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Epidemiological research over the past two decades has highlighted substance use disparities that affect Native Hawaiian and Pacific Islander youth, and the lack of effective approaches to address such disparities (Okamoto et al. in Asian American Journal of Psychology 10(3):239-248, 2019). The Ho'ouna Pono curriculum is a culturally grounded, teacher-implemented, video-enhanced substance use prevention program that has demonstrated efficacy in rural Hawai?i in a large-scale trial (Okamoto in Asian American Journal of Psychology 10(3):239-248, 2019). Despite its potential to ameliorate health disparities and address youth substance use, prevention programs such as Ho'ouna Pono have been poorly disseminated and implemented across Hawai?i, raising the question: "Why are effective prevention programs not used in communities that most need them?" The present study used concept mapping to understand previously identified implementation barriers and develop implementation strategies for Ho'ouna Pono. Seven Hawai?i Department of Education (HIDOE) educational leaders and administrators sorted Ho'ouna Pono implementation barriers (e.g., "There is a lack of HIDOE funding to support prevention curricula"), named concepts, and rated barriers' perceived impact and difficulty. Multidimensional scaling and cluster analysis yielded a five-cluster solution: (1) Kumu (Hawaiian word for teacher) Controlled, (2) School Level Buy-in, (3) Curriculum, (4) Student Attitudes + Mindsets (Family + Community), and (5) Policy. Participant ratings identified eight high-impact and low-difficulty barriers. Discussion revealed important intersections among barriers indicating the need for coordinated and cross-level implementation strategies to support Ho'ouna Pono sustainment. Brainstormed implementation strategies using participants' own language highlighted a need for participatory methods in school settings to bidirectionally share ways to best sustain substance use prevention programs.

Becoming a healthcare professional is a complex process, where learning occurs in various ways. This study explores an extracurricular learning approach, called the Social Health Bridge-Building Programme, designed to address health inequities. Student volunteers accompany persons in a socially vulnerable situation to healthcare appointments. Operating outside the realms of health education, the programme intends to provide an alternative road to training healthcare students to become capable of engaging with diverse populations, and reducing barriers to healthcare access. Based on an ethnographic fieldwork, using interviews and participant observation ("walking along") as methods, the aim of the study was to explore the learning processes and learning outcomes associated with bridge-building, as experienced by students. Our findings show that this extracurricular learning complemented the formal curriculum, and bridged the gap from theoretical knowledge to practice and to real persons, preparing students for their future roles. The particular positioning of walking alongside or sitting beside persons made the invisible visible, enabling student volunteers to see the variety of persons in need of bridge-building, ways of living in a socially vulnerable situation, inequity in health, and see the persons, beyond initial impression, fostering a deeper understanding and empathy among the students. Learning outcomes included communicational, relational, and observations skills, and a more comprehensive grasp of the healthcare system's complexity. We conclude that a non-governmental organization, independent of the healthcare system, may have found a novel way of providing extracurricular learning about health inequity to students. Demonstrating how the Social Health Bridge-Building Programme complements formal curricula, the concept could be applicable in other settings.

Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15-18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention.

Childcare providers experience a variety of mental and physical challenges that impact their personal wellbeing as well as the quality of care they provide for children. Rural family childcare (FCCH) providers--an individual who professionally provides care to children within their home--may especially need resources to support their physical and mental wellbeing. An existing program, Here For You, For Them (HERE), may be able to support these providers; however, previous testing of the program has only been conducted in childcare centers. Therefore, the purpose of this pilot study was to assess the acceptability and feasibility of the HERE program for rural FCCH providers. 27 rural FCCH providers took part in a 16-week pilot study of the HERE program focused on mindfulness techniques and practices. Participants attended a monthly virtual training and received an activity pack consisting of different activity ideas including breathing techniques, mantras, yoga poses, and yoga stories. Participants completed bi-weekly implementation surveys and a post-intervention survey and semi-structured interview. Overall, the breathing activities were one of the most implemented activities and took the least amount of time (< 5 min). Providers stated they enjoyed the flexibility of the program and the activities but felt some of the yoga poses and stories were difficult to implement. Common barriers included challenges with children's behavior and the age of children as well as time constraints. Overall, the HERE program appeared feasible and acceptable for rural FCCH providers. Future efforts should consider providing additional wellbeing support for FCCH providers.

This study modelled the Mediating Role of Work-Life Balance on the Relationship between Work Arrangement and Employee Performance in Higher Education. The explanatory research design was adopted for this study, and a sample of 316 was drawn from a study population of 2,045 administrative staff of a public university in Ghana. A questionnaire was used for the data collection, and data gathered were analyzed with Partial Least Square-Structural Equation Modelling. The study found that flexible work arrangements and wellness programs are individually and significantly related to employee performance and work-life balance. Also, family responsibilities significantly influenced employee performance but had a non-significant relationship with work-life balance. It can also be concluded that work-life balance significantly mediated the relationship between flexible work arrangements and employee performance as well as wellness programs and employee performance. It is recommended that human resource managers in academia should take specific action to enhance work-life balance among their administrative staff to elicit higher performance from them.

Objective: The goal of this study was to report on the development and early usability of a new interactive mHealth app for reducing cardiovascular risk in primary care patients of low socioeconomic status attending clinics in Chile. Design: Mixed-methods design with qualitative and quantitative components. Setting: Three Chilean primary care clinics located in one urban (Santiago) and two rural areas (San Clemente and Chiguayante). Each clinic serves a population of about 24,000 people of generally low socioeconomic status with an average of 8.5 years of education. Methods: A qualitative co-design participatory framework was used to develop the "Mi Salud-APS" mHealth app. Three iterations of virtual workshops were held with healthcare providers and patient participants to develop the new app. Once developed, the usability phase identified, invited and followed up for 3 months a sample of primary care patients with moderate (N = 119) or high (N = 329) cardiovascular risk. Results: A total of 24 healthcare providers and 24 patients participated in the developmental workshops. Three emergent categories represented the core attributes for the mHealth app design: 'Friendly', 'Interactive' and 'Pertinent'. In the usability phase of the sample of 448 patients, 98% downloaded the app, and 64.6% of them logged in and used it for an average of 1.46 (0.5-10) times weekly. Conclusion: Findings suggest that patient and healthcare provider contributions to the development of the mHealth app accurately reflect the interests and experiences of both groups and together helped achieve the high usability levels observed among primary care patients enrolled in clinics in underserved communities.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

The National School Nutrition Programme (NSNP) in South Africa provides thousands of needy children with school meals on school days. One, and in some cases 2, of these meals per week are soya based. A review of the NSNP revealed that many children do not eat on those days because they find the soya mince meal unappetising. As the meal served within the NSNP may be the only meal these learners receive during a day, it is essential to ensure learners' willingness to consume the meal, and, therefore, that the meal is made appetising and nutritious. During visits to 3 schools in the Tshwane district, interviews were conducted with school meal handlers. Information gathered from these sessions was used to develop 4 new recipes that fall within the guidelines and budget of the NSNP. The final recipes were beef bolognaise soya mince, chicken curry soya mince, chilli con carne soya mince and one-pot soya mince biryani. To evaluate the acceptability of these newly developed recipes, a sensory panel of 100 university students that formed part of the NSNP during their schooling years was assembled. The sensory evaluation was done by comparing the existing soya mince meal with the 4 new soya mince recipes. One of the new soya mince meals was found to be the preferred dish and was rated significantly higher in acceptability than the original soya mince meal.

This practice report outlines the application of culture change methodology to co-design a whole-of-university health and wellbeing strategy. We outline considerations that necessitate a change in the way higher education contributes to student and staff mental health and wellbeing. We provide an overview of an Appreciative Inquiry culture change methodology; a map of the process followed; the benefits of applying Appreciative Inquiry principles; and a description of outcomes, which include funding for a new health and wellbeing strategy implementation team. We argue that by co-designing a strategy, with representatives of the whole system taking a strengths-based perspective, we enabled self-determined change. We also argue that the process of co-designing and co-developing a strategy can be a wellbeing intervention in and of itself.

With the continued push by organizations such as the Centers for Disease Control and Prevention and the World Health Organization to build healthy K-12 campuses, it is important to find ways to prepare preservice physical education teachers to successfully contribute to these whole-school models. This article shares the first-hand experience of an undergraduate student who took on the role of physical activity champion at a university campus. The health and physical education program at the university became the first college campus to adopt the Daily Mile as a whole-campus physical activity initiative. The initiative was used to give an undergraduate student first-hand experience as a physical activity leader. This article shares the joys and challenges faced in this role and reflects on the usefulness of the process to prepare for a future role as a physical education teacher.

Background: Health coaching sessions that incorporate goal setting may help improve college students' health behaviors. Purpose: This study examined whether specific goal-setting practices moderated changes in health behaviors during an online wellness intervention in college students. Methods: Participants were 90 college students recruited from one US university. The intervention was a one-hour virtual one-on-one health coaching session where participants set two goals for either physical activity (Metabolic Equivalent Task (MET)-minutes or MET-minutes), nutrition, sleep, or stress management. Self-reported baseline behaviors were collected, and follow-up surveys were completed at 6- and 12-weeks. Mixed effects models examined behavior change outcomes across the follow-up timepoints while testing the moderating effect of goal setting using interactions. Results: The Goal×Time interaction was significant for moderate MET-minutes at 1st follow-up (b = 443, p = 0.003), and for total MET-minutes at the 2nd follow-up (b = 717, p = 0.047). The Goal×Time interaction was also significant for stress management at 1st follow-up (Odds Ratio = 7.3, p = 0.042). Discussion: Participants who set physical activity and stress management goals had significantly higher physical activity and utilized more stress management techniques. Translation to Health Education Practice: The use of specific goal-setting strategies for physical activity and stress management is recommended during online health coaching sessions. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars.

Objective: To evaluate implementation of nutrition/physical activity-related policies/practices at colleges participating in a healthy campus initiative and campus health leaders' perceptions of policies/practices' support for student health and ease of/barriers to implementation. Participants: Health leaders at colleges participating in the Healthier Campus Initiative (HCI), with completed or ongoing three-year HCI commitments. Methods: Surveys asked which of 41 guidelines were implemented and perceptions around support for student health and ease of/barriers to implementation. Qualitative interviews explored similar domains. Results: Campuses with completed HCI commitments (n = 17) averaged 27.6 guidelines implemented, versus 21.1 on campuses with commitments ongoing (n = 13; p = 0.003). Perceived support for student health and implementation ease varied by guideline. Common implementation barriers included financial costs and time. Interviews largely reinforced these findings. Conclusions: Completion of a campus environmental change initiative may be associated with more health-supporting practices. Campuses may benefit from implementing coordinated policy/practice changes supporting healthy eating and physical activity.

The District 87 Wellness Collaborative is a multi-dimensional, interprofessional initiative in the Midwest region of the United States that was co-designed to facilitate collaboration, civic engagement, and partnerships among university scholar-practitioners, community agencies, and school administrators and personnel. The primary aims of the Wellness Collaborative are to develop, enhance, and extend school initiatives that address mental, emotional, and behavioral health outcomes of school-age children, their families, and the education workforce. The Wellness Collaborative is composed of disciplinary expertise in kinesiology, school counseling and psychology, social work, nursing, geography, and community health. Broader campus and community partners include specialists from civic and community engagement offices, extension services, and healthcare providers. This ecologically framed initiative supports strategic and system-level change within the district (system) and individual schools (sub-systems). It addresses complex school-level organizational factors (i.e., environment, norms, organizational culture, incentives, etc.) that influence wellness behaviors that affect school and physical education workforce professionals.

This article explores multilevel governance networking and innovation to better understand how nature-based public health can be promoted at a grassroot level within an urban context. Hence, the leading research question examines the "extent of networking and collaboration within state and municipal policymaking and the implementation of socially inclusive nature-based activities among urban youths conducted by local volunteer organisations." Multilevel networking and collaboration represent an analytical alternative to bottom-up and top-down strategies, which dominate the socio-political policies of outdoor studies in several countries. The exploration draws on empirical research conducted in 2020 based on a qualitative design. A website review was carried out to analyse facilitated nature-based health innovations embracing educational activities, leadership, and organisation run by local volunteer organisations targeting youth aged 6-19 across Oslo, Norway's capital. The investigation was substantiated by twenty-eight interviews with leaders of volunteer organisations and primary healthcare coordinators in five of Oslo's fifteen city districts, exploring their organisational experiences and reflections on nature-based innovations as a measure to promote health. The governance approach revealed several paradoxes and ambiguities in policy and practice. For example, there is a gap between the policy vision and available resources. There is also a need to understand better the complex networks and collaboration of public agencies and dedicated volunteers, their organisations, and interests. Furthermore, the continuous professionalisation of the voluntary sector and its significance in building a governance infrastructure that increases the capability of ongoing nature-based activity innovations need to be developed to meet policy goals and young people's needs and interests. Social inequalities were reported among those participating in nature-based activities and those who were not engaged. This pattern follows the well-documented spatial distribution of socioeconomic disparities.

Aims: To determine the effect of a 16-week fitness program (strength vs. aerobic) on different indicators of body composition and components of health-related physical fitness in youths with Down syndrome. Methods and procedures outcomes: Fifty adolescents (19 girls and 31 boys; average age, 18.33 ± 1.42 years) with Down syndrome were recruited and randomized to two groups (strength group vs. aerobic group). Adolescents allocated in the aerobic group carried out a physical activity program three times a week for 16 weeks meanwhile adolescents allocated in the strength group performed a fitness program three times a week for 16 weeks. Results: The exercise group had significant improvements in all health-related physical fitness variables (p < 0.05) but not on body composition. Conclusions and implications: A sixteen week fitness program consisting of three sessions of 60 min is able to increase levels of health-related physical fitness but not on body composition in youths with Down syndrome. The aerobic program does not seem to show significant differences.

Holistic and ecological approaches to mental health support have been identified by many as best-practice approaches for creating and sustaining well-being. Those who experience mental health challenges including, for example, Borderline Personality Disorder (BPD), often struggle to find adequate, sustainable and ongoing care from clinical settings, and recent research shows that additional strategies such as peer support programs, arts approaches, and holistic school-based collaboration work effectively. More generally, the mainstream population continues to suffer from outdated, overly medicalised and frequently inaccurate notions of the experience of poor mental health and the effective support of those who suffer, and peer- and school-integrated approaches go some way toward better education about mental ill-health. This article uses a creative ecologies model (Harris, 2016) to help schools implement student- and family-led support programs for students experiencing mental health challenges in school settings.

Objective: School Health Profiles (Profiles) is a national surveillance system operated by the US Centers for Disease Control and Prevention. A school-based system of surveys, Profiles monitors school health policies and practices in US states and other jurisdictions through questionnaires completed by school principals and lead health education teachers. This study used the Profiles principal survey to identify trends in US schools' implementation of diversity-related learning opportunities (i.e. opportunities to learn about people who are different from themselves) in secondary school classrooms and extracurricular settings. Methods: Logistic regression models using data from three cycles of School Health Profiles from 35 US states examined trends in the percentages of secondary schools offering students diversity-related learning opportunities in the following settings, each measured by using dichotomous yes/no response options--(a) clubs; (b) lessons in class and (c) special events (e.g. multicultural week, family night) sponsored by the school or community organisations. Results: Between 2014-2018, no states experienced decreases in opportunities for students to learn about people who are different from themselves; most states demonstrated no significant change. Conclusion: Findings suggest efforts are needed to strengthen capacity for and prioritisation of policies, programmes and practices promoting diversity and culturally relevant education in schools, and in turn, promote positive health and educational outcomes for youth.

Educators and caregivers can foster emotional wellbeing, growth, and resilience, contributing to a fulfilling and balanced adulthood by providing positive childhood experiences (PCEs). PCEs protect the brain and promote healing for people who have experienced adverse childhood environments (ACEs). In the presence of PCEs, adverse experiences in childhood do not always result in lifelong poor mental health. Knowing that PCEs can prevent ACEs, block toxic stress, and promote healing, the HOPE framework incorporates PCEs alongside ACEs. HOPE (Healthy Outcomes from Positive Experiences) is a framework that changes the way service providers engage with children and families. This article examines how the HOPE National Resource Center is transforming systems to create a research-based structured approach to care through PCEs.

Building a strong and vibrant school community is a vital component of fostering an environment where students thrive academically, emotionally, and socially. The APPLE Schools (appleschools.ca) health promotion project identifies eight essential elements that provide a steady formula for cultivating this environment. Backed by world-class research, these essential elements yield remarkable results for supporting happier and healthier kids in underserved school communities. APPLE Schools collaborates with 97 (and counting!) vulnerable school communities across Canada to improve students' lifelong wellness habits.

Some children with autism spectrum disorder (ASD) experience seizures and associated staring episodes, loss of consciousness, weakened muscle tone, and myoclonic jerking. Data recording of seizure frequency, duration, and co-occurring behavior is necessary to document the effects of anti-epileptic medications, identify contextual influences on seizure expression, and differentiate seizures from other movement disorders. We describe the design and operation of a computer-assisted system for recording seizures among children with ASD in a social validity study that revealed uniform approval and acceptance of the system from practitioners, clinicians, and nurse (N = 22), parents (N = 11), and neurologists (N = 7). The objectives and benefits of targeting the social validity of technology-based seizure tracking are discussed are discussed.

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.

This is a school-based intervention study to promote food label understanding among early adolescents. The researcher assessed the existing nutrition knowledge, attitude, and understanding of food labels. Based on Bandura's social cognitive theory, an educational program was developed. The change was accessed from pre- and post-test intervention scores, using questionnaire technique. The sample comprised of 490 children. The developed program was implemented on an experimental group of 250 students. The control group consisted of 240 students. The test scores increased for nutrition knowledge from 2.62 to 8.24, attitude towards information from 20.41 to 29.92, practice of using information from 20.63 to 28.24, and understanding from 1.24 to 3.75, whereas no improvement in scores was observed in control group.

The Education Sector of the recently updated National Physical Activity Plan (NPAP, 2023) was developed to assist schools, early care and education centers, and colleges and universities to establish policies and provide programmatic opportunities to support all students in adopting physically active lifestyles. The 2023 Education Sector strategies target K-12 education, preschool and early childhood education, as well as college and university contexts to develop and advocate for strong policies that promote physical education and physical activity for all students. Successful implementation of the Education Sector strategies has the potential to support high-quality program delivery. Specific to school physical education programs, the strategies' adoption has the capacity for a broad, lifelong impact. This article presents an overview of the Education Sector strategies and their related tactics, along with objectives specific for K-12 school physical education programming.

Loss of social supports and community programs due to lockdowns and other measures associated with COVID-19 has been linked to concerns over mental health and feelings of isolation. These challenges can be particularly acute for the elderly and people living with chronic or pervasive health conditions. "Dance for PD," a program specifically developed for people living with Parkinson's Disease, formerly offered in hundreds of locations around the globe, either halted or shifted to a virtual format. Our study investigates the transition of these dance-based programs to an online environment, with the aim of determining the extent to which a virtual format provides affective support or other benefits. Given the increased incidence of mental health problems and social isolation associated with COVID-19, this investigation aims to contribute to the development of better supports for vulnerable populations while helping us understand the specific contributions of dance-based programs in a virtual environment.

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.

With the beginning of the Corona pandemic at the beginning of 2019 and its rapid spread, the Kingdom of Saudi Arabia was among the countries that moved very quickly to address this matter. All state institutions played the role related to them. Saudi Ministry of Health launched an intensive package of warning, awareness, and guidance in the form of text messages through multiple electronic platforms to reach the largest segment of society. The study took three sources to collect data, three telecommunications companies, the official account of the Ministry of Health on Twitter and the official website of the Ministry. The current study was based on analyzing these messages in terms of warning levels in various speech acts according to the theories of Austin and Searle, in addition to analyzing the content in terms of its relationship to the actual text and the objective context. The study tried to seek the warning levels in the messages which were classified into three sections: high, moderate, and low and identified the types of actions that represent the levels. The significance of the study lies in revealing how language is used to raise the level of awareness in society. Based on the research methods, this study is analytical and descriptive, based on the theory of speech acts in its foundations, and the development of a reference model for analyzing warning levels that depend on the type of action and its implications, taking into account the indirect speech acts. The results of the study concluded that there is a clear discrepancy in the use of speech verbs to express the three levels of warning.

Determining the factors that influence implementation of school-based wellbeing and health programs is essential for achieving desired program effects. Using a convergent mixed-methods, multiple informant design, this study considered factors that influence implementation of health programs for ninth grade students and in what ways implementation is differentially perceived by multiple informants (i.e., participants, instructors, and independent observers). Two types of programs--mindfulness and health education--were implemented with ninth graders (N = 70) in three schools situated in low-resourced urban neighborhoods. Study outcomes were derived from four data sources: (1) focus group participants (N = 45); (2) program instructor fidelity ratings; (3) independent observer fidelity ratings and notes; and (4) instructor open-ended session responses. Using thematic and mixed methods integration analyses, we identified themes related to implementation promoting or challenging factors. Theme names differed when data sources were separately analyzed by informant. Mixed methods integration analysis indicated that four themes were common across all informant groups: (1) competent, attentive, and engaging instructors are essential; (2) programs should involve interactive components (e.g., physical activities, applied learning opportunities); (3) adequate time for program delivery is key for student exposure and engagement; and (4) students' availability and preferences should guide program scheduling. A fifth theme, unique to instructor and observer perspectives, was that program implementation was negatively impacted by distractions from multiple sources, including instructors, students, and settings. Recommendations from students, instructors, and observers for implementation optimization are discussed.

This article shares what was learned from the feasibility assessment of a nurse-led school-based active surveillance (SBAS) pilot to track chronic absenteeism using myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an exemplar. This pilot encompassed a 3-year period with training and feedback from school nurses (SNs) on data collection and ME/CFS. SNs found that the SBAS process helped them effectively identifying undiagnosed conditions. The assessment revealed the importance of focusing outreach efforts and establishing relationships with the school leadership in developing health policies and programs in the school setting. The pilot data were used to develop a manual to guide SNs for the SBAS process. This can be viewed as a model for SNs in establishing a surveillance to identify and track conditions like ME/CFS. With overlapping symptoms of Long COVID to ME/CFS, this assessment may provide insights for additional efforts to understand the impact of Long COVID on students' education.

Background: There is a well-documented need for more responsive promotion and prevention programming for young immigrants and refugees in the context of mental health and healthy development. Incorporating the voice of newcomers in the development of promotion and prevention efforts could assist in producing culturally-relevant materials and improve program outcomes. Objective: Our goal was to utilize youth voice to identify considerations for developing programming to support newcomer youths' healthy development. Methods: We employed mixed methods and analyzed data using concept mapping. A total of 37 newcomers between the ages of 14 and 22 participated in focus groups to share their ideas for creating programming that would focus on relationships and well-being. Relevant responses were collated, cleaned, and generated into unique statements, and then sorted individually by 26 youth into thematically similar categories. We used multidimensional scaling and hierarchal cluster analysis to produce a concept map. Results: Six concepts, in rank order of importance, emerged as follows: create a space for sharing; discuss relational issues; teach strategies for adjusting to a new country; teach wellness skills; have feel-good activities; and plan for diversity. Conclusions: Participants' lived experience and their own attendance in programming at newcomer organizations assisted them in brainstorming what types of activities, topics, and skills would be helpful for other newcomer youth, as well as considerations for facilitators implementing such programming. Promotion and prevention efforts intended for newcomer youth may benefit by incorporating ideas from the concept map.

Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; "P"-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.

Objective: To evaluate cardiopulmonary resuscitation (CPR) skills performance and retention in schoolchildren aged 8 to 12 years following instruction by their teachers and with the guidance of a school nurse using paediatric manikins. Design: Descriptive simulation trial. Method: A school nurse provided support to six schoolteachers as they taught a modified 40-minute CPR course. Pupils were shown an out-of-hospital cardiac-arrest recognition video followed by a CPR simulation using paediatric manikins. 117 schoolchildren aged 8 to 12 years received the training. Both the schoolchildren and teachers completed a survey before and afterwards. Children completed an out-of-hospital cardiac-arrest recognition test and a 1-minute CPR test 1 week later. Results: After training, schoolchildren increased their self-efficacy as rescuers (8 ± 2 vs 10 ± 2; p < 0.001). Irrespective of age differences, 74% of schoolchildren performed the entire out-of-hospital cardiac-arrest recognition sequence correctly. Children aged 11 to 12 years and 10 to 11 years performed higher quality CPR (49% and 47%, respectively) compared to 8 to 9 year olds (14%, p = 0.008 and p = 0.014). Children aged 11 to 12 years outperformed younger children aged 8 to 9 years with respect to compression depth (48 ± 6 mm vs 43 ± 5 mm, p = 0.008) Conclusion: Schoolchildren's teachers, who were guided by a nurse using paediatric manikins, taught children aged 10 to 12 years to perform high-quality CPR. We suggest integrating paediatric manikins as part of children's CPR training as feedback from successful CPR performance increases motivation and confidence to act as a rescuer as well as improves skills retention.

Background: Black men and women have the highest rates of obesity in the United States. Behavioral weight loss programs incorporating intimate partners may be effective in combating obesity among this population. Yet, current participation in these programs is low. Identifying motivations and triggers to weight loss may provide insight in designing programs to increase participation. Aim: To determine triggers and motivations for weight loss among Black men and women in committed relationships to inform development of weight loss interventions. Method: Twenty semi-structured interviews, based on an integrated theoretical framework of interdependence and communal coping and the social cognitive theory, were conducted among Black heterosexual couples where one or both individuals intentionally lost [greater than or equal to]5% of their body weight in the last 6 months in a metropolitan region in a southern state. Interviews were transcribed and coded. Themes were identified following multi-rater coding and direct and conventional content analysis. Recommendations were developed from emergent themes. Results: Among individuals with recent weight loss, personal relevancy and awareness (health awareness and self-awareness) were identified as personal triggers for weight loss initiation. Health concerns and appearance were general motivations among the total sample. Conclusion: Emphasizing the impact of weight on daily functioning and quality of life, and increasing awareness of personal weight status and health consequences, may increase weight loss initiation and participation in weight loss programs among Black men and women in committed relationships. Findings also highlight strategies to improve recruitment and retention and guide intervention development and implementation for this population.

Body mass index (BMI) screenings are conducted as part of Head Start's (HS) health and nutrition assessments. Weight status classifications, which rely on the accuracy of the BMI measurements, are communicated to caregivers to engage them in health behavior change. Limited qualitative research has been conducted on the procedures for BMI measurement and reporting in HS programs. Interviews (n=28) were conducted with HS health/nutrition managers in Ohio and North Carolina to understand the processes used to conduct BMI screenings and disseminate reports and identify related needs. Themes included "Personnel, Equipment, and Training for BMI Measurements"; "Classifying and Communicating BMI and Referrals"; "Professional Development Opportunities"; and "Resource, Training/Policy Needs to Support BMI Practices." Programs need additional resources to implement BMI measurement training and improve data accuracy and entry. Clarification of the referral/follow-up process and training around communicating with caregivers is also needed to better support families in implementing behavior change.

Background: Knowing which theoretical constructs work best to design effective interventions is essential for populations with increased disease burden. African American women (AAW) experience a greater prevalence of chronic diseases and fewer benefits from weight loss interventions compared to White women. Purpose: To examine how theoretical constructs were associated with lifestyle behaviors and weight outcomes in the Better Me Within (BMW) Randomized Trial. Methods: BMW used a tailored diabetes prevention program implemented in churches among AAW with BMI [greater than or equal to] 25. Regression models assessed relationships between constructs (self-efficacy, social support, and motivation), and outcomes (physical activity (PA), calories, and weight). Results: Among 221 AAW, mean (SD) age 48.8 years (11.2); mean weight 215.1 pounds (50.5), several significant relationships were found including an association between change in motivation for activity and change in PA (p = <0.01), and weight loss self-efficacy and weight at follow-up (p = <0.01). Discussion: The clearest relationships emerged for PA with motivation for activity and weight management social support demonstrating significance in all models. Translation to Health Education Practice: Self-efficacy, motivation, and social support show promise to promote changes in PA and weight among church-going AAW. Opportunities to keep engaging AAW in research are essential for eliminating health inequities in this population.

In 2019, Native youth had the highest rate of teen pregnancy of all racial/ethnic groups. "Respecting the Circle of Life" (RCL) is one of the first evidence-based teen pregnancy prevention programs for Native teens and there is interest in replicating the program across tribal communities. To inform replication, it is important to consider process data including quality, fidelity, and dosage as these may all moderate impact of the program. Participants were Native youth aged 11-19 and a trusted adult. This study includes participants randomized to the RCL program only (N = 266). Data sources include independent observations, facilitator self-assessments, attendance logs, and self-report assessments completed by enrolled youth at baseline and 3 months post assessment. Data was compiled and summed by cohort. Dosage was number of minutes participating in activities separated by theoretical constructs. Linear regression models were utilized to assess moderation of the effects of the intervention dosage on outcomes of interest. Eighteen facilitators delivered RCL. One hundred eighteen independent observations and 320 facilitator self-assessments were collected and entered. Findings indicate RCL was implemented with high fidelity and quality (4.40 to 4.82 out of a 5-point Likert scale; 96.6% of planned activities completed). Dosage was high with an average completion of 7 out of 9 lessons. There was no association between theoretical construct dosage and outcomes of interest. Overall, this study indicates RCL was delivered with high fidelity, quality, and dosage in this trial. This paper informs future replication of RCL and provides support for hiring paraprofessionals from the local community as facilitators, delivering the RCL to peer groups of the same age and sex, delivering the RCL with short duration and high frequency, and encouraging youth to attend all RCL lessons, but continue to serve youth who have missed one or more lessons.

This article highlights the promise of global health approaches for social studies curricula, especially urgent in the time of the COVID-19 pandemic. Focusing on six facets that inform a global health perspective, the authors offer social studies educators an approach from this applied field of study to support lessons and curriculum on COVID-19 across sociology, geography, and other disciplines within social studies education. The authors provide select digital resources for teachers and students to use in learning and teaching about the COVID-19 pandemic through a global health perspective aligned with the National Council for the Social Studies' Thematic Standards.

An organization's ability to accomplish its mission is often contingent upon its collective capacity to execute projects and/or initiatives in a timely and organized manner. Project management has a critical role in the delivery of projects within designated timelines, budgets, and defined quality. Duke University, in its entirety, comprises both its university campus and a growing health system. The organizational complexity of this enterprise necessitated the creation of a shared resource and platform for project managers across the institution to come together to share ideas, best practices, network, and engage in opportunities for professional development to better support the University's research mission. The mission of the Duke Project Management Community of Practice (Duke PMCoP) is to provide a professional network for project managers, including professional development activities; education and training for students, faculty, and staff; and a repository for best practices, tools, and resources in project management. In just over two years from its official launch, the Duke PMCoP has evolved into an active and robust community and boasts over 400 members participating from across Duke University and the local Veterans Affairs Health Care System in Durham, NC. This manuscript describes the development and implementation of the Duke PMCoP, in the context of the successes, challenges, and lessons learned during its establishment in a large, academic health system. Moving forward, the focus of the PMCoP is to sustain and grow the community to achieve recognition as the primary resource for project management expertise and mentorship across campus.

Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. This approach applied design thinking methods within a Successive Approximation Model design process. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions.

Background: Although positive youth development (PYD) programs have demonstrated effectiveness in improving adolescent reproductive health outcomes, there is a lack of evidence on effective school-based interventions designed especially for high school settings. This study examined the efficacy of Peer Group Connection (PGC-HS), a school-based PYD program, in improving sexual health outcomes for high school participants. Methods: A total of 1523 ninth-grade students at 18 schools were randomly assigned to be offered PGC-HS or a classes-as-usual control condition during 2016 to 2017 and 2017 to 2018 school years. Impacts were assessed on three confirmatory and 6 exploratory outcomes via self-reported participant questionnaire data collected at the beginning of 10th grade. Results: Although the offer of PGC-HS had no statistically detectable effect on confirmatory behavioral outcomes (sexual initiation, frequency of sex, and number of sexual partners) at 10th grade follow-up, causal impact estimates indicate that PGC-HS participants were less likely than control participants to ever have had vaginal sex. PGC-HS participants also scored higher on decision-making skills and perceived connection to peer connectedness. Conclusions: Results suggest that by building social and emotional skills and helping students form supportive peer relationships, PGC-HS may encourage students to make healthier choices and avoid risky behaviors during a critical period in high school, thus, reducing the risk of pregnancy.

The LiveLighter® 2016 'Junk Food' campaign ran for 5 weeks in Western Australia (WA) and urged adults to reduce their junk food consumption to avoid weight gain and associated chronic disease. A cohort design assessed campaign impact on knowledge, beliefs and behaviour. Pre-campaign (n = 1501) and post-campaign (n = 737) telephone surveys of WA adults aged 25-49 were undertaken. A post-campaign-only sample (n = 501) controlled for pre-test effects. The campaign reached 57% of respondents and increased knowledge of the link between overweight and non-alcoholic fatty liver disease (78% cf. 87%; P < 0.01). Following campaign activity, respondents were more likely to avoid purchasing food from settings depicted in the advertisements (fast food outlets: 63% cf. 77%; service stations: 82% cf. 93%; vending machines: 87% cf. 96%; all P < 0.001), particularly among pre-campaign consumers of fast food and salty snacks ([less than or equal to]2 times/week). Weight-loss self-efficacy increased among adults with higher body weight and campaign exposure (89% cf. 97%; P < 0.01), and there was no increased endorsement of overweight stereotypes among the full sample. Support for fiscal disincentives and nutritional disclosure policies increased among healthy weight adults. LiveLighter® positively influenced knowledge, beliefs and behaviours, along with attitudes towards policies to encourage healthy eating, supporting LiveLighter® as an advocacy campaign.

Fruit and Vegetable Prescription (FVRx) Programs combine produce prescriptions and nutrition education to reduce fruit and vegetable consumption barriers and promote health among low-income patient populations. This study examined whether a multi-level FVRx intervention model with intensive education improves dietary behaviors, food security, and health outcomes over single-level interventions alone. A 6-month nonrandomized, parallel, controlled trial was conducted with one intervention, FVRx (n = 31) and two comparison groups, Ad hoc Nutrition Education (n = 13) and Control (n = 16). The FVRx group received produce prescriptions (US$1/day/household member) redeemable at a farmer's market, two SNAP-Ed programs, one financial literacy program, and monthly health screenings. The Nutrition Education (NE) group participated in one SNAP-Ed program, and the Control group received safety-net clinic care only. Surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Pre-post clinical biomarkers (blood lipid and hemoglobin A1c) and monthly biometrics (anthropometrics and blood pressure) were measured. Descriptive analysis and one-way analysis of variance (ANOVA) were conducted. Compared with comparison groups, FVRx participants significantly increased the frequency of consuming dark green vegetables, FVRx (0.36 ± 0.72); NE (0.14 ± 0.33); Control (-0.09 ± 0.19) cups/day (p < 0.05). FVRx participants significantly improved multiple healthful food purchasing practices, and the ability to afford more utilities (FVRx (33%); NE (0%); Control (10%); p < 0.05). Limited changes were observed in food security and clinical biomarker outcomes between groups. Combining expanded nutrition and financial literacy education with produce prescriptions improves low-income adults' financial and food resources, preference, knowledge, purchase, and consumption of locally grown vegetables over single-level interventions.

This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < 0.05). There was no significant intervention effect on body mass index or behavioral outcomes (p > 0.05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.