Fifty Observations About the Health Promotion Discipline: Ambitions, Polemics and Inspiration (Part Two).

In part one of this editorial covering fifty observations about the history and evolution of the health promotion discipline I shared twenty five observations relating to societal trends, definitional nuances and seminal studies and resources that have contributed to the trajectory of the field. In this, part two of the editorial, I list an additional twenty five observations focused on polemics and controversies and on the importance of effective teaching, research and writing. I reflect on the different approaches used by public sector and private sector health promotion experts respectively. I also share inspirational quotes that I consider closely aligned with the vision and mission of our profession.

Fifty Observations About the Health Promotion Discipline: Tributes, Cautions and a Call to Action (Part One).

In observance of having worked for going on five decades in the health promotion profession, this editorial shares fifty observations about the state of our field. In part one, I offer these first twenty five observations that focus on societal trends that have shifted how we frame our work and the movement from wellness to well-being. I reflect on why the wellness term fell out of favor, the roots of the well-being term and attendant definitions of health promotion. Seminal professional text books, popular readership books and key studies that have informed the health promotion discipline are reviewed. I summarize several conundrums that need solving for and conclude with calls to action for health promotion professionals.

Belongingness, Well-Being and an Interview With Dr Pauline Dow.

The Supreme Court decision that race conscious admissions policies in universities are unconstitutional has created questions and concerns about the sustainability of diversity, equity and inclusion programs in many organizations and across sectors. This editorial provides hopeful examples of how belongingness is being embraced as a core value in many organizations. In an interview with education expert, Dr Pauline Dow, we discuss ways that the education sector creates trust and belongingness and explore best practices and leadership development methods that allow teachers to thrive. Lessons learned in the educator sector offer insights into how belongingness can be cultivated in other sectors, organizations and communities.

What are you Reading? A Glimpse Into What is Captivating Health Promotion Professionals.

Story telling is one of the most time honored methods for conveying ideas, inspiring action and offering insights into the foibles and ferment of the human condition. This editorial offers a glimpse into what is sparking the imaginations and passions of health promotion professionals by simply asking them 'what are you reading?' Those who shared the books currently sitting alongside their reading chairs were not asked to select books that were related to improving health and well-being. Still, it came as no surprise that contributors to this article uniformly described plots, characters and narratives that illuminate how life circumstances can accost health and jeopardize well-being. What's more, you will see that in fiction, non-fiction and fanciful fables alike, health promotion professionals extract inspiration from these books and find ways to apply the moral of these stories toward the improvement of our profession.

Research Findings Journalists Cannot Resist: A Tale of Three Mental Health and Well-Being Studies.

Addressing employee mental health needs and fostering organizations that enable thriving has become a priority for most workplace health and well-being initiatives. While mental health issues for the nation were of growing concern before COVID-19, the pandemic amplified concerns about loneliness, burnout and deaths of despair. A recent study that garnered attention from the popular press found that participants of individual-level mental health interventions were no better off than non-participants. This editorial reviews that study, summarizes limitations and beneficial learnings from the research, and argues that organizational factors have been shown to mitigate or amplify the effectiveness of mental health services. Tenets of 'patient-centered care' and the principles behind Total Worker Health® will need to be more broadly embraced so that the voice of employees can better inform workplace well-being strategies and strategic plans.

Ken the Movie: Allyship and When KENough is not Enough.

This editorial reviews Barbie the Movie in the context of workplace and community health and well-being. Issues of gender equity, patriarchy, and the role of women in empowering women were all factors that were dealt with thoughtfully and poignantly in the movie's script. A missed opportunity in the movie related to the role men could play as allies in the gender equity movement. Hence, I set out to reconcile this omission by proposing a story line for Ken the Movie. I present gender and health disparities as problems that will require leadership in, and best thinking about, gender equality from both men and women.

Why Not Offer Routine Screenings for Brain Health?

The merits of routine health screening for cancer and cardiovascular diseases are well established given the strong evidence that early detection can lead to effective interventions. Health systems, insurance providers and public health agencies have incorporated systematic approaches to ensuring that preventive screenings for hypertension, hyperlipidemia and cancers are encouraged, readily accessible and reimbursed. Workplace wellness programs intent on containing preventable healthcare costs have also sponsored age- and risk-adjusted health screenings, often including financial incentives to encourage same. Should we also screen for brain health? Is early detection of value for a condition with no proven treatment or cure? This editorial reviews the pros and cons of testing for cognitive decline, Alzheimer's and related dementias and suggests that with nearly every country in the world getting proportionally older, promoting brain health could emerge as a key intrinsic motivation for promoting healthier lifestyles. I conclude that a person-centered approach to deciding about testing is needed given uncertain evidence connecting health behaviors to cognitive decline.

The "Best of 2023 List" of Health Promotion Researchers.

Each year the editorial team of the American Journal of Health Promotion selects our "Best of the Year List" of health promotion studies from the prior year. This editorial features the Editor's Picks Awards, the Editor in Chief Awards, the Michael P. O'Donnell Award and the Dorothy Nyswander Award for the best research and writing published in 2023 in this journal. Our criteria for selection includes: whether the study addresses a topic of timely importance in health promotion, the research question is clearly stated and the study methods used are well executed; whether the paper is often cited and downloaded; if the study findings offer a unique contribution to the literature; and if the paper is well-written and enjoyable to read. Awardees in 2023 offered new insights into legal issues related to obesity and LGBTQ+ discrimination, the role of employers in the use of lifestyle medicine and the influence of Cannabis use on depression and suicide behaviors. This "best of 2023 list" featured studies based in communities, health systems, workplaces and schools and includes case studies and qualitative and quantitative research methods that enabled researchers to better explain what amplifies or hampers well-being.

The Association between Mediated Deprivation and Ovarian Cancer Survival among African American Women.

BACKGROUND: Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. METHODS: We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. RESULTS: The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS: First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen.

Association of inflammation-related exposures and ovarian cancer survival in a multi-site cohort study of Black women.

BACKGROUND: An association was observed between an inflammation-related risk score (IRRS) and worse overall survival (OS) among a cohort of mostly White women with invasive epithelial ovarian cancer (EOC). Herein, we evaluated the association between the IRRS and OS among Black women with EOC, a population with higher frequencies of pro-inflammatory exposures and worse survival. METHODS: The analysis included 592 Black women diagnosed with EOC from the African American Cancer Epidemiology Study (AACES). Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of the IRRS and OS, adjusting for relevant covariates. Additional inflammation-related exposures, including the energy-adjusted Dietary Inflammatory Index (E-DIITM), were evaluated. RESULTS: A dose-response trend was observed showing higher IRRS was associated with worse OS (per quartile HR: 1.11, 95% CI: 1.01-1.22). Adding the E-DII to the model attenuated the association of IRRS with OS, and increasing E-DII, indicating a more pro-inflammatory diet, was associated with shorter OS (per quartile HR: 1.12, 95% CI: 1.02-1.24). Scoring high on both indices was associated with shorter OS (HR: 1.54, 95% CI: 1.16-2.06). CONCLUSION: Higher levels of inflammation-related exposures were associated with decreased EOC OS among Black women.

The 2023 GOLD Report: Updated Guidelines for Inhaled Pharmacological Therapy in Patients with Stable COPD.

Over the past 22 years, annual GOLD Reports have documented important changes in guidance and recommendations for uniformly treating patients with chronic obstructive pulmonary disease (COPD) with the goal of improving outcomes in patients suffering from this condition. The most recent GOLD Report, released in 2023, shows continued refinement in several areas, including more precise definitions of COPD and exacerbations of COPD, a new set of parameters to assess exacerbation severity, an updated COPD assessment tool, updated guidelines for initial and follow-up treatment, new information regarding the association between pharmacological triple therapy and reduction in mortality, and new discussions of inhaler device choice and adherence to COPD medications. Whereas we do not address all of the new or updated material in GOLD's 2023 Report, we summarize key changes in GOLD's recommendations regarding inhalation therapy for stable COPD and frame these changes in the context of previous GOLD recommendations.

Reciprocal Effect of Environmental Stimuli to Regulate the Adipogenesis and Osteogenesis Fate Decision in Bone Marrow-Derived Mesenchymal Stem Cells (BM-MSCs).

Mesenchymal stem cells derived from bone marrow (BM-MSCs) can differentiate into adipocytes and osteoblasts. Various external stimuli, including environmental contaminants, heavy metals, dietary, and physical factors, are shown to influence the fate decision of BM-MSCs toward adipogenesis or osteogenesis. The balance of osteogenesis and adipogenesis is critical for the maintenance of bone homeostasis, and the interruption of BM-MSCs lineage commitment is associated with human health issues, such as fracture, osteoporosis, osteopenia, and osteonecrosis. This review focuses on how external stimuli shift the fate of BM-MSCs towards adipogenesis or osteogenesis. Future studies are needed to understand the impact of these external stimuli on bone health and elucidate the underlying mechanisms of BM-MSCs differentiation. This knowledge will inform efforts to prevent bone-related diseases and develop therapeutic approaches to treat bone disorders associated with various pathological conditions.

The Most Influential Women Leaders in Health Promotion.

This editorial features 13 of the most accomplished female leaders working in health promotion based on their contributions to health science, their mentorship, and their executive leadership for organizations with far reaching health impact. Meeting and far exceeding these criteria, the American Journal of Health Promotion is pleased to honor: Gail Christopher, Michelle Nunn, Karen Moseley, Kerry Evers, Wendy Lynch, Rachel Mosher Henke, Catherine Baase, Carter Blakey, Kinari Webb, Laurie Whitsel, Jessica Grossmeier, Vicki Shepard, and Michelle McMacken. Other renowned experts in the health promotion profession authored biographies of these amazing leaders and offered thoughts on how their influence will be felt in years to come. I offer reflections on the differential impact women leaders are having on the direction of the health promotion discipline.

Deprivation and segregation in ovarian cancer survival among African American women: a mediation analysis.

PURPOSE: Deprivation and segregation indices are often examined as possible explanations for observed health disparities in population-based studies. In this study, we assessed the role of recognized deprivation and segregation indices specifically as they affect survival in a cohort of self-identified Black women diagnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study. METHODS: Mediation analysis was used to examine the direct and indirect effects between deprivation or segregation and overall survival via a Bayesian structural equation model with Gibbs variable selection. RESULTS: The results suggest that high socioeconomic status-related indices have an association with increased survival, ranging from 25% to 56%. In contrast, index of concentration at the extremes-race does not have a significant impact on overall survival. In many cases, the indirect effects have very wide credible intervals; consequently, the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS: Our results show that Black women living in higher socioeconomic status neighborhoods are associated with increased survival with ovarian cancer using area-level economic indices such as Yost or index of concentration at the extremes-income. In addition, the Kolak urbanization index has a similar impact and highlights the importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.

The Ten Most Influential Women Scholars in Health Promotion.

This article features 10 of the most influential women scholars in health promotion: Drs Shiriki Kumanyika, Andrea Gielen, Leslie B. Hammer, Peggy A. Hannon, Sara Johnson, Michelle C. Kegler, Laura A. Linnan, Keshia Pollack Porter, Anastasia M. Snelling, and Glorian Sorensen. Other of the most influential researchers specializing in health promotion authored brief biographies of these extraordinary women summarizing what they are best known for and explaining how their influence on this profession will continue to be felt in the years ahead. I reflect on the merits of celebrating women in leadership and how women are shaping the health promotion discipline.

ESG Standards are TBD in Health Promotion: What the ESG Movement can Learn From the Workforce Wellness Movement.

Large organizations produce annual shareholder reports that tout their business success, and many also describe their role in doing well by their employees and communities. What if systemic efforts to improve employee and community health were a reporting requirement on par with the reporting of profits, losses and liquidity? This editorial examines the nascent ESG movement and its potential role in sparking systems changes that improve individual and organizational health. ESG is an acronym for the Environmental, Social and Governance (ESG) standards that many investment fund managers are considering as a component of evaluating company performance. Today, assessing investments that factor in health alongside other business success measures is commonplace but, recently, ESG factors have become political fodder. How is it that there is growing acceptance of corporate social responsibility principles among business leaders but a growing opposition to ESG standards by many politicians who otherwise identify as pro-business?

Role of neighborhood context in ovarian cancer survival disparities: current research and future directions.

Ovarian cancer is the fifth leading cause of cancer-associated mortality among US women with survival disparities seen across race, ethnicity, and socioeconomic status, even after accounting for histology, stage, treatment, and other clinical factors. Neighborhood context can play an important role in ovarian cancer survival, and, to the extent to which minority racial and ethnic groups and populations of lower socioeconomic status are more likely to be segregated into neighborhoods with lower quality social, built, and physical environment, these contextual factors may be a critical component of ovarian cancer survival disparities. Understanding factors associated with ovarian cancer outcome disparities will allow clinicians to identify patients at risk for worse outcomes and point to measures, such as social support programs or transportation aid, that can help to ameliorate such disparities. However, research on the impact of neighborhood contextual factors in ovarian cancer survival and in disparities in ovarian cancer survival is limited. This commentary focuses on the following neighborhood contextual domains: structural and institutional context, social context, physical context represented by environmental exposures, built environment, rurality, and healthcare access. The research conducted to date is presented and clinical implications and recommendations for future interventions and studies to address disparities in ovarian cancer outcomes are proposed.

Excellence in Total Worker Health® and an Interview With Dr Laura Linnan.

The National Institute of Occupational Safety and Health (NIOSH) defines Total Worker Health® as "policies, programs and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being." This editorial features an interview with Dr Laura Linnan, a leader of the workplace health and well-being movement and a Principal Investigator for one of the ten 'Centers of Excellence in Total Worker Health®' sponsored by NIOSH to study how approaches to better integrating health and safety can improve outcomes. We discuss differences between "comprehensive approaches" to workplace wellness and a Total Worker Health® approach. I also interview ChatGBT to assess whether the latest in artificial intelligence is accurate in its understanding of contemporary workplace based health promotion.

The association of preexisting severe asthma with COVID-19 outcomes.

PURPOSE OF REVIEW: Three years after the emergence of coronavirus disease 2019 (COVID-19), many studies have examined the association between asthma and COVID-related morbidity and mortality, with most showing that asthma does not increase risk. However, the U.S. Centers for Disease Control (CDC) currently suggests that patients with severe asthma may, nonetheless, be particularly vulnerable to COVID-19-related morbidity. RECENT FINDINGS: With respect to poor COVID-19 outcomes, our search yielded nine studies that quantified associations with severe asthma, seven that considered use of monoclonal antibodies (mAB), and 14 that considered inhaled corticosteroids (ICS) use. mAb and ICS use have been used as measures of severe asthma in several studies. Severe asthma was significantly associated with poor COVID-19 outcomes. The results for mAb and ICS were mixed. SUMMARY: An increased risk of poor COVID-19 outcomes in patients with severe asthma is possible. However, these studies remain sparse and suffer from several methodological limitations that hinder their interpretation. Additional evidence is needed to provide clear, cogent guidance for health agencies seeking to inform patients with asthma about potential risks due to COVID-19.