Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations.

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) (p < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.

Adolescent Social Networks and Alcohol Use: Variability by Gender and Type.

BACKGROUND: Scientists have established that social networks influence adolescents' substance use behavior, an influence that varies by gender. However, the role of gender in this mechanism of influence remains poorly understood. Particularly, the role an adolescent's gender, alongside the gender composition of his/her network, plays in facilitating or constraining alcohol use is still unclear. OBJECTIVES: This study examined the associations among the gender composition of adolescents' networks, select network characteristics, intrapersonal and interpersonal factors, and alcohol use among a sample of adolescents in the United States. METHODS: We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Analyses of adolescents' network characteristics were conducted using UCINET 6; and logistic regression analyses testing the associations between gender composition of the network and alcohol use were conducted using SPSS 20. RESULTS: Our results indicate that the gender composition of adolescents' networks in our sample is associated with alcohol use. Adolescents in predominantly female or predominantly male friendship networks were less likely to report alcohol use compared to adolescents in an equal/balanced network. In addition, depending upon the context/type of network, intrapersonal and interpersonal factors varied in their association with alcohol use. Conclusions/Importance: Based on these findings, we make several recommendations for the future research. We call for researchers to further examine gender as a risk factor for alcohol abuse, particularly within the complex interplay between gender and network contexts.

What's love got to do with it? Adolescent romantic networks and substance use.

This study examined how romantic aspiration network characteristics at the individual level (in-degree and out-degree) are associated with substance use (i.e. smoking and drinking) among a cross-sectional sample of US adolescents (10th grade, n = 1523) from 4 high schools in Los Angeles. Findings highlighted that, with an increase in out-degree (romantic aspiration nominations made), adolescents in our sample were less likely (OR = .824, CI = .688-.986, p < .05) to report smoking in the past 30 days. Additionally, with an increase in in-degree (romantic aspiration nominations received), adolescents were more likely (OR = 1.186, CI = 1.04-1.36, p < .05) to report drinking in the past 30 days. We conclude that romantic aspirations/relations influence adolescents' substance use behaviour (i.e. smoking and drinking alcohol), particularly because of the intensity of such relationships and the desire to please or be acceptable to the other person. Moreover, understanding adolescents' aspirations/relations can be useful for the development of intervention/prevention programmes to target adolescents' substance use.

Children's active commuting to school: an interplay of self-efficacy, social economic disadvantage, and environmental characteristics.

BACKGROUND: Active commuting to school (ACS) can promote children's physical activity and may help prevent childhood obesity. Previous researchers in various disciplines, e.g., health, urban planning, and transportation, have identified various predictors of ACS. However, little research has been carried out into investigating the effect of self-efficacy on ACS. The purpose of this study is to investigate the roles of children's and parents' self-efficacy in children's ACS, controlling for sociodemographic and objective environmental characteristics. METHODS: This study is part of the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, which includes data from 857 parent/child pairs from 74 schools who lived within two miles of school in Texas. Measures included children's usual modes of commuting to school, participants' sociodemographics, perceived self-efficacy toward ACS, sources of children's self-efficacy, school settings, and objective environmental constraints. Multilevel structural equation modeling (SEM) was employed to test the hypothesized pathways using Mplus 7.0. RESULTS: Around 18% of the children were active commuters. Two sources of children's self-efficacy were identified, i.e., emotional states (ß = 0.36, p < 0.001) and social modeling (ß = 0.28, p < 0.01). Compared with children's self-efficacy (ß = 0.16, p < 0.001), parents' self-efficacy (ß = 0.63, p < 0.001) had a stronger influence on children's ACS. Participants' social economic disadvantage (ß = 0.40, p < 0.001), environmental constraints (ß = -0.49, p < 0.001), and school setting (ß = -0.17, p = 0.029) all had statistically significant direct effects on children's ACS. CONCLUSIONS: Future initiatives should consider both parents' and children's self-efficacy in developing strategies for promoting children's ACS. Social disadvantage and environmental constraints also need to be addressed for effective interventions. The work reported here provides support for the continuing exploration of the role of self-efficacy in children's ACS.

Blending Health Literacy With an English as a Second Language Curriculum: A Systematic Literature Review.

About 21% of the U.S. population ages 5 and older speaks a language other than English at home, and many of them cannot communicate in English fluently. A possible intervention to improve health literacy for people with limited English proficiency is the use of an English as a second language curriculum. The purpose of this systematic review is to assess the characteristics (e.g., theoretical framework, developing processes, classroom activities, goals and topics) and effectiveness of English as a second language health literacy curricula that are currently available in English-dominant countries. We searched the online databases of ERIC, Sage, Springer, PubMed, Medline, and Scopus, identifying 7 curricula within 18 published reports. We synthesize the strengths and weaknesses of the reviewed curricula and provide recommendations for improving future health literacy interventions and research.

Effectiveness of a Web-based genomics training for health educators in Texas.

PURPOSE: With advanced genomic developments, better prevention strategies are available via personalized genomic services. Because there is a shortage of genetic professionals, and primary-care providers are overwhelmed with routine practice, involving health educators--whose expertise includes educating the general public and promoting healthy behavior--to provide basic genomics education may facilitate better services. We developed the first evidence- and theory-based family health history Web-based training for Texas health educators. This report presents its evaluation results. METHODS: Approximately one-third of Texas health educators holding (Master) Certified Health Education Specialist designation (~40% were racial/ethnic minorities) participated in the family health history Web-based training. Attitudes, self-efficacy, intention, knowledge, and practice were assessed at baseline, immediately after training, and 3 months posttraining. Qualitative data were collected to provide additional evaluation findings. RESULTS: Participants significantly improved their attitudes, knowledge, intention, and self-efficacy regarding family health history education, immediately posttraining and after 3 months. The number of participants practicing family health history was significantly increased. Participants' overall assessment of the program was positive. CONCLUSION: This family health history Web-based training successfully increased the number of genomically competent and culturally diverse Texas health educators. Ongoing efforts are needed to sustain and expand this education as well as to disseminate it to all health educators in the United States.

Perceived barriers to children's active commuting to school: a systematic review of empirical, methodological and theoretical evidence.

Active commuting to school (ACS) may increase children's daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children's ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children's ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child's ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers' awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.

Genomics education training needs of U.S. health educators: a (qualitative) pilot study.

As genomic advances have turned the promise of personalized prevention and health promotion into a concrete possibility in the near future, scholars and the Centers for Disease Control and Prevention have begun to call for U.S. health educators to develop their genomic competencies. This advocacy, however, begs the question whether health educators feel the need for further genomic training. Using an emergent design, the authors analyze qualitative data obtained from in-depth interviews with 24 health educators in the United States. Data are searched for salient, emergent themes (salience is determined by the frequency of a theme's occurrence across interviews). Findings indicate that although the majority (78.3%) of health educators have received minimal or no genomic education, 81.0% acknowledge the importance of adding some type of training to their future professional development. Participants suggest conference presentations, workshops, and symposia (54.5%) as the most preferable approach for delivering such training. The four most frequently desired training topics include applied genetics/genomics (85.7%), basic genetics/genomics (42.9%), current and future developments in genetics/genomics (28.6%), and genetic testing and screening (19.0%). Findings from this qualitative study can become catalysts for future examinations of this topic and provide the conceptual basis for developing genomics training materials specifically for health educators.

Continuity of maternal and infant care through integrated health service delivery networks in Latin America: a scoping review.

Latin America has experienced substantial development over the last three decades; however, development has been uneven with persistent inequalities, especially in the areas of maternal and child health. Since the early 1990s, most Latin American health-care systems have undergone a series of reforms to improve access to services, with the most recent being the implementation of integrated health service delivery networks (IHSDNs). This model posits that patients will receive better continuity of care and higher-quality health services and avoid duplicated efforts. While decreased maternal and infant mortality rates have been observed in the region since IHSDN implementation, there is limited evidence on this model's implications for maternal and infant care. The purpose of this study is to explore how IHSDNs affect access to and continuity of maternal and infant care in Latin America, according to the peer-reviewed literature. A scoping review was conducted systematically to identify peer-reviewed articles published since 2007 on studies that took place in Latin America, include IHSDNs, focus on the antenatal and/or postnatal period, include women and/or infants under 2 years of age and are written in English, Spanish or Portuguese. Seven studies (n = 7) met the inclusion criteria for this review. Barriers identified were related to person-centred care (n = 5) and logistical challenges (n = 5). The most cited facilitator encompassed social support for women when accessing care (n = 3). Potential solutions to improve care access included an improvement in the network structure and a greater focus on care provision, rather than regulations and compliance. Findings from this study suggest that the IHSDN model has the potential to improve care for women during pregnancy and post-birth if the model is implemented to its full extent. However, implementation of the model in Latin America is still weak, creating barriers for women when seeking care, particularly for disparate populations and those residing in rural areas.

Decision to abort after a prenatal diagnosis of sex chromosome abnormality: a systematic review of the literature.

We performed a systematic review of factors affecting parental decisions to continue or terminate a pregnancy after prenatal diagnosis of a sex chromosome abnormality, as reported in published studies from 1987 to May 2011. Based on the Matrix Method for systematic reviews, 19 studies were found in five electronic databases, meeting specific inclusion/exclusion criteria. Abstracted data were organized in a matrix. Alongside the search for factors influencing parental decisions, each study was judged on its methodological quality and assigned a methodological quality score. Decisions either to terminate or to continue a sex chromosome abnormality-affected pregnancy shared five similar factors: specific type of sex chromosome abnormality, gestational week at diagnosis, parents' age, providers' genetic expertise, and number of children/desire for (more) children. Factors unique to termination decisions included parents' fear/anxiety and directive counseling. Factors uniquely associated with continuation decisions were parents' socioeconomic status and ethnicity. The studies' average methodological quality score was 10.6 (SD = 1.67; range, 8-14). Findings from this review can be useful in adapting and modifying guidelines for genetic counseling after prenatal diagnosis of a sex chromosome abnormality. Moreover, improving the quality of future studies on this topic may allow clearer understanding of the most influential factors affecting parental decisions.

Contextual factors influencing U.S. college students' decisions to drink responsibly.

This mixed-methods study qualitatively (n = 13-convenience) explored contextual factors influencing decisions to drink responsibly, and quantitatively (n = 729-random) assessed the prevalence of these factors and whether they varied as a function of sex and binge-drinking status. Data were collected in 2007 among Texas college students. The constant comparison model was used to analyze the qualitative data, while one-way ANOVAs and logistic regression were employed to assess the quantitative data. Effect sizes are reported for all significant ANOVA interactions. Psychometric properties are supplied for all quantitative scales. Implication and limitations are noted, and future research directions discussed.

Neutral or Framed? A Sentiment Analysis of 2019 Abortion Laws.

Introduction: This study employs sentiment analysis (SA) to examine the semantic structures of restrictive and protective abortion bills enacted in 2019. SA is a Natural Language Processing (NLP) technique that uses automation to extract affective indicators (emotive language) from text data. Assessing these indicators can help identify whether legal texts are framed, or intentionally biased in their wording. Identifying framing is important for understanding potentially biased interpretations of these laws. Methods: We identified a sample of 2019 abortion bills using the legislative tracking tool Legiscan and included those that met specified criteria (N = 19 bills). We categorized each bill as restrictive (n = 12) or protective (n = 7). We ran aggregate (i.e., all bills) and separate (protective × restrictive) SA, generating scores that we interpreted qualitatively (higher scores indicated predominance of positive wording). Results: In the aggregate analysis, 56% of text comprised negative terms (44% positive). Restrictive bills contained more negative language than protective bills (67% vs 58%). Although SA scores varied from -222 to +13, two laws scored 0, indicating neutrality. For comparison, the US Constitution's score equaled 1. Conclusion: Our findings confirm SA is useful to examine legal documents for language biases. The abortion bills we assessed seem framed along political ideologies, although the sample provided evidence that neutral wording is possible. Policy Implications: With the recent additions of conservative-leaning Justices to the US Supreme Court, Roe v. Wade is again at the center of partisan conflict. Thus, how abortion laws are framed draws further implications for how they may be interpreted when challenged in the court system.

Language Bias in Health Research: External Factors That Influence Latent Language Patterns.

Background: Concerns with problematic research are primarily attributed to statistics and methods used to support data. Language, as an extended component of problematic research in published work, is rarely given the same attention despite language's equally important role in shaping the discussion and framings of presented data. Purpose: This study uses a topic modeling approach to study language as a predictor of potential bias among collected publication histories of several health research areas. Methods: We applied Latent Dirichlet Allocation (LDA) topic models to dissect publication histories disaggregated by three factors commonly cited as language influencers: (1) time, to study ADHD pharmacotherapy; (2) funding source, to study sugar consumption; and (3) nation of origin, to study Pediatric Highly-Active Anti-Retroviral Therapy (P-HAART). Results: We found that, for each factor, there were notable differences in language among each corpus when disaggregated by each factor. For time, article content changed to reflect new trends and research practices for the commonly prescribed ADHD medication, Ritalin. For funding source, industry and federally funded studies had differing foci, despite testing the same hypothesis. For nation of origin, regulatory structures between the United States and Europe seemingly influenced the direction of research. Conclusion: This work presents two contributions to ethics research: (1) language and language framing should be studied as carefully as numeric data among studies of rigor, reproducibility, and transparency; and (2) the scientific community should continue to apply topic models as mediums to answer hypothesis-driven research questions.

Evaluating a genomics short course for undergraduate health education students.

Background: There is a significant shortage of genomics training curricula targeting health education (HE) students. This study assessed the impact of an online theory-based genomics short course focusing on family health history (FHH) to undergraduate HE students. Materials & methods: Junior and senior HE students (n = 69) at a research-intensive university completed the course and took the pre- and post-course surveys. Results: Participants demonstrated positive improvements in their scores regarding FHH knowledge as well as attitudes, intention and confidence in adopting FHH-based genomics skills into future practice. They also showed satisfaction with the genomics course. Conclusion: Based on the initial success of the results, offering this genomics course to more HE students for further testing is recommended in the future.

Barriers to adopting genomics into public health education: a mixed methods study.

PURPOSE: To examine public health educators' perceptions of barriers to incorporate genomic content (information, discoveries, technologies) into health promotion. METHODS: Mixed methods (qualitative and quantitative approaches)-using a fully mixed sequential dominant status design-were employed. Qualitative data were collected from a convenient sample of 24 public health educators, through personal interviews. Quantitative data, from a nation-wide sample of 1607 professionals (from four professional organizations/groups), were collected through a Web-based survey (adjusted response rate = 23.1%). Content analysis guided the interpretation of the qualitative data; descriptive statistics were used to analyze the survey data and to compare prevalence of themes across the qualitative and survey samples. RESULTS: Specific barriers highlighted by the qualitative and the survey samples included lack of genomic knowledge (basic and applied), having to deal with the lay public's reaction, lack of priority, time and resources, and incompatibility between genomics and public health educators' religious and ethical beliefs. CONCLUSION: This study suggests that public health educators perceive numerous barriers to incorporating genomics into health promotion. More research is needed to confirm this study's findings, to explore potential sources, and to propose viable strategies to overcome many of these barriers.

Predictors of secondary abstinence in U.S. college undergraduates.

This study examined (1) the percentage of participants who practiced secondary sexual abstinence and (2) factors associated with its practice among a sample of U.S. college students. College undergraduate men and women (n = 1,133) in Texas completed a web-based survey assessing abstinence status and predictors of abstinent behavior. Results revealed that 12.5% of participants practiced secondary abstinence. Of eight variables, five significantly predicted secondary abstinence (following sexual initiation). Predictors were positive attitude toward abstinence, subjective norm supporting abstinence, greater religious ties, and previous negative sexual experiences. The fifth variable, participation in abstinence education, however, was associated with a significantly reduced likelihood of secondary abstinence. Fewer perceived barriers, less environmental manipulation (efforts to make physical and social environments supportive of abstinence), and greater religious ties significantly predicted self-efficacy for secondary abstinence. Findings provide an estimate of the percentage of participants who practiced secondary abstinence and suggest focal points for future research.

Social network analysis for assessing college-aged adults' health: A systematic review.

OBJECTIVE: Social network analysis (SNA) is a useful, emerging method for studying health. College students are especially prone to social influence when it comes to health. This review aimed to identify network variables related to college student health and determine how SNA was used in the literature. PARTICIPANTS: A systematic review of relevant literature was conducted in October 2015. METHODS: Studies employing egocentric or whole network analysis to study college student health were included. We used Garrard's Matrix Method to extract data from reviewed articles (n = 15). RESULTS: Drinking, smoking, aggression, homesickness, and stress were predicted by network variables in the reviewed literature. Methodological inconsistencies concerning boundary specification, data collection, nomination limits, and statistical analyses were revealed across studies. CONCLUSIONS: Results show the consistent relationship between network variables and college health outcomes, justifying further use of SNA to research college health. Suggestions and considerations for future use of SNA are provided.

Moving college health research forward: Reconsidering our reliance on statistical significance testing.

Understanding the unique health needs of college students and establishing best practices to address them depend, heavily, on the inherent quality and contribution of the research identifying these needs. College health-focused publications currently exemplify less than ideal statistical reporting practices. Specifically, college health practitioners and researchers continue to rely heavily upon null hypothesis significance testing (NHST) as the sole standard for effectiveness, validity, and/or replicability of scientific studies, even though NHST itself was not designed for such purposes. Herein we address the following questions: (a) What is NHST? (b) What are the inherent limitations of NHST? (c) What are recommended alternatives to NHST? and (d) How can editorial policies promote adopting NHST alternatives? Using college health data from the CORE 2011 Alcohol and Drug survey, we provide a heuristic example demonstrating how effect sizes do not suffer from the same limitations as NHST.

Training Texas Public Health Professionals and Professionals-In-Training in Genomics.

PURPOSE: The purpose of this study is to evaluate the effects of genomics training workshops for public health professionals and professionals-in-training. DESIGN: A pre- and post-test evaluation design with 3-month follow-up. SETTING AND PARTICIPANTS: Thirteen genomics training workshops were delivered across Texas to 377 public health professionals and professionals-in-training (66.7% were ethnic minorities). INTERVENTION: Three-hour theory-based, face-to-face genomics training workshops focusing on family health history practice were delivered. METHODS: We administered surveys prior to the workshops, immediately post-workshops, and at 3-month follow-up to examine the changes in participants' knowledge, attitudes, intention, self-efficacy, and behavior in adopting genomics into public health practice. Linear mixed modeling analyses were used to analyze the quantitative survey data. A content analysis was also conducted for qualitative survey data analysis. RESULTS: Genomics practice significantly improved among public health professionals at 3-month follow-up (P < .01). For all participants, knowledge, attitudes, intention, and self-efficacy scores increased significantly immediately post-workshop compared to the pre-workshop scores (all Ps < .01). Knowledge and attitudes scores at the 3-month follow-up remained significantly higher than those scores at the pre-workshop (all Ps < .01). The feedback from workshop participants was positive. CONCLUSION: Our genomics training workshop is an effective program that can be disseminated at a national level to establish genomic competencies among public health professionals and professionals-in-training in the United States.

US health educators' likelihood of adopting genomic competencies into health promotion.

OBJECTIVES: We examined US health educators' likelihood of adopting genomic competencies--specific skills and knowledge in public health genomics--into health promotion and the factors influencing such likelihood. METHODS: We developed and tested a model to assess likelihood to adopt genomic competencies. Data from 1607 health educators nationwide were collected through a Web-based survey. The model was tested through structural equation modeling. RESULTS: Although participants in our study were not very likely to adopt genomic competencies into their practice, the data supported the proposed model. Awareness, attitudes, and self-efficacy significantly affected health educators' likelihood to incorporate genomic competencies. The model explained 60.3% of the variance in likelihood to incorporate genomic competencies. Participants' perceived compatibility between public health genomics and their professional and personal roles, their perceptions of genomics as complex, and the communication channels used to learn about public health genomics significantly related to genomic knowledge and attitudes. CONCLUSIONS: Because US health educators in our sample do not appear ready for their professional role in genomics, future research and public health work-force training are needed.