The Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada.

PURPOSE: Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians. METHODS: We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations. RESULTS: High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use. CONCLUSIONS: The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers.

Inclusion of People With Disabilities in Community Health Needs Assessments in Florida, United States.

Community health needs assessments (CHNAs) play a crucial role in identifying health needs of communities. Yet, unique health needs of people with disabilities (PWDs) are often underrecognized in public health practice. In 2010, the Patient Protection and Affordable Care Act (ACA) required the implementation of standardized data collection guidelines, including disability status, among federal agencies. The extent to which guidance from ACA and the U.S. Centers for Disease Control and Prevention has impacted disability inclusion in CHNAs is unknown. This study used a content analysis approach to review CHNAs conducted by local health councils and the top 11 nonprofit hospitals in Florida (n = 77). We coded CHNAs based on mentioning disability in CHNA reports, involving disability-related stakeholders, and incorporating data on disability indicators. Findings indicate that PWDs are widely not included in CHNAs in Florida, emphasizing the need for equitable representation and comprehensive understanding of PWDs in community health planning.

Impact of community health interventions on maternal and child health indicators in the upper east region of Ghana.

BACKGROUND: This paper reports on results of a health system strengthening implementation research initiative conducted the Upper East Region of northern Ghana. Transformative interventions to accelerate and strengthen the health delivery were implemented that included empowering community leaders and members to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, providing basic medical equipment to community clinics, and improving the skills of critical health staff through training. METHODS: A mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. To assess impact, a pre-versus-post randomized cluster survey design was used. Qualitative research was conducted with focus group data and individual in depth interviews to gauge the views of various stakeholders associated with the implementation process. RESULTS: After intervention, significant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage were observed and increases in the proportion of deliveries occurring in health facilities and assisted by skilled health personnel relative to pre-intervention conditions. There was also increased uptake of oral rehydration salts (ORS) for treatment of childhood diarrhoea, as well as marked reductions in the incidence of upper respiratory infections (URI). CONCLUSIONS: A pre-and post-evaluation of impact suggests that the programme had a strong positive impact on the functioning of primary health care. Findings are consistent with the proposition that the coverage and content of the Ghana Community-based Health Planning and Services programme was improved by program interventions and induced discernable changes in key indicators of health system performance.

Effect of 2-week postpartum check-ups on screening positive for postpartum depression: a population-based cohort study using instrumental variable estimation in Japan.

BACKGROUND: Postpartum depression is experienced by approximately 10% of women and affects the health and development of their children. Although it is recommended that all mothers have the opportunity for early detection and intervention for postpartum depression, it is unclear whether early postpartum check-ups help to reduce postpartum depression. OBJECTIVE: The aim of this study was to assess the effect of 2-week postpartum check-ups on screening positive for postpartum depression in Japan. METHODS: This was a population-based cohort study that used the administrative database of Tsuyama, Japan. Participants were women who received postpartum home visits from a public health nurse in Tsuyama during the fiscal years 2017-2019. Data were obtained on participant's attendance at a 2-week postpartum check-up and their responses on the Edinburgh Postpartum Depression Scale. Owing to the initiation of a publicly funded postpartum check-up programme, participants were pseudo-randomly assigned to receive/not receive a 2-week postpartum check-up. We conducted instrumental variable estimation to assess the causal effects of the check-up on screening positive for postpartum depression. RESULTS: The characteristics of the 1,382 participants did not differ by fiscal year of childbirth. We found a 6.7% (95% confidence interval 2.2-11.2) reduction in the prevalence of screening positive for postpartum depression as an effect of 2-week postpartum check-ups among women received 1-month postpartum home visits. CONCLUSION: The results suggest that 2-week postpartum check-ups are effective in reducing the prevalence of screening positive for postpartum depression among 1-month postpartum women. Despite some limitations, early postpartum care could reduce postpartum depression.

Impact of a Community-Based Pelvic Floor Kinesic Rehabilitation Program on the Quality of Life of Chilean Adult Women with Urinary Incontinence.

The pelvic floor forms the primary bottom tissue of the pelvic cavity. It comprises muscles that play a fundamental role in bowel and bladder emptying. Alterations of pelvic floor muscles will result in dysfunctions such as urinary incontinence (UI). Given the high prevalence of UI and its impact on the quality of life (QoL) in patients with pelvic floor muscle dysfunctions, it is necessary to implement public, community, and generalized programs focused on treating these dysfunctions. OBJECTIVE: To determine the effect of a community rehabilitation program on QoL, UI severity, and pelvic floor muscle strength in patients with UI. PATIENTS AND METHOD: A descriptive prospective cohort study. Twenty subjects between 44 and 75 years old with a diagnosis of UI, participants of a community kinesic rehabilitation program on the pelvic floor in Maipú, Santiago, Chile, were evaluated. These volunteers were intervened for six months, and QoL was measured with the 36-Item Short-Form Health Survey (SF-36) and International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) scales, UI severity with the Sandvick test, and pelvic floor muscle strength with the Oxford scale. Patients were followed up three months post-intervention. RESULTS: Significant improvements were observed in all scales after applying for the community kinesic rehabilitation program, and the changes were maintained at a 3-month follow-up. CONCLUSIONS: Since the improvement in QoL, UI severity, and pelvic floor muscle strength after the intervention, it is relevant to consider the implementation of community programs aimed at education, screening, and early rehabilitation of these patients.

Bottom-up innovative responses to COVID-19 in Latin America and the Caribbean: addressing deprioritized populations.

Objective: To identify and describe innovative initiatives implemented as a response to the interruption of health services during the COVID-19 pandemic in Latin America and the Caribbean (LAC). Methods: This was a descriptive study that reviewed 34 initiatives implemented during the COVID-19 pandemic in LAC to address health services needs among deprioritized groups. The review of initiatives included four phases: a call for submissions of innovative initiatives from LAC countries; a selection of initiatives that had the ability to address health services gaps and that were innovative and effective; systematization and cataloging of the selected initiatives; and a content analysis of the information collected. Data were analyzed from September to October 2021. Results: The 34 initiatives show important variations regarding the target populations, the stakeholders involved, level of implementation, strategies, scope, and relevance of the innovative initiative. There was also evidence of the emergence of a bottom-up set of actions in the absence of top-down actions. Conclusion: The findings of this descriptive review of 34 initiatives implemented during the COVID-19 pandemic in LAC suggest that systematizing the strategies and lessons learned has the potential to expand learning for re-establishing and improving post-pandemic health services.

[Community participation in health as an essential element for health system strengthening in the AmericasLa participación en salud como elemento indispensable para el fortalecimiento de los sistemas de atención de salud en las Américas]. / Participação em saúde como elemento indissociável para o fortalecimento dos sistemas de atenção à saúde nas Américas.

The present narrative review discusses the relevance and challenges of community participation in health for health system strengthening. Based on a definition of community participation in health as a dynamic process that gives people access and control over health resources through involvement and experience, the article summarizes information obtained from documents and debate at an international event (Seminario Internacional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe). In addition, the SciELO, PubMed and Google Scholar databases were searched using the terms "community participation", "community engagement", "social control" and "community health planning" to identify national or transnational review and opinion articles. Community participation in health is a current concept, acknowledged in the recommendations for health policies described in recent documents and publications. Around the world, the number of studies on the subject is growing; however, in the Americas, three countries (United States, Canada and Brazil) accounted for most of the scientific publications identified in the databases. The studies address timely questions and show consensus among investigators within each individual research group. However, the area lacks exchanges and comparative analyses that contrast different experiences transcending national borders and expanding knowledge on community participation in health. The creation of more spaces for the sharing of experiences and research is advised, as well as the establishment of professional and research networks in the field of community participation in health.

En esta revisión narrativa se analizan la relevancia y los retos de la participación en salud para el fortalecimiento de los sistemas de atención de salud. A partir de una definición de la participación en salud como un proceso dinámico que da a las personas acceso y control sobre los recursos de salud por medio de la intervención y la experiencia, en el artículo se sintetiza la información obtenida de documentos y en un debate realizado en el denominado Seminario Internacional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe. A este material se agregaron los resultados de búsquedas en las bases de datos SciELO, PubMed y Google Académico con los términos "community participation", "community engagement", "social control" y "community health planning". Se seleccionaron artículos de revisión y opinión de los ámbitos nacional o transnacional, sin límite de fecha ni de idioma. La participación en salud es un concepto actual, legitimado en las recomendaciones sobre políticas de salud descritas en documentos y publicaciones recientes. El número de estudios sobre el tema ha aumentado en todo el mundo, pero en las Américas, la mayoría de las publicaciones se concentran en tres países (Brasil, Canadá y Estados Unidos). En los estudios se abordan asuntos de actualidad y se demuestra el consenso existente entre los investigadores de cada grupo independiente. Sin embargo, en este campo no hay intercambios ni análisis comparativos que permitan contrastar las diferentes experiencias más allá de las fronteras nacionales y ampliar el conocimiento sobre la participación en salud. Se recomienda crear ámbitos de intercambio de experiencias y oportunidades de investigación, y establecer redes profesionales y de investigación en el campo de la participación en salud.

Inoculating Black/African American and LGBTQ Communities Against the Tobacco Industry: The Role of Community Connectedness and Tobacco Denormalization Beliefs.

The purpose of this study was to explore how connectedness to Black/African American or lesbian, gay, bisexual, transgender and queer (LGBTQ) communities can promote anti-tobacco industry beliefs and to examine the role of targeted anti-tobacco industry messaging (i.e., tobacco industry denormalization [TID] messages).We hypothesized that community connectedness would predict anti-tobacco industry motivation (H1) and that this effect would be mediated by community-specific anti-industry beliefs (H2). We also hypothesized that these effects would be greater (i.e., moderated) for individuals exposed to targeted TID messages (H3). This study was a secondary analysis of data from a web-based experiment focused on the effects of counter-industry messages (data collected in 2020). The sample consisted of 430 Black/African Americans and 458 LGBTQ young adults. Hypotheses were tested using structural equation modeling. In support of hypothesis 1, community connectedness was associated with anti-tobacco industry motivation for both the LGBTQ and Black/African American subsamples. Hypothesis 2 was also supported. The associations between community connectedness and anti-industry motivations were partially mediated by anti-industry beliefs. Hypothesis 3 was not supported. Exposure to counter-industry messages did not modify the structural model; however, counter-industry messages increased anti-industry beliefs in both subsamples. Fostering community connectedness may help to mobilize community-based tobacco control efforts. Furthermore, interventions targeting anti-tobacco industry beliefs may be effective at reducing tobacco-related disparities. Anti-tobacco industry beliefs can be increased using brief targeted TID messages. Collectively, these findings suggest that community-based approaches rooted in consciousness-raising action may provide a useful model for future tobacco control interventions.

Cardiovascular Risk Factor Trajectories Since Childhood and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study.

BACKGROUND: Cardiovascular risk factors, such as high blood pressure, adverse serum lipids, and elevated body mass index in midlife, may harm cognitive performance. It is important to note that longitudinal accumulation of cardiovascular risk factors since childhood may be associated with cognitive performance already since childhood, but the previous evidence is scarce. We studied the associations of cardiovascular risk factors from childhood to midlife, their accumulation, and midlife cognitive performance. METHODS: From 1980, a population-based cohort of 3596 children (3-18 years of age) have been repeatedly followed up for 31 years. Blood pressure, serum lipids, and body mass index were assessed in all follow-ups. Cardiovascular risk factor trajectories from childhood to midlife were identified using latent class growth mixture modeling. Cognitive testing was performed in 2026 participants 34 to 49 years of age using a computerized test. The associations of the cardiovascular risk factor trajectories and cognitive performance were studied for individual cardiovascular risk factors and cardiovascular risk factor accumulation. RESULTS: Consistently high systolic blood pressure (ß=-0.262 SD [95% CI, -0.520 to -0.005]) and serum total cholesterol (ß=-0.214 SD [95% CI, -0.365 to -0.064]) were associated with worse midlife episodic memory and associative learning compared with consistently low values. Obesity since childhood was associated with worse visual processing and sustained attention (ß=-0.407 SD [95% CI, -0.708 to -0.105]) compared with normal weight. An inverse association was observed for the cardiovascular risk factor accumulation with episodic memory and associative learning (P for trend=0.008; 3 cardiovascular risk factors: ß=-0.390 SD [95% CI, -0.691 to -0.088]), with visual processing and sustained attention (P for trend<0.0001; 3 cardiovascular risk factors: ß=-0.443 SD [95% CI, -0.730 to -0.157]), and with reaction and movement time (P for trend=0.048; 2 cardiovascular risk factors: ß=-0.164 SD [95% CI, -0.318 to -0.010]). CONCLUSIONS: Longitudinal elevated systolic blood pressure, high serum total cholesterol, and obesity from childhood to midlife were inversely associated with midlife cognitive performance. It is important to note that the higher the number of cardiovascular risk factors, the worse was the observed cognitive performance. Therefore, launching preventive strategies against cardiovascular risk factors beginning from childhood might benefit primordial promotion of cognitive health in adulthood.

Activating people to partner in health and self-care: use of the Patient Activation Measure.

Patient activation is a behavioural concept and is at the heart of personalised care. It is defined as an individual's knowledge, skill and confidence for managing their health and health care. Evidence indicates that patient activation scores can predict health behaviour and are closely linked to various clinical outcomes: reduced unnecessary emergency department visits, hospital admissions and re-admissions. Patients with lower activation levels (25-40% of the population) are less likely to adopt healthy behaviour, and more likely to have poorer clinical outcomes and higher rates of hospitalisation. Effective interventions can improve a patient's activation level, and positive change in activation equates to positive change in self-care behaviour. But to improve patient activation, we must first measure it using a robust evidence-based tool such as the Patient Activation Measure (PAM) survey. Armed with the patient's PAM score, providers can tailor their care and help patients achieve better self-care, which can improve outcomes of care and reduce unnecessary health care utilisation. The PAM is also useful for population segmentation and risk stratification - to target interventions and health strategies to meet the needs of patients who are at different points along the activation continuum, to measure the performance of health care systems, and to evaluate the effectiveness of health care interventions. The role of patient activation requires further serious consideration if we are to improve the long-term health and wellbeing of all Australians. The PAM tool is a feasible and cost-effective solution for achieving the Quadruple Aim - improving population health, the cost-efficiency of the health system, and patient and provider experience.

Improving allocative efficiency from network consolidation: a solution for the health workforce shortage.

BACKGROUND: Public hospitals are facing a critical shortage of health workers. The area-based network consolidations could be the solution to increase the system capacity for human resources by improving local allocative efficiency. METHODS: This study develops counterfactual simulations for area-based network allocations for the health workforce in 10500 public hospitals in Thailand and examines improvements in allocative efficiency from the health workforce redistribution at different administrative levels such as sub-districts, districts, provinces, and health service areas. The workload per worker is calculated from the output measured by numbers of outpatient and inpatient cases and the input measured by numbers of health workers. Both output and input are weighted with their economic values and controlled for heterogeneity through regression analysis. Finally, this study compares the workload per worker and economic valuation of the area-based networks or ex-ante scenarios with the hospital-level or status quo scenario. RESULTS: Network consolidations of the sub-district primary-level hospitals within the same district could reduce workload per worker by seven percentage points. Another practical policy option is to consolidate similar hospital levels such as primary, first-level secondary, and mid-level secondary hospitals altogether within the same province which could result in the reduction of the workload per worker by 6-7 percentage points. The total economic value gained from consolidating similar hospital levels within the same province is about 15-18 percentage points of total labor cost in the primary hospitals. CONCLUSION: This study illustrates the improvement in allocative efficiency of the health workforce in public hospitals from the area-based network consolidations. The results provide an insightful example of economic gains from efficiently reallocating the medical workforce within the same local areas. Major reforms are required such that the health care delivery units can automate their resources in corresponding to the population's health needs through a strengthening gatekeeping system.

Building a Community Based Mental Health Program for Adolescents in Botswana: Stakeholder Feedback.

BACKGROUND: When planning interventions for adolescents, adult interventions should not be used 'as is' in youth settings. Stakeholder engagement can help understand the overall adolescent mental health ecosystem and adapt existing evidence-based interventions for the youth. OBJECTIVE: To understand the overall mental health needs of adolescents in Botswana and the necessary adaptations required for an adolescent lay counselor based intervention in the country. METHODS: We used the theory of change model and the nominal group technique in five stakeholder meetings. Meetings were held to discuss the mental health needs of youth in Botswana and identify priorities for a lay counsellor based intervention modelled after the Friendship Bench intervention, an existing mental health intervention for adults. RESULTS: The root causes of mental health problems among Botswana's youth identified by stakeholders included limited mental health knowledge among the youth and the community, family problems, poor communication, low self-esteem, the rapid growth of technology, and biological/genetic predisposition. Structurally barriers included: mental illness-related stigma, lack of psychosocial support, incomplete follow up for health services, cultural beliefs about mental illness, and fragmented mental health services. The stakeholders envisage a program that could empower adolescents and youth counselors to address mental health concerns for a healthier community. The group identified and prioritized several key elements of an effective lay counselor intervention. CONCLUSIONS: A diverse group of community stakeholders can illustrate critical mental health needs and elements that countries could use to adapt and contextualize a lay counsellor based mental health intervention for new populations such as the youth.

Creating a community-based protocol to prevent unintended pregnancy in homeless women in north central Appalachia.

Homeless women are pregnant about twice the rate of other U.S. women of reproductive age. It is estimated that at the time of conception, approximately three out of four pregnancies among homeless women are unintended. In addition, children born into homelessness have about 12 times the chance of other children being placed into foster care. This rapid-cycle improvement project focused on developing a community-based protocol to address unintended pregnancy in homeless women in north central Appalachia. Phone interviews with four homeless women and a focus group of ten community stakeholders were used to develop the protocol. The protocol was positively evaluated by the stakeholders based on the acceptability of the development process and its usefulness in the community. This project also served as a pilot for a larger community-based participatory research study to address unintended pregnancy in homeless women using the developed protocol.

Role of Religious Leaders in COVID-19 Prevention: A Community-Level Prevention Model in Sri Lanka.

The COVID-19 pandemic has affected all countries irrespective of their state of development. In countries with traditional societies, religious leaders have been acknowledged as key stakeholders in community engagement activities, including disease prevention. A community-level prevention model was established in 2020 by the Health Promotion Bureau (HPB), Sri Lanka, which incorporated mobilisation of the clergy to support the prevention and response schemes to COVID-19 with non-governmental stakeholders. This model was part of a more extensive community engagement network established by the HPB in cooperation with the country offices for WHO and UNICEF. Building trust, empowering behavioural traits applicable to minimise risks from COVID-19, leadership and coordination, message dissemination, addressing stigma and discrimination, supporting testing procedures, contact tracing activities and vaccination, building community resilience, spiritual and psychosocial support, and welfare provision are some of the useful factors that were identified in the model. Furthermore, a much broader and holistic approach is needed to focus on health behaviours and social and cultural aspects in a multi-faceted nature. This paper highlights a novel COVID-19 prevention model with active involvement of religious leaders that can be implemented in low resource settings. Our experience from Sri Lanka demonstrates the feasibility of implementing this model to mitigate the disastrous situation following the COVID-19 outbreak.

Community-based homecare nursing in Denmark: exploring factors related to substitution of nurses by ancillary health professionals.

BACKGROUND: Demographic changes and shorter hospital stays have made community-based homecare nursing an increasingly important part of the healthcare organisation. This development may also impact the secondary healthcare system. Optimal use of resources is key to meeting the future challenges. Nevertheless, the research-based knowledge on homecare nursing is scarce. The aim of this study was to examine factors related to homecare nursing tasks that could have been performed by ancillary health professionals. METHODS: A population-based survey involving all homecare nurses in the homecare services in one municipality in Denmark was performed. The nurses registered all contacts during daytime for one week using a registration form with a series of items to identify factors related to possible substitution of nurse-performed tasks. Statistical analyses were used to identify associations between specific factors and potential substitution of the performing type of healthcare professional. The study was approved by and is registered at VIA University College in accordance with the General Data Protection Regulation of the EU. RESULTS: Homecare nurses registered 941 representative visits in the municipality. Substitution by ancillary health professionals was considered a possibility by the nurses in 28.3% of the cases. When adjusting for age, gender, type of visit, need for extra healthcare services and vulnerability, we established that the nurses more often found that ancillary health professionals could have provided the care in unplanned visits and in visits to patients above 90 years of age. CONCLUSIONS: The results indicate potential for optimising the available nursing resources as substitution by ancillary health professionals was considered possible in numerous visits. In view of the increasing demands for community-based homecare nursing, it is important to make the most of the available resources in the future. Substitution of nurses for some tasks could be a feasible solution.

Development of a Home Health Patient Assessment Tool for Disaster Planning.

BACKGROUND: Historically, older adults have been disproportionately affected by disasters. In particular, homebound adults are especially at risk. As one facet of bolstering community resilience, home health agencies have been tasked with improving their patients' disaster preparedness. However, home health practitioners often lack the information necessary to fulfill these requirements. Providing resources about disaster preparedness will allow these practitioners, often seen as trusted advisors, to better prepare their patients. OBJECTIVE: This study explores the utility of implementing a checklist-style assessment tool to guide Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) practitioners in disaster preparedness assessments of their patients. METHODS: The HBPC Patient Assessment Tool for Disaster Planning ("Tool") was fielded by practitioners at 10 VHA HBPC programs with all patients seen over the course of a 3-week period. Descriptive statistics and bivariate analysis of the data collected via the Tool were used to understand the baseline levels of preparedness education provided by practitioners to their patients. Data from a follow-up survey and follow-up interviews with Program Managers were analyzed, the latter using content analysis methods. RESULTS: 754 surveys were returned for analysis. We examined how frequently practitioners reviewed the included preparedness items with their patients. Of those patients on oxygen, adherence ranged from 67 to 94% for practitioners covering a discussion about smoking materials/open flame, despite strong efforts to achieve high compliance on this measure as reported by several program managers. Of those items applicable to the general population, certain items were more frequently discussed than others. How to activate 911 services was most frequently reviewed (87%). Providing information about emergency shelter registration and specialty transport was the item least frequently reviewed (44%). Strengths about the Tool included its ease of use, flow, comprehensiveness, and that it fits on one page. CONCLUSION: Home-based care programs, such as the VHA HBPC program, are tasked with supporting the emergency preparedness of their patients, but often do not have the expertise to do so. This study shows that the checklist-like structure of an assessment tool can assist with this role by encouraging practitioners to cover key points with patients and their caregivers.

Utilizing selected social determinants and behaviors to predict obesity in military personnel.

OBJECTIVE: Like the general population, the military is experiencing an increase in the number of obese personnel. This study aimed to identify predictors of obesity by assessing social determinants of health and behaviors in relation to Body Mass Index (BMI), and to use these variables to build a model to predict obesity in Active Duty Military Personnel (ADMP). Predicting obesity would allow early intervention of at risk personnel, potentially reducing the number of ADMP who are separated from the service for failing to meet weight standards. DESIGN: A secondary data analysis of the 2011 Survey of Health-Related Behaviors of Active Duty Military Personnel was performed. The survey included 39,197 responders. MEASURES: Descriptive statistics, bivariate analyses, and logistic regression analysis were conducted to examine the relationship between social determinants of health, behaviors in relation to Healthy People 2020 recommendations, and obesity. Moderator variables were used to determine what affects the direction and/or strength of the relationship between the independent variables (e.g., social determinants and behaviors) and the outcome variable of obesity. RESULTS: At the bivariate level, these variables mirror existing research. However, logistic regression identified few statistically significant obesogenic lifestyle behaviors in relation to Healthy People 2020 recommendations and a weak interactive effect between the variables. CONCLUSION: The low number of significant variables identified to predict obesity highlights the multifactorial nature of obesity making it difficult for weight-loss interventions to be effective if limited to one group or one specific behavior.