Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program.

BACKGROUND: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. OBJECTIVE: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. METHODS: Grounded in dialogic learning, the program entails training community-based "trusted messengers" and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. RESULTS: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. CONCLUSIONS: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37713.

A Review of Current Literature on Vital Sign Assessment of Physical Activity in Primary Care.

PURPOSE: To conduct an integrated review of the performance and implementation of two physical activity (PA) assessment tools, the exercise vital sign (EVS) and the physical activity vital sign (PAVS), in U.S. primary care practice. DESIGN: An integrative review following Whittemore and Knafl's methodology. METHODS: Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched. Search terms were "exercise vital sign" OR "physical activity vital sign" AND "primary care". Additional inclusion criteria were studies conducted in the United States, published in English, in primary care, between 2010 and 2016. RESULTS: Nine studies met inclusion criteria. Five studies reported validity data of the EVS tool, while four studies reported data from the PAVS tool. Compared with the accelerometer, the EVS tool overestimated moderate-vigorous PA, while the PAVS tool demonstrated moderate agreement in identifying those not meeting national PA guidelines. The EVS tool was successfully implemented in large, integrated practices utilizing electronic health record systems. PA documentation increased compared to non-EVS practices. The predictive ability of the PAVS tool for clinical outcomes was shown. Studies of PA assessment tool use in children were not found. CONCLUSIONS: Preliminary evidence on the validity of both the EVS and PAVS tools support cautious use of each as a screening tool in primary care. There were no data on reliability, with limited data on tool use in diverse populations or settings. Data in children, older adults, and diverse population subgroups were lacking. CLINICAL RELEVANCE: Two brief exercise vital signs tools have each shown some initial validity for use by primary care clinicians as measures to identify patients not meeting PA guidelines.

Associations between healthy lifestyle behaviors and academic performance in U.S. undergraduates: a secondary analysis of the American College Health Association's National College Health Assessment II.

PURPOSE: To examine associations between academic performance and moderate-vigorous physical activity, strength training, fruit and vegetable intake, and sleep. DESIGN: Cross-sectional observational study. SETTING: Forty U.S. colleges and universities participating in the Fall 2008 National College Health Assessment-II (NCHA-II) (median response, 27%). SUBJECTS: A total of 16,095 undergraduate students (18-24 years; 70.3% female). MEASURES: Self-reported lifestyle variables from the NCHA-II questions were dichotomized as meeting or not meeting public health recommendations. Grade average ranged from 1.00 to 4.00 points. ANALYSIS: Linear regression, adjusting for sociodemographic and health-related variables. RESULTS: The prevalence of meeting public health recommendations was as follows: moderate-vigorous physical activity, 41.9%; strength training, 32.4%; fruit and vegetable intake, 4.6%; and sleep, 23.6 %. Grade average was higher in students meeting moderate-vigorous physical activity, fruit and vegetable intake, and sleep recommendations (p ≤ .019). If moderate-vigorous physical activity was met, grade average was higher by .03 points, .15 points higher when meeting fruit and vegetable intake recommendations, and .06 points higher for sleep. There was no significant change in grade average in those meeting strength-training recommendations. CONCLUSION: College students who adhere to public health recommendations for lifestyle behaviors have modestly higher grade averages after adjusting for sociodemographic and negative health behaviors.

Interventions for the management of weight and body composition changes in women with breast cancer.

Weight gain and body composition changes are common during the first year after breast cancer diagnosis. Women who are overweight or obese at the time of diagnosis or who gain weight following diagnosis are at higher risk for adverse clinical outcomes. Unhealthy weight conditions, compounded or caused by weight gain after diagnosis, are a considerable challenge for women with breast cancer during and after treatment. Despite the prevalence of weight gain in women with breast cancer as well as its adverse effects, little research has examined preventive and therapeutic interventions targeting reduction of weight and/or body fat. The purpose of this article is to update the state of knowledge on weight gain and body composition changes in women with breast cancer. Current evidence from weight intervention studies, including diet, exercise, and combined approaches for weight loss-or for prevention of weight gain-are reviewed. Along with published practice guidelines, the currently available information provides guidance for oncology nurses on the methods that can impact unhealthy weight conditions associated with breast cancer.