behaviors of non-DDs and DDs were different, and (c) whether the alcohol consumption of DDs resulted in BrAC levels that affected driving performance or caused psychomotor impairment., Method: We conducted six anonymous field studies during a 3-month period in a southeastern college community restaurant and bar district. Intercept interviews were conducted with 1,071 bar patrons. Alcohol-related behaviors, BrAC, and whether one was serving as a DD were measured. The sample was primarily White (72.7%), male (62.4%) college students (64.7%). Descriptive statistics and an independent sample t test compared the BrACs of DDs versus non-DDs. A one-way analysis of variance examined the differences in the alcohol-related behaviors (Alcohol Use Disorders Identification Test-consumption [AUDIT-C] score) across DDs abstaining from drinking (BrAC = .00 g/210 L), drinking DDs (BrACs ≥ .02 and < .05 g/210 L), and impaired DDs (BrACs ≥ .05 g/210 L). A logistic regression assessed the impact of alcohol-related behaviors (AUDIT-C) on whether one was serving as a DD., Results: Of the 165 DDs, approximately 40% did not abstain from drinking. Approximately 17% of DDs had BrACs between .02 g/210 L and .049 g/210 L, whereas 18% recorded BrACs at .05 g/210 L or greater. The mean AUDIT-C score for impaired DDs significantly differed from both abstaining DDs and drinking DDs. Participants with greater AUDIT-C scores were more likely to serve as a DD and have a BrAC that significantly inhibited driving ability and psychomotor function., Conclusions: These findings identify the need for consensus across researcher, layperson, and communication campaigns that a DD must be someone who has abstained from drinking entirely.

The purpose of this article is to provide a summative report of the applications submitted for the Experience Documentation Opportunity (EDO), implemented by the National Commission for Health Education Credentialing, Inc. (NCHEC). The EDO was a one-time, 6-month opportunity for health education specialists holding the entry-level certification (Certified Health Education Specialist or CHES) for 5 or more continuous years, with active status, to submit documentation to verify practice at the advanced level to become a Master Certified Health Education Specialist (MCHES), the new advanced certification. The EDO process was rigorous and effective in verifying a professional's level of practice. A total of 862 applications were submitted to NCHEC; 819 were approved, 36 denied, and 7 withdrew. Frequency distributions indicate which advanced-level subcompetencies were used the most and least for applications. Results of the EDO process provide valuable information regarding characteristics of the first cohort of MCHES, as well as a direct assessment of advanced-level practice in the field of health education.

Objective: This article is a systematic review conducted of the research literature on digital videogames played by older adults and health outcomes associated with game play. Findings from each study meeting the inclusion criteria were analyzed and summarized into emergent themes to determine the impact of digital games in promoting healthy behaviors among older adults., Materials and Methods: A systematic review of the research literature was conducted through multiple academic databases for works, published between the years 2000 and 2011, looking at digital videogame interventions with adults 65 years of age and older. Multiple combinations of search terms and Boolean operators relevant to digital videogames and older adults were queried. A criteria matrix was created to code and evaluate studies., Results: Thirteen studies met specific criteria for inclusion and were analyzed in the final review. Significant mental, physical, and social health factors, type of digital game platform, study design, and measurements are among emergent themes summarized from the reviewed research literature. Significant mental health outcomes of digital game interventions were found in the majority of the reviewed studies, followed by physical and lastly social health outcomes in older adults., Conclusions: A majority of the studies revealed significant positive effects on health outcomes associated with digital videogame play among older adults. With current advancements in technology, including advanced motion sensing, digital game platforms have significant potential for positive health impact among older populations. More robust and rigorous research designs are needed to increase validity and reliability of results and establish stronger causal relationships on the health benefits of digital videogame play for older adults.

The American Association for Health Education (AAHE), a national health education organization with the mission of advancing the profession of health education, launched the 2011 AAHE membership survey between October 13, 2011 and November 1, 2011, under the leadership of the AAHE Board of Directors and AAHE Staff. The primary objective of the survey was to provide insight into the perspectives of AAHE members on several important issues facing the organization including: AAHE exiting its parent organization, the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD), and the proposed "modified" merger with the Society for Public Health Education (SOPHE), another national health education organization. A total of 240 AAHE members completed the survey. A majority of respondents were university faculty members in health education, and results provide keen insight into AAHE members' perspectives on the AAHE-SOPHE modified merger.

What exactly is health education? Professionals with advanced degrees in health education have most likely encountered questions such as these either during introductory coursework or from those inquiring about the field. These queries can prove quite perplexing when asked by individuals who are unaware of the health education profession. Because the act of marketing health education is crucial to the sustainability of the field, the purpose of this article is to (a) explore the issue of describing and promoting health education, (b) establish ideas that can facilitate the provision of coordinated marketing efforts, and (c) offer marketing management and implementation principles that can assist in marketing both health education and health educators. Based on this discussion, the authors suggest building mainstream consensus in regards to marketing message development and implementation to better position health education.

This exploratory study assessed the self-management learning needs, experiences, and perspectives of COPD patients treated at a Certified Federal Rural Health Clinic to inform the development of a COPD self-management DVD. A purposive, homogeneous sample of COPD patients participated in focus group interviews. Data from these interviews were referenced to edit a library of Rvision COPD self-management DVDs into a single condensed DVD containing only the most pertinent self-management topics. Patients reported a lack of knowledge and skill development related to purse lipped breathing, controlled coughing, and stress management; while medication management skills were found to be quite adequate. Engaging rural communities in formal qualitative inquiries to describe COPD specific needs for self-management may lead to future use of educational technologies aimed at improving quality of life for these rural, hard to reach populations.

In the past decade, there has been an enormous growth of distance education courses and programs in higher education. The growth of distance education is particularly evident in the field of health education. However, the enormous potential of distance education is tempered by one overriding question: How does one ensure that distance education coursework and degrees are of high quality? To this end, the purpose of this study is twofold: to identify quality indicators of distance education and to provide implications of the identified quality indicators for health education researchers and practitioners. The results of the study reveal common benchmarks and quality indicators that all parties deem important in designing, implementing, and evaluating distance education courses and programs.