Arthritis Among Children and Adolescents Aged <18 Years - United States, 2017-2021.

Arthritis affects persons of all ages, including younger adults, adolescents, and children; however, recent arthritis prevalence estimates among children and adolescents aged <18 years are not available. Previous prevalence estimates among U.S. children and adolescents aged <18 years ranged from 21 to 403 per 100,000 population depending upon the case definition used. CDC analyzed aggregated 2017-2021 National Survey of Children's Health data to estimate the national prevalence of parent-reported arthritis diagnosed among children and adolescents aged <18 years. An estimated 220,000 (95% CI = 187,000-260,000) U.S. children and adolescents aged <18 years (305 per 100,000) had diagnosed arthritis. Arthritis prevalence among non-Hispanic Black or African American children and adolescents was twice that of non-Hispanic White children and adolescents. Co-occurring conditions, including depression, anxiety, overweight, physical inactivity, and food insecurity were associated with higher prevalences of arthritis. These findings highlight that children and adolescents should be prioritized for arthritis prevention and treatments by identifying risk factors for arthritis, developing self-management interventions to improve arthritis, physical activity or weight control, and screening and linking to mental health services. Health systems and payors can take steps to ensure equitable access to therapies (e.g., physical therapies and medications).

Prevalence of Diagnosed Arthritis - United States, 2019-2021.

Arthritis includes approximately 100 conditions that affect the joints and surrounding tissues. It is a leading cause of activity limitations, disability, and chronic pain, and is associated with dispensed opioid prescriptions, substantially contributing to health care costs. Combined 2019-2021 National Health Interview Survey data were analyzed to update national prevalence estimates of self-reported diagnosed arthritis. An estimated 21.2% (18.7% age-standardized) of U.S. adults aged ≥18 years (53.2 million) had diagnosed arthritis during this time frame. Age-standardized arthritis prevalences were higher among women (20.9%) than men (16.3%), among veterans (24.2%) than nonveterans (18.5%), and among non-Hispanic White (20.1%) than among Hispanic or Latino (14.7%) or non-Hispanic Asian adults (10.3%). Adults aged ≥45 years represent 88.3% of all U.S. adults with arthritis. Unadjusted arthritis prevalence was high among adults with chronic obstructive pulmonary disease (COPD) (57.6%), dementia (55.9%), a disability (54.8%), stroke (52.6%), heart disease (51.5%), diabetes (43.1%), or cancer (43.1%). Approximately one half of adults aged ≥65 years with COPD, dementia, stroke, heart disease, diabetes, or cancer also had a diagnosis of arthritis. These prevalence estimates can be used to guide public health policies and activities to increase equitable access to physical activity opportunities within the built environment and other arthritis-appropriate, evidence-based interventions.

Arthritis Prevalence Among Veterans - United States, 2017-2021.

Arthritis is a chronic inflammatory condition and a leading cause of chronic pain and disability. Because arthritis prevalence is higher among U.S. military veterans (veterans), and because the veteran population has become more sexually, racially, ethnically, and geographically diverse, updated arthritis prevalence estimates are needed. CDC analyzed pooled 2017-2021 Behavioral Risk Factor Surveillance System data to estimate the prevalence of diagnosed arthritis among veterans and nonveterans, stratified by sex and selected demographic characteristics. Approximately one third of veterans had diagnosed arthritis (unadjusted prevalence = 34.7% [men] and 31.9% [women]). Among men aged 18-44 years, arthritis prevalence among veterans was double that of nonveterans (prevalence ratio [PR] = 2.1; 95% CI = 1.9-2.2), and among men aged 45-64 years, arthritis prevalence among veterans was 30% higher than that among nonveterans (PR = 1.3; 95% CI = 1.3-1.4). Among women aged 18-44 years, arthritis prevalence among veterans was 60% higher than that among nonveterans (PR = 1.6; 95% CI = 1.4-1.7); among women aged 45-64 years, arthritis prevalence among veterans was 20% higher than that among nonveterans (PR = 1.2; 95% CI = 1.1-1.3). Cultivating partnerships with veteran-serving organizations to promote or deliver arthritis-appropriate interventions might be advantageous, especially for states where arthritis prevalence among veterans is highest. The high prevalence of arthritis among female veterans, veterans aged ≥65 years, and veterans with disabilities highlights the importance of ensuring equitable access and inclusion when offering arthritis-appropriate interventions.

Correlates of light physical activity among cancer survivors.

OBJECTIVE: Emerging evidence demonstrates the positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Correlates of LPA among cancer survivors were examined, and stratified by moderate-to-vigorous physical activity (MVPA) status. METHODS: A cross-sectional analysis using the American Cancer Society's Studies of Cancer Survivors-I (N = 1751) was conducted. Correlates of interest were health-care provider support for physical activity, perceived health competence, perceived social support, unsupportive partner behaviors, and perceived susceptibility to cancer recurrence. The primary outcome was self-reported LPA categorized at 0, 1-59, 60-119, and 120+ minutes per week. Multivariable ordinal regressions using forced entry were conducted, stratified by MVPA status. RESULTS: Adjusted multivariable models revealed that, among those reporting no MVPA (n = 757), greater provider support for physical activity (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.05-2.17; P = 0.03), greater perceived health competence (aOR = 1.44; 95% CI, 1.10-1.88; P = 0.01), and greater unsupportive partner behaviors (aOR = 1.06; 95% CI, 1.01-1.12; P = 0.03) were significantly correlated with higher LPA. No social cognitive constructs were correlated with LPA among those already engaging in MVPA (n = 994). CONCLUSIONS: LPA interventions targeting cancer survivors not engaging in any MVPA are warranted and may optimize limited intervention resources. Furthermore, interventions may be more efficacious by applying behavior change techniques that incorporate health-care provider support and improves health competence and positive interpersonal skills.

Disentangling Efficacy and Expectations: A Prospective, Cross-lagged Panel Study of Cancer Survivors' Physical Activity.

Background: Despite demonstrated utility of Bandura's social cognitive theory for increasing physical activity among cancer survivors, the validity of the originally hypothesized relationships among self-efficacy, outcome expectations, and physical activity behavior continues to be debated. Purpose: To explore the temporal ordering of outcome expectations and self-efficacy as they relate to moderate-to-vigorous physical activity behavior. Methods: Longitudinal data from cancer survivors (N = 1,009) recently completing treatment were used to fit six cross-lagged panel models, including one parent model, one model representing originally hypothesized variable relationships, and four alternative models. All models contained covariates and used full information maximum likelihood and weighted least squares mean and variance adjusted estimation. Tests of equal fit between the parent model and alternative models were conducted. Results: The model depicting Bandura's originally hypothesized relationships showed no statistically significant relationship between outcome expectations and physical activity (p = .18), and was a worse fit to the data, compared with the parent model [Χ2 (1) = 5.92, p = .01]. An alternative model showed evidence of a reciprocal relationship between self-efficacy and outcome expectations, and was statistically equivalent to the parent model [Χ2(1) = 2.01, p = .16]. Conclusions: This study provides evidence against Bandura's theoretical assertions that (a) self-efficacy causes outcome expectations and not vice versa, and (b) outcome expectation has a direct effect on physical activity. Replication within population subgroups and for other health behaviors will determine whether the social cognitive theory needs modification. Future trials should test whether differential construct ordering results in clinically meaningful differences in physical activity behavior change.

Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).

OBJECTIVE: Research has increasingly documented sociodemographic inequalities in the assessment and management of cancer-related pain. Most studies have focused on racial/ethnic disparities, while less is known about the impact of other sociodemographic factors, including age and education. We analyzed data from a large, national, population-based study of cancer survivors to examine the influence of sociodemographic factors, and physical and mental health comorbidities on barriers to cancer pain management. METHODS: The study included data from 4707 cancer survivors in the American Cancer Society's Study of Cancer Survivors-II, who reported experiencing pain from their cancer. A multilevel, socioecological, conceptual framework was used to generate a list of 15 barriers to pain management, representing patient, provider, and system levels. Separate multivariable logistic regressions for each barrier identified sociodemographic and health-related inequalities in cancer pain management, controlling for years since diagnosis, disease stage, and cancer treatment. RESULTS: Two-thirds of survivors reported at least 1 barrier to pain management. While patient-related barriers were most common, the greatest disparities were noted in provider- and system-level barriers. Specifically, inequalities by race/ethnicity, education, age, and physical and mental health comorbidities were observed. CONCLUSION: Findings indicate survivors who were nonwhite, less educated, older, and/or burdened by comorbidities were most adversely affected. Future efforts in research, clinical practice, and policy should identify and/or implement new strategies to address sociodemographic inequalities in cancer pain management.

Health and wellness programming in faith-based organizations: a description of a nationwide sample.

INTRODUCTION: Most of the U.S. population is affiliated with faith-based organizations (FBOs) and regularly attends services. Health and wellness activities (HWA) delivered through FBOs have great potential for reach, but the number of FBOs offering health programs and the characteristics of these programs are currently unknown. The purpose of this study was to better understand rates, characteristics, and factors influencing faith-based HWA across the United States. METHOD: Faith leaders (N = 844) completed an online survey assessing faith leader demographics and health, FBO demographics (e.g., denomination, size, location, diversity), and details of HWA within their FBO. RESULTS: Respondents were primarily White (93%), male (72%), middle-aged (53.2 ± 12.1 years), and affiliated with Methodist (42.5%) or Lutheran (20.2%) denominations. Although most faith leaders report meeting physical activity recommendations (56.5%), most were overweight/obese (77.4%), did not meet fruit and vegetable recommendations (65.9%), and had been diagnosed with 1.25 ± 1.36 chronic diseases. Respondents reported offering 4.8 ± 3 HWA within their FBO over the past 12 months. Most common HWA included clubs/teams related to physical activity (54.8%), individual-level health counseling (54%), and providing health/wellness pamphlets. Leaders cited a lack of lay leadership (48.1%) and financial resources for staff time (47.8%) as the most common barriers to HWA. An increase in interest/awareness in health topics from FBO members was the most common facilitator for HWA (66.5%). CONCLUSION: Although faith-based HWA are prevalent nationally, types of HWA and the factors influencing HWA are dependent on FBO characteristics. Future faith-based interventions should consider existing capabilities and moderating factors for HWA.

A qualitative study of faith leaders' perceptions of health and wellness.

The effectiveness of faith-based health and wellness interventions is moderated by the attitudes, perceptions, and participation of key leaders within faith-based organizations. This qualitative study examined perceptions about the link between health, spirituality, and religion among a volunteer sample of faith leaders (n = 413) from different denominations. The major themes included: influences on health and wellness promotion and a relationship between spirituality and health. The results indicated that perceptions about the link among health, spirituality, and religion vary among faith leaders, regardless of denomination. Future faith-based interventions should be developed with consideration for denomination as a socially and culturally relevant factor.

Engaging community partners to develop a culturally relevant resource guide for physical activity and nutrition.

BACKGROUND: Community-based participatory research (CBPR) is an increasingly popular approach for obesity prevention efforts among ethnically diverse communities. There is limited documentation for practitioners and researchers attempting to initiate new CBPR partnerships within predominantly Hispanic communities. OBJECTIVES: To document the process underlying the initiation of a new CBPR collaborative and the development of a culturally relevant community resource guide for physical activity and nutrition. SETTING: Three similar cities in southwest Kansas (40-60% Hispanic). The mission of local partner organizations included health or serving Hispanic community needs. RESULTS: The CBPR collaborative combined community-specific cultural and historical information with physical activity and nutrition health education materials into community-specific resource guides. The guides were tailored to each community, culturally relevant, and highlighted free and low-cost resources. The guides were printed in English and Spanish and distributed to residents. Evaluation of the guide's reach showed small-moderate dissemination, and good acceptance by community residents. CONCLUSION: Collaborative CBPR partnerships for obesity prevention can be formed by identifying a common, realistic and practical goal such as the creation of a community resource guide for physical activity and nutrition. The approach is relatively noninvasive for community members, requires minimal resources from community agencies and represents a positive first step in the CBPR approach to obesity and chronic disease prevention. Currently, the guide is being used in combination with other health promotion efforts to prevent obesity and related diseases. Furthermore, our CBPR partnership continues to thrive and provide the necessary foundation for health promotion efforts.

Individual and institutional influences on faith-based health and wellness programming.

The majority of the US population is affiliated with faith-based organizations (FBO). Health and wellness activities (HWAs) within FBOs have great potential for reach, though the factors influencing faith-based HWA are not well understood. The purpose of this study was to examine individual faith leader and institutional influences on HWAs offered within FBOs. A national convenience sample of faith leaders (N = 844) completed an online survey assessing individual (demographics, health, health behaviors and attitudes) and institutional influences (size, location and external support) on health and HWA within FBO. Respondents were primarily White (93%), male (72%), middle-aged and affiliated with Methodist (42.5%) or Lutheran (20.2%) religions. Respondents reported 4.8 ± 3.2 HWA within their FBO per year. Faith leader education, length of service to the FBO, physical activity and fruit/vegetable intake were positively related to HWA and body mass index was negatively related. Denomination, congregation diversity, location and size were also related to HWA. Results show a strong relationship between faith leaders' health and HWA, indicating the influence of the social environment on health promotion in FBOs. Institutional variables, though not modifiable, were significant predictors of HWA and should be considered when delivering interventions to achieve a significant impact.

Cancer-related problems, sleep quality, and sleep disturbance among long-term cancer survivors at 9-years post diagnosis.

OBJECTIVE: To estimate the prevalence of sleep difficulties in a large cohort of long-term cancer survivors (>5 years) and examine associations with four domains of cancer-related problems. METHODS: This study analyzed a nationwide sample (N = 1903) of cancer survivors (31% Breast; 20% prostate) at nine years (m = 8.9 sd = 0.6) post-diagnosis with a mean age of 64.5 years. Sleep quality and sleep disturbance were assessed by the Pittsburgh Sleep Quality Index. Multivariable logistic regression models examined associations between cancer-related problems (physical distress, emotional distress, economic distress, and fear of recurrence) and sleep difficulty (poor vs. low sleep quality and high vs. low sleep disturbance). Odds ratios (OR) and 95% confidence intervals (CI) were estimated, adjusting for medico-demographics, behavioral factors, and sleep medication use. RESULTS: In sum, 20% percent of the sample reported poor sleep quality, 51% reported high sleep disturbance and 17% reported both. Sleep medication use was reported by 28% of the total sample. All four domains of cancer-related problems were significantly associated with poor sleep quality and high sleep disturbance. Above median cancer-related physical distress had the strongest association with both poor sleep quality (OR = 3.42; 95% CI = 2.44-4.79) and high sleep disturbance (OR = 4.06; 95% CI = 3.09-5.34). CONCLUSIONS: Among nine-year cancer survivors, multiple domains of cancer-related health problems were associated with sleep difficulties. Knowledge of the relationship between cancer-related problems and sleep may aid clinicians during the evaluation and treatment of sleep problems in long-term cancer survivors. Future research should utilize prospective data to better understand the causal nature of the associations.

Physical Activity, Sitting Time, and Risk of Myelodysplastic Syndromes, Acute Myeloid Leukemia, and Other Myeloid Malignancies.

INTRODUCTION: There is limited research on associations of moderate-to-vigorous physical activity (MVPA) and sitting with risk of myeloid neoplasms (MN) or MN subtypes. We examined these associations in the Cancer Prevention Study-II Nutrition Cohort. METHODS: Among 109,030 cancer-free participants (mean age 69.2, SD 6.1 years) in 1999, 409 were identified as having been diagnosed with a MN [n = 155 acute myeloid leukemia (AML), n = 154 myelodysplastic syndromes (MDS), n = 100 other ML] through June 2013. Cox proportional hazards regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations of MVPA (MET-h/wk) and sitting (h/d) with risk of all MN, myeloid leukemia only, MDS, and AML. RESULTS: Compared with insufficient MVPA [>0-<7.5 metabolic equivalent hours/week (MET)-h/wk], the HR (95% CI) for meeting physical activity guidelines (7.5-<15 MET-h/wk MVPA) and risk of MN was 0.74 (95% CI, 0.56-0.98) and for doubling guidelines (15-<22.5 MET-h/wk) was 0.75 (0.53-1.07); however, there was no statistically significant association for higher MVPA (22.5+ MET-h/wk, HR, 0.93; 95% CI, 0.73-1.20). Similarly, meeting/doubling guidelines was associated with lower risk of MDS (HR, 0.57; 95% CI, 0.35-0.92/HR, 0.51; 95% CI, 0.27-0.98), but there was no association for 22.5+ MET-h/wk (HR, 0.93; 95% CI, 0.63-1.37). MVPA was not associated with risk of myeloid leukemia or AML. Sitting time was not associated with risk of any outcome. CONCLUSIONS: These results suggest that there may be a nonlinear association between MVPA and risk of MDS and possibly other MN. IMPACT: Further studies are needed to better understand the dose-response relationships between MVPA and risk of MDS, a highly fatal and understudied cancer.

Self-efficacy, pros, and cons as variables associated with adjacent stages of change for regular exercise in Japanese college students.

This study examined self-efficacy (confidence to exercise), pros (exercise's advantages), and cons (exercise's disadvantages) as variables associated across the transtheoretical model's six stages of change in 403 Japanese college students. A series of logistic regression analyses were conducted. Results showed that higher pros and lower cons were associated with being in contemplation compared to precontemplation. Lower cons were associated with being in preparation compared to contemplation. Higher self-efficacy was associated with being in action compared to preparation as well as being in maintenance compared to action. Lower cons were associated with being in termination compared to maintenance.

Health care provider advice for African American adults not meeting health behavior recommendations.

INTRODUCTION: Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Healthy People 2010 goals are for 85% of physicians to counsel their patients about physical activity and for 75% of physician office visits made by patients with cardiovascular disease, diabetes, or dyslipidemia to include dietary counseling. The purpose of this study was to 1) determine the rate of participant-reported health care provider advice for healthy lifestyle changes among African Americans who do not meet recommendations for physical activity, fruit and vegetable consumption, and healthy weight; 2) examine correlates of provider advice; and 3) assess the association between provider advice and stage of readiness for change for each of these health behaviors. METHODS: Data for this study were collected as part of a statewide faith-based physical activity program for African Americans. A stratified random sample of 20 African Methodist Episcopal churches in South Carolina was selected to participate in a telephone survey of members aged 18 years and older. The telephone survey, conducted over a 5-month period, asked participants a series of questions about sociodemographics, health status, physical activity, and nutrition. Analyses for moderate to vigorous physical activity, fruit and vegetable consumption, and weight loss were conducted separately. For each of these behaviors, logistic regression analyses were performed to examine the independent association of sex, age, body mass index, education, number of diagnosed diseases, perceived health, and stage of change with health care provider advice for health behaviors. RESULTS: A total of 572 church members (407 women, 165 men; mean age, 53.9 years; range, 18-102 years) completed the survey. Overall, participant-reported provider advice for lifestyle changes was 47.0% for physical activity, 38.7% for fruit and vegetable consumption, and 39.7% for weight. A greater number of diagnosed diseases and higher body mass index were independently associated with receiving advice to increase physical activity. A more advanced stage of change and a greater number of diagnosed diseases were independently associated with receiving advice for fruit and vegetable consumption. Body mass index, stage of change, and poorer perceived health were independently associated with receiving advice about weight. CONCLUSION: Health care provider advice appears to be based predominantly on comorbidities. Because of the preventive benefit of physical activity, fruit and vegetable consumption, and healthy weight, all health care providers are urged to increase counseling for all patients not meeting health behavior recommendations.

Acute Thermotherapy Prevents Impairments in Cutaneous Microvascular Function Induced by a High Fat Meal.

We tested the hypothesis that a high fat meal (HFM) would impair cutaneous vasodilation, while thermotherapy (TT) would reverse the detrimental effects. Eight participants were instrumented with skin heaters and laser-Doppler (LD) probes and tested in three trials: control, HFM, and HFM + TT. Participants wore a water-perfused suit perfused with 33°C (control and HFM) or 50°C (HFM + TT) water. Participants consumed 1 g fat/kg body weight. Blood samples were taken at baseline and two hours post-HFM. Blood pressure was measured every 5-10 minutes. Microvascular function was assessed via skin local heating from 33°C to 39°C two hours after HFM. Cutaneous vascular conductance (CVC) was calculated and normalized to maximal vasodilation (%CVCmax). HFM had no effect on initial peak (48 ± 4 %CVCmax) compared to control (49 ± 4 %CVCmax) but attenuated the plateau (51 ± 4 %CVCmax) compared to control (63 ± 4 %CVCmax, P < 0.001). Initial peak was augmented in HFM + TT (66 ± 4 %CVCmax) compared to control and HFM (P < 0.05), while plateau (73 ± 3 % CVCmax) was augmented only compared to the HFM trial (P < 0.001). These data suggest that HFM negatively affects cutaneous vasodilation but can be minimized by TT.

Changing weight-loss expectations: a randomized pilot study.

Participants in weight-loss programs expect unreasonably large weight losses and believe that such reductions will produce dramatic improvements in their lives. The failure to achieve such benefits may contribute to poor maintenance of lost weight. This randomized pilot study investigated a new cognitive-behavioral intervention designed to modify unrealistic expectations regarding weight loss and its likely impact on appearance, attractiveness, and self-esteem. Twenty-eight overweight and obese young women who completed 10 sessions of standard behavioral weight-loss treatment were randomly assigned to 10 additional sessions of either standard behavioral (SB) treatment or a reformulated cognitive-behavioral (RCB) treatment. At posttreatment, the RCB intervention produced more realistic weight-loss expectations, decreased participants' motivation to lose weight as a means of improving self-confidence, and increased their overall self-esteem, compared with the SB condition (all p's<.05). The mean posttreatment weight changes achieved in the SB (-6.2+/-4.5 kg) and RCB (-5.5+/-3.6 kg) conditions were equivalent, as were the amounts of weight regained during a 6-month follow-up (SB=2.3+/-2.7 kg; RCB=1.5+/-1.7 kg). Collectively, these findings indicate that the RCB intervention was effective in changing unrealistic weight-loss expectations, but it did not produce significantly better maintenance of lost weight than did the SB intervention.

Prevalence of body dissatisfaction among a United States adult sample.

Body dissatisfaction (BD) is a primary determinant of eating disorders and has been linked to chronic disease via decreased likelihood of cancer screening self-exams and smoking cessation. Yet, there are few recent estimates of the prevalence of BD among United States adults. Using an internet-based, opt-in, cross-sectional survey, United States adults (N=1893) completed assessments of demographic variables, body areas satisfaction, appearance evaluation, fitness evaluation, health evaluation, and overweight preoccupation. Results revealed that the range of BD is 13.4%-31.8% among women and 9.0%-28.4% among men. Compared to previous assessments of prevalence (1973, 1986, 1995, 1997), the prevalence of BD among United States adults may have plateaued or declined over time.

Prevalence of body dissatisfaction among United States adults: review and recommendations for future research.

As the evidence supporting the role of body dissatisfaction (BD) in chronic disease risk factors and health behaviors increases, documenting the prevalence of BD is an essential first step in determining to what degree BD is a public health problem. Therefore, the primary purpose of this study is to critically evaluate research examining the population prevalence of BD among U.S. adults. Seven studies were located and provided estimates of prevalence of BD among U.S. adults that were extremely varied (11%-72% for women, and 8%-61% for men). While some of the variation may be due to increases in BD over time, the literature is also clouded by a lack of randomly selected samples, lack of consistency in measurement tools, lack of consistency in operational definitions of BD, and lack of standardized cut-off points for BD. Recommendations for improving BD prevalence research to enable public health research are provided.

Factors associated with faith-based health counselling in the United States: implications for dissemination of evidence-based behavioural medicine.

Health counselling is an evidence-based behavioural medicine approach and the most commonly reported form of faith-based health interventions. Yet, no research has explored the factors influencing the implementation of faith-based health counselling. Therefore, this study examined individual, organisational and environmental factors associated with offering/not offering faith-based health counselling programmes within faith-based organisations. A national, internet-based, opt-in, cross-sectional survey of faith leaders (N = 676) was conducted (March-December 2009) to assess faith leaders' demographic information, health status, fatalism, health-related attitudes and normative beliefs, attitudes towards health counselling, institutional and occupational information, and perceptions of parent organisation support for health and wellness interventions. Most faith leaders reported offering some type of health counselling in the past year [n = 424, 62.7%, 95% CI (59.0, 66.3)]. Results of a multivariate logistic regression showed that faith leaders reporting greater proxy efficacy (OR = 1.40, P = 0.002), greater comfort in speaking with church members about health (OR = 1.25, P = 0.005), greater perceived health (OR = 1.27, P = 0.034), and who worked at larger churches (OR ≥ 3.2, P ≤ 0.001) with greater parent organisation support (OR = 1.33, P = 0.002) had significantly higher odds of offering faith-based health counselling. Church size and parent organisation support for faith-based health interventions appear to be important factors in the presence of faith leader health counselling. The content of faith leader health counselling training should aim to increase faith leaders' confidence that church members will successfully change their health behaviours as a result of the health counselling and increase faith leaders' comfort in speaking with church members about health. Future research is needed to examine efficacious and effective dissemination methods such as the use of internet trainings, CD ROM materials and incorporating health counselling into seminary school.