Evaluating Methods for Mapping Historical Redlining to Census Tracts for Health Equity Research.

Neighborhood characteristics including housing status can profoundly influence health. Recently, increasing attention has been paid to present-day impacts of "redlining," or historic area classifications that indicated less desirable (redlined) areas subject to decreased investment. Scholarship of redlining and health is emerging; limited guidance exists regarding optimal approaches to measuring historic redlining in studies of present-day health outcomes. We evaluated how different redlining approaches (map alignment methods) influence associations between redlining and health outcomes. We first identified 11 existing redlining map alignment methods and their 37 logical extensions, then merged these 48 map alignment methods with census tract life expectancy data to construct 9696 linear models of each method and life expectancy for all 202 redlined cities. We evaluated each model's statistical significance and R2 values and compared changes between historical and contemporary geographies and populations using Root Mean Squared Error (RMSE). RMSE peaked with a normal distribution at 0.175, indicating persistent difference between historical and contemporary geographies and populations. Continuous methods with low thresholds provided higher neighborhood coverage. Weighting methods had more significant associations, while high threshold methods had higher R2 values. In light of these findings, we recommend continuous methods that consider contemporary population distributions and mapping overlap for studies of redlining and health. We developed an R application {holcmapr} to enable map alignment method comparison and easier method selection.

Young Adult Sexual Behavior in South Africa: How Important is Parental Social Support?

Risky sexual behavior exposes young adults to poor reproductive health outcomes. Parental social support is associated with reduced incidence of risky sexual behavior, but this association has not been adequately investigated in South Africa. We used data from Waves 1 and 3 of the Cape Area Panel Study (a longitudinal study of adolescents and young adults aged 14-22 years and living in the Cape Town metropolitan area) to investigate the associations between parental social support and young adult risky sexual behavior in South Africa. We conducted multivariable logistic regression analyses to assess whether lack of specific categories of parental social supports at wave 1 (baseline) are associated with higher risky sexual behaviors by young adults at wave 3 (follow-up). We found that young adults who never ate meals with their mothers and those who never discussed personal matters with their fathers had increased risks of multiple sexual partnerships. Also, young adults who never got pocket money or money for gifts from their mothers had increased risk to engage in unprotected sex during their first sexual encounter. Our findings suggest that eating family meals, discussing personal matters with youth, and providing them with pocket money, may protect young adults in South Africa from risky sexual behavior.

Organizational response to workplace violence, and its association with depressive symptoms: A nationwide survey of 1966 Korean EMS providers.

OBJECTIVES: This study investigated whether organizational responses modified the associations between experiencing violence and depressive symptoms among emergency workers. METHODS: A nationwide survey of 1966 Korean emergency medical service (EMS) providers was analyzed. Experience of workplace violence (ie, physical violence, verbal abuse) was classified into four groups based on the victims' reporting and organizational responses: (i) "Not experienced," (ii) "Experienced, not reported," (iii) "Experienced, reported, responded by organization,"and (iv) "Experienced, reported, not responded by organization." Depressive symptoms were assessed by 11-item version of the Centers for Epidemiologic Studies Depression Scale. RESULTS: Compared to "Not experienced" group, physical violence was significantly associated with depressive symptoms among EMS providers responding "Experienced, not reported" (PR: 1.67, 95% CI: 1.37, 2.03) and "Experienced, reported, not responded by organization" (PR: 2.58, 95% CI: 1.75, 3.82), after adjusting for confounders. No significant difference was detected for workers responding "Experienced, reported, responded by organization" group (PR: 1.45, 95% CI: 0.87, 2.41). Similar trends were observed in the analysis with verbal abuse. CONCLUSIONS: Our findings suggest that organizational responses could play a critical role in mitigating depressive symptoms among EMS providers who experience violence at work.

Integrating children's physical activity enjoyment into public health dialogue (United States).

Physical activity engagement during childhood is associated with positive health outcomes in adulthood. Exercise and sport science research links physical activity enjoyment with physical activity adoption and maintenance, among other positive health behaviors. However, public health researchers rarely measure enjoyment or discuss its role in interventions or theory. In this paper, we present the rationale for bringing enjoyment to the forefront of public health dialogue and action to increase physical activity in children and across the life course. We outline five potential explanations for the lack of physical activity enjoyment research in public health, and offer solutions and action steps for each. Enjoyment research has the potential to improve people's health by working on multiple levels, from individuals to schools to public sectors, and could have positive implications for various health behaviors.

Associations Between Marijuana Use and Involuntary Job Loss in the United States: Representative Longitudinal and Cross-Sectional Samples.

OBJECTIVE: To investigate whether marijuana use is associated with involuntary job loss. METHODS: Multivariable survey logistic analysis of longitudinal (2001 to 2002/2003 to 2004) and cross-sectional data (2012 to 2013) from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS: Marijuana use increased for all user groups with most workers who use marijuana using marijuana monthly (2.7% in 2001 to 2002 and 10.8% in 2012 to 2013). Past year marijuana users in 2001 to 2002 had higher odds of involuntary job loss in 2003 to 2004 (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.13 to 1.41). Daily marijuana use is associated with higher odds of job loss in adjusted analyses using longitudinal (OR 2.18; 95%CI 1.71 to 2.77) and cross-sectional data (OR 1.40; 95%CI 1.06 to 1.86). Income significantly modifies these effects. CONCLUSIONS: Findings indicate that job loss may be an overlooked social cost of marijuana use for US workers. Future studies using an occupational health perspective are needed.

A Cluster Randomized Controlled Trial of a Total Worker Health® Intervention on Commercial Construction Sites.

This study evaluated the efficacy of an integrated Total Worker Health® program, "All the Right Moves", designed to target the conditions of work and workers' health behaviors through an ergonomics program combined with a worksite-based health promotion Health Week intervention. A matched-pair cluster randomized controlled trial was conducted on ten worksites (five intervention (n = 324); five control sites (n = 283)). Worker surveys were collected at all sites pre- and post- exposure at one- and six-months. Linear and logistic regression models evaluated the effect of the intervention on pain and injury, dietary and physical activity behaviors, smoking, ergonomic practices, and work limitations. Worker focus groups and manager interviews supplemented the evaluation. After controlling for matched intervention and control pairs as well as covariates, at one-month following the ergonomics program we observed a significant improvement in ergonomic practices (B = 0.20, p = 0.002), and a reduction in incidences of pain and injury (OR = 0.58, p = 0.012) in the intervention group. At six months, we observed differences in favor of the intervention group for a reduction in physically demanding work (B = -0.25, p = 0.008), increased recreational physical activity (B = 35.2, p = 0.026) and higher consumption of fruits and vegetables (B = 0.87, p = 0.008). Process evaluation revealed barriers to intervention implementation fidelity and uptake, including a fissured multiemployer worksite, the itinerant nature of workers, competing production pressures, management support, and inclement weather. The All the Right Moves program had a positive impact at the individual level on the worksites with the program. For the longer term, the multi-organizational structure in the construction work environment needs to be considered to facilitate more upstream, long-term changes.

Maternal Cannabis Use During a Child's Lifetime Associated With Earlier Initiation.

INTRODUCTION: Earlier cannabis initiation is associated with more severe neuropsychiatric and social consequences. The authors investigated whether mothers' cannabis use is associated with earlier cannabis initiation by their children. METHODS: Mother and child data were from the National Longitudinal Survey of Youth 1979 (1980-1998 waves) and Child and Young Adults (1988-2014 waves) cohorts, respectively. Cox proportional hazard models assessed the effect of maternal cannabis use prior to a child's adolescence on the child's risk of subsequent cannabis initiation. Models were stratified by race and child's age category (6-16, 17-24, ≥25 years). Adjusted analyses controlled for sociodemographic variables. Analyses were conducted in 2017. RESULTS: Median age of cannabis initiation for children of maternal ever users was age 16years compared with age 18years among children of maternal never users. Children of 1-year and multiple-year users were at increased risk of cannabis initiation between ages 6 and 16years (hazard ratio=1.38, p<0.001, and hazard ratio = 1.45, p<0.001, respectively). Effects were slightly stronger among non-Hispanic non-black children. CONCLUSIONS: As cannabis legalization expands across the U.S., adult use may become increasingly normative. This study indicates that maternal cannabis use may be a risk factor for early initiation among their offspring. Preventive interventions should consider strategies to delay initiation among children of cannabis users.

Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children's Food, Beverage, and Calorie Consumption among Snacks Served.

BACKGROUND: Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children's snacking behaviors. OBJECTIVE: Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack. DESIGN: This was a secondary analysis of a group-randomized controlled trial. PARTICIPANTS/SETTING: Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation. INTERVENTION: The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education. MAIN OUTCOME MEASURES: Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up. STATISTICAL ANALYSES PERFORMED: This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type. RESULTS: Children in intervention sites had greater decreases in consumption of juice (-0.61 oz/snack, 95% CI -1.11 to -0.12), beverage calories (-29.1 kcal/snack, 95% CI -40.2 to 18.0), foods with trans fats (-0.12 servings/snack, 95% CI -0.19 to -0.04), total calories (-47.7 kcal/snack, 95% CI -68.2 to -27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice. CONCLUSIONS: Results demonstrate that an afterschool intervention can improve children's dietary snack consumption, particularly at sites with on-site foodservice.

Intimate partner violence against low-income women in Mexico City and associations with work-related disruptions: a latent class analysis using cross-sectional data.

BACKGROUND: Disrupting women's employment is a strategy that abusive partners could use to prevent women from maintaining economic independence and stability. Yet, few studies have investigated disruptions in employment among victims of intimate partner violence (IPV) in low-income and middle-income countries. Moreover, even fewer have sought to identify which female victims of IPV are most vulnerable to such disruptions. METHODS: Using baseline data from 947 women in Mexico City enrolled in a randomised controlled trial, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Furthermore, multilevel logistic regression analyses were performed on a subsample of women reporting current work (n=572) to investigate associations between LCA membership and IPV-related employment disruptions. RESULTS: Overall, 40.6% of women who were working at the time of the survey reported some form of work-related disruption due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); High Sexual and Low Physical Violence class (9.6%); High Physical and Low Sexual Violence and Injuries (36.5%); High Physical and Sexual Violence and Injuries (14.8%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of work disruption (adjusted relative risk (ARR) 2.44, 95% CI 1.80 to 3.29; ARR 2.05, 95% CI 1.56 to 2.70, respectively). No other statistically significant associations emerged. CONCLUSION: IPV, and specific patterns of IPV experiences, must be considered both in work settings and, more broadly, by economic development programmes. TRIAL REGISTRATION NUMBER: NCT01661504.

Measuring Best Practices for Workplace Safety, Health, and Well-Being: The Workplace Integrated Safety and Health Assessment.

OBJECTIVE: To present a measure of effective workplace organizational policies, programs, and practices that focuses on working conditions and organizational facilitators of worker safety, health and well-being: the workplace integrated safety and health (WISH) assessment. METHODS: Development of this assessment used an iterative process involving a modified Delphi method, extensive literature reviews, and systematic cognitive testing. RESULTS: The assessment measures six core constructs identified as central to best practices for protecting and promoting worker safety, health and well-being: leadership commitment; participation; policies, programs, and practices that foster supportive working conditions; comprehensive and collaborative strategies; adherence to federal and state regulations and ethical norms; and data-driven change. CONCLUSIONS: The WISH Assessment holds promise as a tool that may inform organizational priority setting and guide research around causal pathways influencing implementation and outcomes related to these approaches.

The Effect of Workforce Mobility on Intervention Effectiveness Estimates.

Background: Little is known about how mobile populations of workers may influence the ability to implement, measure, and evaluate health and safety interventions delivered at worksites. Methods: A simulation study is used to objectively measure both precision and relative bias of six different analytic methods as a function of the amount of mobility observed in the workforce. Those six methods are then used to reanalyze a previously conducted cluster-randomized control trial involving a highly mobile workforce in the construction industry. Results: As workforce mobility increases, relative bias in treatment effects derived from standard models to analyze cluster-randomized trials also increases. Controlling for amount of time exposed to the intervention can greatly reduce this bias. Analyzing only subsets of workers who exhibit the least amount of mobility can result in decreased precision of treatment effect estimates. We demonstrate a 59% increase in the treatment effect size from the reanalysis of the previously conducted trial. Conclusions: When evaluating organizational interventions implemented at specific worksites by measuring perceptions and outcomes of workers present at those sites, researchers should consider the effects that the mobility of the workforce may have on the estimated treatment effects. The choice of analytic method can greatly affect both precision and accuracy of estimates.

The Family Time Squeeze: Perceived Family Time Adequacy Buffers Work Strain in Certified Nursing Assistants With Multiple Caregiving Roles.

Purpose of the Study: This study examined how certified nursing assistants (CNAs) with unpaid family caregiving roles for children ("double-duty-child caregivers"), older adults ("double-duty-elder caregivers"), and both children and older adults ("triple-duty caregivers") differed from their nonfamily caregiving counterparts ("workplace-only caregivers") on four work strain indicators (emotional exhaustion, job satisfaction, turnover intentions, and work climate for family sacrifices). The moderating effects of perceived family time adequacy were also evaluated. Design and Methods: Regression analyses were conducted on survey data from 972 CNAs working in U.S.-based nursing homes. Results: Compared with workplace-only caregivers, double-and-triple-duty caregivers reported more emotional exhaustion and pressure to make family sacrifices for the sake of work. Triple-duty caregivers also reported less job satisfaction. Perceived family time adequacy buffered double-duty-child and triple-duty caregivers' emotional exhaustion and turnover intentions, as well as reversed triple-duty caregivers' negative perceptions of the work climate. Implications: Perceived family time adequacy constitutes a salient psychological resource for double-duty-child and triple-duty caregivers' family time squeezes. Amid an unprecedented demand for long-term care and severe direct-care workforce shortages, future research on workplace factors that increase double-and-triple-duty caregiving CNAs' perceived family time adequacy is warranted to inform long-term care organizations' development of targeted recruitment, retention, and engagement strategies.

An Inspection Tool and Process to Identify Modifiable Aspects of Acute Care Hospital Patient Care Units to Prevent Work-Related Musculoskeletal Disorders.

A dearth of practical resources is available for evaluating ergonomic risk factors in dynamic health care work environments. Of particular need are tools for inspecting patient care environments for hazards. The goal of this study was to describe the development and application of an inspection tool and a process for identifying hazards inherent in the modifiable aspects of the physical environment to reduce injury risk to hospital workers. Through an iterative and participatory process, the tool and inspection process were developed with three purposes in mind: (a) create a framework for the inspection of physical work environments and physical conditions of work associated with injury risk (hazards), (b) document the physical conditions, and (c) provide feedback to decision makers. The tool and process were used by an ergonomics researcher on four patient care units as part of the Be Well, Work Well Total Worker Health® intervention. The resulting inspection process provided a structured method for recognizing hazards in the dynamic modifiable physical work environment and reporting both observations and recommendations to decision makers. The development and implementation of the inspection tool provided guidance to modify the physical work environment by implementing ergonomic solutions. The tool allowed the organization to plan and prioritize ergonomic hazard abatement (e.g. resource allocation and tracking trends). Within a Total Worker Health® framework, this tool can measure work practices which can then be used to inform organizational programs and policies within a health care setting.

Cigarette graphic health warning labels and information avoidance among individuals from low socioeconomic position in the U.S.

PURPOSE: Although graphic health warning labels (GHWs) on cigarette packs have influenced cessation behaviors in other countries, no U.S. studies have explored the impact of avoidance of GHW content among individuals from low socioeconomic position (SEP). The purpose of this study was to determine the predictors of intention to avoid GHWs, and how avoidance impacts cessation intention, in a low SEP sample in the U.S. METHODS: Data come from low SEP smokers (n = 541) involved in a field experiment. The participants responded to questions pre- and post viewing of GHWs assessing SEP, intention to avoid them, emotional reactions, and intention to seek health information or quit smoking. Backwards stepwise logistic regression determined the predictors for intention to avoid GHWs. Simple and adjusted logistic regression analyzed the association between avoidance and its main predictors and outcomes of intentions to seek information or quit smoking. RESULTS: Predictors for avoidance included being somewhat addicted to cigarettes (OR 2.3, p = 0.002), younger than 25 (OR 2.6, p = 0.008), and having medium (OR 3.4, p < 0.001) or high (OR 4.7, p < 0.001) levels of negative emotional reaction to the labels. Intention to avoid GHWs was positively associated with the intent to look for health information about smoking (OR 2.2, p = 0.002). Higher levels of negative emotional reaction were positively associated with cessation behaviors, with high negative emotional reaction associated with nine times the odds of quitting (p < 0.001). CONCLUSIONS: Results indicate avoidance of GHWs does not detract from the labels' benefit and that GHWs are an effective means of communicating smoking risk information among low SEP groups.

Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults.

PURPOSE: Gender nonconformity, that is, transgressing conventionally "masculine" vs. "feminine" characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such social stressors and health-related quality of life (HRQOL). This paper aimed to examine associations between perceived gender nonconformity and HRQOL in a cohort of U.S. adolescents and young adults. METHODS: Using data from 8408 participants (18-31 years) in the U.S. Growing Up Today Study (93% white, 88% middle-to-high income), we estimated risk ratios (RRs) for the association of gender nonconformity (three levels: highly gender conforming, moderately conforming, and gender nonconforming) and HRQOL using the EuroQol questionnaire (EQ-5D-5L). Models were adjusted for demographic characteristics, including sexual orientation identity. RESULTS: Gender nonconformity was independently associated with increased risk of having problems with mobility [RR (95% confidence interval): 1.76 (1.16, 2.68)], usual activities [2.29 (1.67, 3.13)], pain or discomfort [1.59, (1.38, 1.83)], and anxiety or depression [1.72 (1.39, 2.13)], after adjusting for sexual orientation and demographic characteristics. Decrements in health utility by gender nonconformity were observed: compared to persons who were highly gender conforming, mean health utility was lower for the moderately gender conforming [beta (SE): -0.011 (.002)] and lowest for the most gender nonconforming [-0.034 (.005)]. CONCLUSIONS: In our study, HRQOL exhibited inequities by gender nonconformity. Future studies, including in more diverse populations, should measure the effect of gender-related harassment, discrimination, and violence victimization on health and HRQOL.

Effects on cigarette consumption of a work-family supportive organisational intervention: 6-month results from the work, family and health network study.

BACKGROUND: Observational studies have linked work-family issues with cigarette consumption. This study examined the 6-month effects on cigarette consumption of a work-family supportive organisational intervention among nursing home workers. METHODS: Group randomised controlled trial where 30 nursing homes across New England states were randomly assigned to either usual practice or to a 4-month intervention aimed at reducing work-family conflict via increased schedule control and family supportive supervisory behaviours (FSSB). Cigarette consumption was based on self-reported number of cigarettes per week, measured at the individual level. RESULTS: A total of 1524 direct-care workers were enrolled in the trial. Cigarette consumption was prevalent in 30% of the sample, consuming an average of 77 cigarettes/week. Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes, while no reduction was observed among smokers at usual practice sites (b=-7.12, 95% CI -13.83 to -0.40, p<0.05) (d=-0.15). The majority of smokers were US-born White nursing assistants, and among this subgroup, the reduction in cigarette consumption was stronger (b=-12.77, 95% CI -22.31 to -3.22, p<0.05) (d=-0.27). Although the intervention prevented a decline in FSSB (d=0.08), effects on cigarette consumption were not mediated by FSSB. CONCLUSIONS: Cigarette consumption was reduced among smokers at organisations where a work-family supportive intervention was implemented. This effect, however, was not explained by specific targets of the intervention, but other psychosocial pathways related to the work-family interface. TRIAL REGISTRATION NUMBER: NCT02050204; results.

Beyond access: barriers to internet health information seeking among the urban poor.

OBJECTIVE: Communication inequalities deepen health disparities even when internet access is achieved. The goal of this study is to understand how a range of barriers may inhibit individuals from low socioeconomic position (SEP) from engaging with online health information even when it is freely available. MATERIALS AND METHODS: Detailed data were collected from 118 low-SEP individuals from a randomized controlled trial providing internet access. Measures triangulated the health-seeking experience through internet use tracked in real-time, call log data, and self-reported barriers. Negative binomial regression models were fitted with technology and perceived predictors, and our outcome, health information seeking, and then stratified by medical status. RESULTS: Participants experienced a median of two computer issues (median 6 days) and two internet issues (median 6.5 days). Duration of internet problems was associated with a decrease in the rate of internet health information seeking by a factor of 0.990 (P = .03) for each additional day. Participants with a medical problem who were frustrated in their search for health information had half the rate of health information seeking of those who were not frustrated (incidence rate ratio = 0.395, P = .030). DISCUSSION: Despite IT support, participants still experienced internet connectivity issues that negatively impacted their health information seeking. Frustration in their search to find information may serve as an additional barrier to those who have medical issues. CONCLUSION: After initial internet access, a second-level digital divide emerged due to connectivity issues, highlighting the need to understand the complex network of barriers experienced by low-SEP internet users.

Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care.

We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59-0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality.

Effects of a Workplace Intervention on Parent-Child Relationships.

This study tested whether effects of a workplace intervention, aimed at promoting employees' schedule control and supervisor support for personal and family life, had implications for parent-adolescent relationships; we also tested whether parent-child relationships differed as a function of how many intervention program sessions participants attended. Data came from a group randomized trial of a workplace intervention, delivered in the information technology division of a Fortune 500 company. Analyses focused on 125 parent-adolescent dyads that completed baseline and 12-month follow-up home interviews. Results revealed no main effects of the intervention, but children of employees who attended 75% or more program sessions reported more time with their parent and more parent education involvement compared to adolescents whose parents attended less than 75% of sessions, and they tended to report more time with parent and more parental solicitation of information about their experiences compared to adolescents whose parents were randomly assigned to the usual practice condition.

Entertainment or Health? Exploring the Internet Usage Patterns of the Urban Poor: A Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: Important gaps remain in our knowledge of how individuals from low socioeconomic position (SEP) use the Internet for resources and in understanding the full range of activities they perform online. Although self-report data indicate that low SEP individuals use the Internet less than high SEP people for health information and for other beneficial capital-enhancing activities, these results may not provide an accurate overall view of online use. OBJECTIVE: The aim of this study was to determine the ways in which low SEP individuals use the Internet, including for entertainment, social networking, and capital-enhancing functions, and how they are associated with health information seeking. METHODS: Detailed Web tracking data were collected from 118 low SEP individuals who participated in the intervention group of a randomized controlled trial that provided Internet access. Websites were grouped by topic, including categories of capital-enhancing websites that provided access to resources and information. Different types of online activities were summed into an Internet use index. Single and multiple negative binomial regression models were fitted with the Internet use index as the predictor and health information seeking as the outcome. Next, models were fitted with low, medium, and high Web usage in capital-enhancing, entertainment, and social network categories to determine their associations with health information seeking. RESULTS: Participants used the Web for diverse purposes, with 63.6% (75/118) accessing the Internet for all defined types of Internet use. Each additional category of Internet use was associated with 2.12 times the rate of health information seeking (95% CI 1.84-2.44, P<.001). Higher use of each type of capital-enhancing information was associated with higher rates of health information seeking, with high uses of government (incident rate ratio [IRR] 8.90, 95% CI 4.82-16.42, P<.001) and news (IRR 11.36, 95% CI 6.21-20.79, P<.001) websites associated with the highest rates of health information seeking compared to their lowest use categories. High entertainment website use (IRR 3.91, 95% CI 2.07-7.37, P<.001) and high social network use (IRR 2.06, 95% CI 1.08-3.92, P=.03) were also associated with higher health information seeking. CONCLUSIONS: These data clearly show that familiarity and skills in using the Internet enhance the capacity to use it for diverse purposes, including health and to increase capital, and that Internet usage for specific activities is not a zero sum game. Using it for one type of topic, such as entertainment, does not detract from using it for other purposes. Findings may inform ways to engage low SEP groups with Internet resources.