The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods.

CONTEXT: The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking. OBJECTIVE: To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences. DESIGN: Cross-sectional survey. SETTING: The Navajo Nation. PARTICIPANTS: A total of 234 Navajo Nation community members across 21 communities. OUTCOME MEASURES: The percentage of participants who were supportive of the HDNA. RESULTS: Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001). CONCLUSIONS: The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.

Online Recruitment Methods for Web-Based and Mobile Health Studies: A Review of the Literature.

BACKGROUND: Internet and mobile health (mHealth) apps hold promise for expanding the reach of evidence-based health interventions. Research in this area is rapidly expanding. However, these studies may experience problems with recruitment and retention. Web-based and mHealth studies are in need of a wide-reaching and low-cost method of recruitment that will also effectively retain participants for the duration of the study. Online recruitment may be a low-cost and wide-reaching tool in comparison to traditional recruitment methods, although empirical evidence is limited. OBJECTIVE: This study aims to review the literature on online recruitment for, and retention in, mHealth studies. METHODS: We conducted a review of the literature of studies examining online recruitment methods as a viable means of obtaining mHealth research participants. The data sources used were PubMed, CINAHL, EbscoHost, PyscINFO, and MEDLINE. Studies reporting at least one method of online recruitment were included. A narrative approach enabled the authors to discuss the variability in recruitment results, as well as in recruitment duration and study design. RESULTS: From 550 initial publications, 12 studies were included in this review. The studies reported multiple uses and outcomes for online recruitment methods. Web-based recruitment was the only type of recruitment used in 67% (8/12) of the studies. Online recruitment was used for studies with a variety of health domains: smoking cessation (58%; 7/12) and mental health (17%; 2/12) being the most common. Recruitment duration lasted under a year in 67% (8/12) of the studies, with an average of 5 months spent on recruiting. In those studies that spent over a year (33%; 4/12), an average of 17 months was spent on recruiting. A little less than half (42%; 5/12) of the studies found Facebook ads or newsfeed posts to be an effective method of recruitment, a quarter (25%; 3/12) of the studies found Google ads to be the most effective way to reach participants, and one study showed better outcomes with traditional (eg in-person) methods of recruitment. Only one study recorded retention rates in their results, and half (50%; 6/12) of the studies recorded survey completion rates. CONCLUSIONS: Although online methods of recruitment may be promising in experimental research, more empirical evidence is needed to make specific recommendations. Several barriers to using online recruitment were identified, including participant retention. These unique challenges of virtual interventions can affect the generalizability and validity of findings from Web-based and mHealth studies. There is a need for additional research to evaluate the effectiveness of online recruitment methods and participant retention in experimental mHealth studies.

Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction.

BACKGROUND: Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. OBJECTIVE: To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). METHOD: Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. RESULTS: Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26). CONCLUSION AND RELEVANCE: Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.

Precision mentoring (PM): a proposed framework for increasing research capacity in health-related disciplines.

PROBLEM: Research productivity is expected of academic faculty, and mentoring can facilitate it. This paper presents a framework for using mentoring to develop researchers in health disciplines. APPROACH: We utilized recent literature reviews, and experience developing researchers at an emerging research institution within the Research Centers for Minority Institutions (RCMI) program, to propose a precision mentoring (PM) framework for research development. OUTCOMES: Although we cannot precisely determine how much improvement was due to the PM framework, over the 4 years of our program, the quality and quantity of pilot project proposals (PPP) has increased, the number of external proposals submitted and funded by PPP investigators has increased, and the number of faculty participating in our program has increased. Surveys distributed to our 2021-22 PPP applicants who did not receive funding (n = 5/6 or 86.7%) revealed that new investigators most frequently sought mentoring related to career guidance (e.g., institutional culture, pre-tenure survival strategies), grant proposal basics (e.g., working with funding agencies, reviewing aims, balancing priorities, and enhancing scientific rigor), and identifying funding opportunities. NEXT STEPS: We recommend shifting the mentoring paradigm such that: (a) mentees are pre-screened and re-screened for their current skill set and desired areas of growth; (b) mentoring occurs in teams vs. by individuals; (c) mentors are trained and rewarded, and (d) attention is paid to enhancing institutional culture.

Mentoring New and Early-Stage Investigators and Underrepresented Minority Faculty for Research Success in Health-Related Fields: An Integrative Literature Review (2010-2020).

Mentoring to develop research skills is an important strategy for facilitating faculty success. The purpose of this study was to conduct an integrative literature review to examine the barriers and facilitators to mentoring in health-related research, particularly for three categories: new investigators (NI), early-stage investigators (ESI) and underrepresented minority faculty (UMF). PsychINFO, CINAHL and PubMed were searched for papers published in English from 2010 to 2020, and 46 papers were reviewed. Most papers recommended having multiple mentors and many recommended assessing baseline research skills. Barriers and facilitators were both individual and institutional. Individual barriers mentioned most frequently were a lack of time and finding work-life balance. UMF mentioned barriers related to bias, discrimination and isolation. Institutional barriers included lack of mentors, lack of access to resources, and heavy teaching and service loads. UMF experienced institutional barriers such as devaluation of experience or expertise. Individual facilitators were subdivided and included writing and synthesis as technical skills, networking and collaborating as interpersonal skills, and accountability, leadership, time management, and resilience/grit as personal skills. Institutional facilitators included access to mentoring, professional development opportunities, and workload assigned to research. Advocacy for diversity and cultural humility were included as unique interpersonal and institutional facilitators for UMF. Several overlapping and unique barriers and facilitators to mentoring for research success for NI, ESI and UMF in the health-related disciplines are presented.

Seasonal Variability in Weight Gain Among American Indian, Black, White, and Hispanic Children: A 3.5-Year Study.

INTRODUCTION: Several studies have reported that children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children, and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children, including 2,184 American Indian/Alaskan Native children. METHODS: Children's height and weight were measured before and after the summer from 2012-2015 and analyzed in 2019-2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed-effects models tested whether the percentage of the 95th BMI percentile and BMI differed by season (summer versus the rest of the year) and ethnicity. RESULTS: American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the percentage during the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35, 4.03, p<0.001) or overweight (b=1.47, 95% CI=0.56, 2.35, p<0.01). In BMI units, summer BMI increase was 0.50 kg/m2 higher (obese model) and 0.27 kg/m2 higher (overweight) than that of the rest of the year. Seasonal effects were significantly less pronounced for American Indian/Alaskan Native children than for White children. CONCLUSIONS: Children gained significantly more weight during the summer season, with the strongest effects for children who were obese. American Indian/Alaskan Native children had less seasonal variability than White children, but higher overall obesity rates. These data underscore summer as a critical time for obesity prevention among children who are overweight/obese but suggest that seasonal patterns may vary for American Indian/Alaskan Native children.

Is subjective well-being independently associated with mortality? A 14-year prospective cohort study in a representative sample of 25 139 US men and women.

OBJECTIVES: To examine whether the inverse association of subjective well-being with mortality is independent of self-rated health and socioeconomic status in healthy adults. DESIGN: A population-based prospective cohort study based on an in-person interview. Cox regression was used to examine mortality hazards for happiness alone and for a standardised summary well-being measure that included happiness, life satisfaction and negative emotions. Using prespecified analyses, we first adjusted for age and then additionally adjusted for self-rated health and then race/ethnicity, marital status, smoking and socioeconomic status. SETTING: Probability sample of adult US residents interviewed in their homes in 2001. PARTICIPANTS: 25 139 adults free of cardiovascular disease and cancer at baseline. PRIMARY OUTCOME MEASURE: All-cause mortality 14 years after the baseline interview as assessed by probabilistic matching using the National Death Index. RESULTS: Age-adjusted unhappiness was associated with mortality (HR 1.27; 95% CI 1.11 to 1.45, p=0.001) but the association attenuated after adjusting for self-rated health (HR 1.01; 95% CI 0.88 to 1.16, p=0.85). A similar pattern was seen for the summary well-being measure in fully adjusted models (HR 1.00; 95% CI 0.99 to 1.00, p=0.30). In contrast, self-rated health was strongly associated with mortality. In the fully adjusted model with the summary well-being measure the hazards for good, very good and excellent self-rated health were 0.71 (95% CI 0.62 to 0.80, p<0.001), 0.63 (95% CI 0.55 to 0.71, p<0.001) and 0.45 (95% CI 0.39 to 0.51, p<0.001), respectively. CONCLUSIONS: In this representative sample of US adults, the association between well-being and mortality was strongly attenuated by self-rated health and to a lesser extent socioeconomic status.

Relationship of athletic and academic identity to concussion reporting intentions.

BACKGROUND: Understanding concussed athletes' motivations for reporting concussion symptoms is important for health care professionals who are charged with the care, management, and prevention of future injury. OBJECTIVES: To examine if athletic and academic identity predict concussion symptom reporting intentions above and beyond traditional socio-cognitive predictors. DESIGN: Cross-sectional study using self-report measures during the 2016 collegiate football season. METHOD: In a sample of National Collegiate Athletic Association (NCAA) Division I American football athletes (N = 205) we examined the relationship of athletic and academic identity with three indices of symptom reporting behavior: reporting during a game, reporting 24 h after a game, and reporting on behalf of a teammate. We used descriptive statistical analyses, correlations, and linear regression to examine hypotheses. RESULTS: Controlling for traditional predictors, athletic identity was associated with a lower likelihood to report symptoms during a game (ß = -0.22, t = -3.28, p < .001) or within 24 h (ß = -0.28, t = -4.12, p < .001). Academic identity was positively associated with reporting intentions during a game (ß = 0.12, t = 1.68, p < .05), 24 h later (ß = 0.13, t = 1.85, p < .05), and on behalf of a teammate (ß = 0.22, t = -3.36, p < .001). CONCLUSIONS: Athletic and academic identities offer additional insight into athletes' motivation for concussion symptom reporting intentions, above and beyond traditional socio-cognitive predictors. Discussion focuses on the benefit of incorporating these important self-identities into educational health interventions to improve their impact.

Improving Concussion-Reporting Behavior in National Collegiate Athletic Association Division I Football Players: Evidence for the Applicability of the Socioecological Model for Athletic Trainers.

CONTEXT: Few researchers have examined the views of important stakeholders in football student-athletes' spheres of influence and whether their views map well in a systems approach to understanding concussion-reporting behavior (CRB). OBJECTIVE: To examine the extent to which stakeholders' beliefs about what influences football players' CRBs reflect system-level influences that go beyond individual-level factors. DESIGN: Qualitative study. SETTING: Four National Collegiate Athletic Association Division I university athletic programs. PATIENTS OR OTHER PARTICIPANTS: A total of 26 individuals (athletic directors = 5, athletic trainers [ATs] = 10, football coaches = 11). DATA COLLECTION AND ANALYSIS: Semistructured interviews with stakeholders were transcribed and analyzed using the socioecological model according to the Miles and Huberman coding methods. RESULTS: Stakeholders largely identified individual-level factors (attitudes), followed by exosystem-level factors (university policies and support for ATs), with fewer microsystem- and mesosystem-level factors (coach influence and communication between coaches and ATs, respectively) and almost no macrosystem-level factors (media influence, cultural norms about aggression and toughness in football). CONCLUSIONS: Promising evidence indicates growing stakeholder awareness of the importance of exosystem-level factors (eg, medical personnel and CRB policies) in influencing CRB rates. However, frontline stakeholders and policy makers may benefit from practices that bridge these influences (eg, coach involvement and communication), allowing for a more integrated approach to influence student-athletes' willingness to improve their CRBs.