Engaging Teens with Asthma in Designing a Patient-Centered Mobile App to Aid Disease Self-Management.

BACKGROUND: Despite the growing market of e-health disease self-management tools, few studies have reported the presence of teen patients in all phases of product design. While rates of American teens using mobile Internet grow, an opportunity to deliver disease self-management targeted for teen patients exists. Building on findings from previous investigations with teens with asthma, we explored teens' insights on the development of a patient-centered asthma management application (app). MATERIALS AND METHODS: Two existing asthma apps were used by 16 teen asthmatics for 7-10 days. At the end of the trial period, in-depth interviews were conducted with each participant to gather insights about the user experience. RESULTS: Participants requested more asthma-related content that educates them about their condition. Suggested improvements to currently available apps included a longer list of selectable symptoms to track, medication tracking, and more compelling interface features. CONCLUSIONS: Participants showed interest in using apps for managing their asthma, yet recommended improvements on current design. Whereas national figures point to a more ubiquitous mobile device environment, implementation efforts must respond to participants' recommendations while minding lingering digital divides. Currently available apps lack appealing components that teens seek or desire. Subsequent development should include teens' participation in component design insights.

Risk factors associated with increased depressive symptoms among Latinas diagnosed with breast cancer within 5 years of survivorship.

BACKGROUND: Co-occurring depression in women with cancer can complicate cancer treatment, lead to poor treatment adherence for both conditions, and decrease survival if left untreated. The purpose of this study was to explore risk factors for depression among Latina breast cancer survivors. METHODS: A closed-ended questionnaire was administered by telephone to 68 Latinas diagnosed with breast cancer within the past 5 years. Depression symptoms were measured using the Patient Health Questionaire-9 with the Endicott substitutive criteria applied. The Cognitive Appraisal Health Scale and the Brief COPE were used to measure appraisal and coping. Descriptive statistics, bivariate and multiple linear regression analyses were completed. RESULTS: Approximately 45.6% of women reported depressive symptoms. Multivariate analyses showed that a cognitive appraisal variable (decreased challenge or the potential to overcome), coping variables (increased acceptance, less positive reframing, less active coping, less use of emotional support, substance use and more self-blame), poor body image, less family and peer support to be significantly associated with an increased risk for depression. Intrapersonal variables accounted for the greatest explained variance (69%). CONCLUSIONS: This study identified several risk factors for depression. Study findings highlight the need for intervention programs to help women normalize emotions and thoughts related to cancer and its treatments, and to improve their cognitive abilities to overcome, accept, and positively reframe cancer and other difficult situations women face throughout the cancer continuum. The importance of family and peer support to improve depressive symptoms was also evident.

The better model to predict and improve pediatric health care quality: performance or importance-performance?

BACKGROUND: The perpetual search for ways to improve pediatric health care quality has resulted in a multitude of assessments and strategies; however, there is little research evidence as to their conditions for maximum effectiveness. A major reason for the lack of evaluation research and successful quality improvement initiatives is the methodological challenge of measuring quality from the parent perspective. PURPOSE: Comparison of performance-only and importance-performance models was done to determine the better predictor of pediatric health care quality and more successful method for improving the quality of care provided to children. APPROACH: Fourteen pediatric health care centers serving approximately 250,000 patients in 70,000 households in three West Central Florida counties were studied. A cross-sectional design was used to determine the importance and performance of 50 pediatric health care attributes and four global assessments of pediatric health care quality. Exploratory factor analysis revealed five dimensions of care (physician care, access, customer service, timeliness of services, and health care facility). Hierarchical multiple regression compared the performance-only and the importance-performance models. In-depth interviews, participant observations, and a direct cognitive structural analysis identified 50 health care attributes included in a mailed survey to parents(n = 1,030). The tailored design method guided survey development and data collection. FINDINGS: The importance-performance multiplicative additive model was a better predictor of pediatric health care quality. PRACTICE IMPLICATIONS: Attribute importance moderates performance and quality, making the importance-performance model superior for measuring and providing a deeper understanding of pediatric health care quality and a better method for improving the quality of care provided to children. Regardless of attribute performance, if the level of attribute importance is not taken into consideration, health care organizations may spend valuable resources targeting the wrong areas for improvement. Consequently, this finding aids in health care quality research and policy decisions on organizational improvement strategies.

Cigarette Use among Parents with Children in the Home: A Comparison of Civilian Parents and Parents with a Military Connection.

We tested the null hypothesis of equal likelihood of cigarette use among parents with a military connection and parents without a military connection, and independently compared risk factors for cigarette use. We obtained National Health Interview Survey (NHIS) data from 2015 to 2019 survey waves. We delimited analysis to 2-parent households who reported children aged <18 years living with them. After a 2:1 nonparametric age matching procedure, our sample included 1106 civilian parents and 553 parents with a military connection. Using the NHIS survey-design weights, we estimated a design-based F statistic for differences in cigarette use by military connection status. We also estimated population-stratified, survey-weighted multivariable logistic regression models to determine risk factors for parent cigarette use. Whereas 6.87% parents with a military connection used cigarettes, 16.64% of age-matched civilian parents reported cigarette use. This difference was significant even after adjustment for covariates (aOR = 0.49, 95% CI = 0.32, 0.74). Recommendations for programing and policy are provided.

Preventing eye injuries among citrus harvesters: the community health worker model.

OBJECTIVES: Although eye injuries are common among citrus harvesters, the proportion of workers using protective eyewear has been negligible. We focused on adoption of worker-tested safety glasses with and without the presence and activities of trained peer-worker role models on harvesting crews. METHODS: Observation of 13 citrus harvesting crews established baseline use of safety eyewear. Nine crews subsequently were assigned a peer worker to model use of safety glasses, conduct eye safety education, and treat minor eye injuries. Safety eyewear use by crews was monitored up to 15 weeks into the intervention. RESULTS: Intervention crews with peer workers had significantly higher rates of eyewear use than control crews. Intervention exposure time and level of worker use were strongly correlated. Among intervention crews, workers with 1 to 2 years of experience (odds ratio [OR] = 2.89; 95% confidence interval [CI] = 1.11, 7.55) and who received help from their peer worker (OR = 3.73; 95% CI = 1.21, 11.57) were significantly more likely to use glasses than were other intervention crew members. CONCLUSIONS: Adaptation of the community health worker model for this setting improved injury prevention practices and may have relevance for similar agricultural settings.

Characteristics of 'tween' participants and non-participants in the VERB™ summer scorecard physical activity promotion program.

Creating community-based opportunities for youth to be physically active is challenging for many municipalities. A Lexington, Kentucky community coalition designed and piloted a physical activity program, 'VERB™ summer scorecard (VSS)', leveraging the brand equity of the national VERB™--It's What You Do! campaign. Key elements of VSS subsequently were adopted in Sarasota County, FL. This study identified characteristics of Sarasota's VSS participants and non-participants. Students in Grades 5-8 from six randomly selected public schools completed a survey assessing VSS participation, physical activity level, psychosocial variables, parental support for physical activity and demographics. Logistic regression showed that VSS participants were more likely to be from Grades 5 to 6 versus Grades 7 and 8 [odds ratio (OR) = 6.055] and perceive high versus low parental support for physical activity (OR = 4.627). Moreover, for each unit rise in self-efficacy, the odds of VSS participation rose by 1.839. Chi-squared automatic interaction detector (CHAID) analysis suggested an interaction effect between grade and school socioeconomic status (SES), with a large proportion of seventh and eighth graders from high SES schools being non-participants (76.6%). A VSS-style program can be expected to be more effective with tweens who are younger, in a middle SES school, having high self-efficacy and high parental support for physical activity.

Utility of the physical activity resource assessment for child-centric physical activity intervention planning in two urban neighborhoods.

Children's physical activity (PA) may be determined, in part, by environmental influences such as access to diverse and safe places to play. As part of the development of a community-based PA program, a PA asset assessment was conducted in two low-income urban neighborhoods that support elementary schools serving minority youth. Resources were rated using an adapted version of the Physical Activity Resource Assessment (PARA), a multi-dimensional instrument that rates various venues on their features, amenities, and incivilities. Seventy-one child-centric venues (e.g., parks, playgrounds, community centers, sports facilities, fitness centers, etc.) were assessed within a three-mile radius of each school. Community member feedback via interviews with parent-child dyads revealed issues (e.g., bullying) not captured by the PARA that can influence venue use. Whereas the PARA can be a useful needs assessment and program planning tool for community-based PA programs, supplementing PARA data with community-based input may reduce contextual error in program development.

Vigorous physical activity among tweens, VERB Summer Scorecard program, Lexington, Kentucky, 2004-2007.

INTRODUCTION: Empirical examinations of the efficacy of community-based programs to increase and sustain physical activity among youth are lacking. This study describes changes in vigorous physical activity during a 3-year period among children aged 9 to 13 years (tweens) in Lexington, Kentucky, following introduction of the VERB Summer Scorecard (VSS) intervention. METHODS: A community coalition, guided by a marketing plan that addressed motivators for tweens to participate in physical activity, designed and implemented VSS. Youth used a scorecard to monitor their physical activity, which was verified by adults. There were 3,428 students surveyed in 2004; 1,976 in 2006; and 2,051 in 2007 (mean age for 2004, 2006, and 2007, 12 y). For each year, we performed Χ(2) tests and computed summary statistics for age, sex, and grade. Chi-square tests and cumulative logit models were used to analyze physical activity trends among VSS participants, VSS nonparticipants, and a reference group. RESULTS: The proportion of youth who reported frequent vigorous physical activity increased from 32% in 2004 to 42% in 2007. The proportion of VSS participants with moderate or high levels of vigorous physical activity increased by approximately 17 percentage points, more than twice the proportion of nonparticipants. CONCLUSION: Interventions such as VSS may empower communities to take action to encourage greater physical activity among youth.

Rebranding School Health: The Power of Education for Health Literacy.

BACKGROUND: The relationship between health and learning generally goes without question in developed countries, and has a philosophic, economic, and statutory basis. Historically, school health and school health education have evolved in response to addressing the public health needs of the times. Health literacy skills are more important now than ever. Living in an ongoing COVID-19 global pandemic reminds us of the vital role of being in control of our health, wherein health literacy plays a "life or death" role in our daily lives. METHODS: Considering the evolution of school health education, we examine the significance of health literacy in our society and schools in contemporary times. RESULTS: We must take a critical look at a place for education for health literacy and why it should be an innovative path in adaptive, reimagined, and revitalized schools. CONCLUSIONS: It is time to rebrand school health in general, and school health education specifically. Improved health literacy is an asset leading to greater opportunities for health and life-long learning.

What's in a Name? Re-Branding and Re-Framing School Health Education to School Boards and Legislators as Education for Health Literacy-A Commentary.

BACKGROUND: Branding involves "labeling" (for identification) and "meaning" (for understanding) to a product, service, person, idea, or other entity. We are familiar with "brands" of soft drinks, automobiles, mobile phones, soups, cigarettes, and sports teams, and some brands have greater "market share" than others. METHODS: In this commentary, we review some of the ways that school health has been branded over the past 50+ years. RESULTS: The brand we know as school health education has failed to compete successfully with other school subject areas (eg, the so-called STEM subjects) for the attention of school board members, administrators, legislators, and other policymakers. Perhaps more importantly, school health education advocates have lost the market share game to subject areas that school board members and legislators see as ones with better return on investment, at least politically speaking. In short, we have failed to make the sale. CONCLUSION: An alternative is to re-brand and re-frame school health education as education for health literacy. Literacy as a brand commands the attention of education gatekeepers, and may be more strongly related conceptually to what gatekeepers see as education-centric programs deserving of funding. Adopting a marketing mindset may elevate education for health literacy to a place where key stakeholders are more likely to "purchase" it as a relevant school "product."

Increasing physical activity in children 8 to 12 years old: experiences with VERB Summer Scorecard.

Interventions which facilitate physical activity of youth are vital for promoting community health and reducing obesity. This study assessed the results of a community-driven program, VERB Summer Scorecard, as knowledge of exposure to and awareness of community-based interventions for physical activity among youth could inform design and implementation of such interventions. A total of 2,215 youth ages 8 to 12 years responded to a survey about physical activity. Ordinal logistic regression suggested that youth who participated in this program were 1.73 times (95% CI = 1.41, 2.11) more likely to report high physical activity than nonparticipating youth 9 mo. after the intervention's first full-scale application. The program appeared to appeal more to girls than boys. Such results are encouraging for use in communities.

Using social marketing to understand the family dinner with working mothers.

The family dinner is a valued tradition that affords opportunities for social interaction and attachment, as well as sharing events of the day, role modeling, connectedness, and problem solving. Guided by the social-marketing framework, this study explored factors associated with the frequency of the family dinner among working mothers with children ages 8-11 years. A qualitative design was used, employing focus groups and Atlas-ti software for thematic analysis. Lack of time, cost, and exhaustion/lack of energy emerged as barriers. Working mothers indicated that a youth-based organization operating as a community partner could increase the frequency of the family dinner by helping with homework completion during after-school care, thereby providing mothers with the time necessary to prepare dinner. This research identified both community partners and working mothers as valued resources for prevention strategies. Interventions developed to increase family dinner frequency should emphasize the perceived value while decreasing the costs/barriers.

Predicted prevalence of oral human papillomavirus (HPV) by periodontitis status and HPV vaccination status.

OBJECTIVES: The purpose of the present study was to examine differences in oral human papillomavirus (HPV) prevalence among adults based on HPV vaccination status and periodontitis status. METHODS: Data from 2011 to 2012 and 2013 to2014 National Health and Nutrition Examination Surveys (n = 822) were retrieved in order to predict the prevalence of oral HPV in 24 separate demographic groups (age by sex by race) based on the following characteristics: HPV vaccination status and periodontitis status. A multiple logistic regression model, controlling for gender, age, race, smoking behavior, alcohol consumption, and sexual partners, was calculated in order to generate prevalence estimates. RESULTS: Median predicted oral HPV prevalence rates per 1,000 in 2011-2012 were highest among nonvaccinated individuals with periodontitis [median ( x˜ ) = 31.62, interquartile range (IQR) = 102.97], followed by nonvaccinated individuals without periodontitis ( x˜ = 24.63, IQR = 81.84), vaccinated individuals with periodontitis ( x˜ = 18.40, IQR = 62.27), and vaccinated individuals without periodontitis ( x˜ = 14.29, IQR = 48.96). Median predicted oral HPV prevalence rates per 1,000 in 2013-2014 were highest among nonvaccinated individuals with periodontitis ( x˜ = 9.50, IQR = 33.02), followed by nonvaccinated individuals without periodontitis ( x˜ = 7.37, IQR = 25.76), vaccinated individuals with periodontitis ( x˜ = 5.48, IQR = 19.27), and vaccinated individuals without periodontitis ( x˜ = 4.25, IQR = 14.98). CONCLUSIONS: Interventions that integrate primary care and dental care are needed, given increased risk for oral HPV among unvaccinated individuals with periodontitis.

Prevalence of childhood asthma in US military and non-military families: Comparisons by rural-urban residence and geographic region.

OBJECTIVE: We sought to determine variables associated with asthma among children from military and non-military families. METHODS: We performed secondary data analysis on the 2016 Behavioral Risk Factor Surveillance System. Parents with and without military experience (n = 61,079) were asked whether a child ever had asthma and currently has asthma. We used two multiple logistic regression models to determine the influence of rurality and geographic region on "ever" and "current" asthma in children of military and non-military families, while controlling for socio-demographic and behavioral variables. RESULTS: Overall childhood asthma prevalence for children in military families was lower than non-military families (ever, 9.7% vs. 12.9%; currently, 6.2% vs. 8.2%) in 2016. However, multiple logistic regression showed variation in "ever" and "current" asthma among children of military and non-military families by rurality and race. DISCUSSION: Developers of public health asthma interventions should consider targeting African-American children of military families living in urban areas. This population is approximately twice as likely to have asthma as Caucasian children of non-military families.

Estimating maternal mortality in Monseñor Nouel Province, Dominican Republic.

OBJECTIVES: Maternal deaths are estimated by the World Health Organization at over 500,000 annually. Various methods of calculating mortality ratios have been utilized throughout the world, but many are inaccurate. The purpose of this study was to measure maternal mortality by using a sibling survivorship survey and by recording and tracking death certificates. METHODS: The data for the survey were collected within a specific province in the Dominican Republic that represents predominately rural communities. Interviews with 2,180 women and data from their 17,807 siblings were recorded, 9,723 of which were sisters. The Death Certificate data were obtained by tracking 3,430 records at the local government office in the same province. RESULTS: The results from the rural sibling survey show a maternal mortality ratio significantly higher than other national estimates (348/100,000 live births versus 72-250/100,000). Data collection methods are discussed, including government record keeping and potential sources of inaccuracy. CONCLUSION: Reported maternal mortality ratios may not portray the true magnitude of the poor health status of women in developing countries.

A community-school district-university partnership for assessing physical activity of tweens.

INTRODUCTION: Obesity among youth is related to a decline in physical activity, and data on physical activity levels among children in elementary and middle schools are limited. METHODS: We leveraged a community-school district-university partnership in Sarasota County, Florida, in May of 2005 to assess physical activity levels among tweens (youth aged 9-13 years) and to measure the relationship between tweens' awareness of the Centers for Disease Control and Prevention's VERB program and participation in physical activity, using a minimally obtrusive survey. After surveying participating schools (4 elementary schools and 3 middle schools), we obtained 1,407 responses from children in grades 5 through 7. RESULTS: In all, 83.1% of students met the federal recommendation for daily participation in vigorous-intensity physical activity (VPA), and 58.6% had tried a new game or sport within the previous 2 months. Mean number of days in the previous week engaging in VPA was significantly higher (P < .001) for boys (5.22) than for girls (4.35). Mean number of days engaging in VPA in the previous week was significantly higher (P = .006) among 6th-grade students (4.93) than 7th-grade students (4.54), but no consistent decline through the grade levels occurred. Activity was significantly correlated with the number of friends reported as playing a game or sport daily (r = .369, P < .001). Most students (88.8%) reported having seen, read, or heard messages or ads about VERB, a tween-centric national social marketing campaign promoting physical activity and participation in new games and sports. CONCLUSION: Although participation in VPA was high, girls reported significantly fewer days spent engaged in VPA than did boys. We found a modest association between engaging in VPA and having active friends. Capitalizing on leadership from multiple community-based organizations to monitor youth physical activity may inspire implementation of strategies for motivating youth to try new games and sports that they can sustain through the adolescent years and beyond.

VERB summer scorecard: findings from a multi-level community-based physical activity intervention for tweens.

The benefits of physical activity for adolescents are well established. Multi-level interventions may be especially effective in establishing and sustaining health-enhancing behaviors. This study explored the influences of a multi-level community intervention aimed at increasing physical activity among tweens (youth 9-13). Two Florida school districts far apart served as intervention and comparison sites in a quasi-experimental post-test design. Youth in grades 5 through 8 in the intervention community (n = 1,253) and comparison community (n = 866) completed an anonymous post-intervention survey. An intent-to-treat analysis did not show any statistically significant group differences for the physical activity outcomes examined. However, a subset analysis revealed that students who reported participating in the intervention were more likely to be physically active than youth in the comparison group, as well as youth in the intervention community who reported not participating. Participating in the intervention was significantly related to meeting recommendations for vigorous physical activity (OR = 2.08, P = 0.0259), being physically active on weekends (OR = 1.84, P = 0.0017), and reporting more days of trying a new game or sport (OR = 1.49, P = 0.046) after controlling for grade, gender, race/ethnicity, and SES. These findings support the efficacy of multi-level interventions to create effective health behavior change, especially when linkages among community, media, schools, and the home are present.

Influences on physical activity participation among Latinas: an ecological perspective.

OBJECTIVES: To explore intrapersonal, social environmental, and physical environmental influences that promote or impede total physical activity (TPA) among Latinas in Lee County, Florida. METHODS: In-depth interviews (n=41) and face-to-face surveys (n=358). RESULTS: Women who worked outside the home, had positive attitudes about activity, perceived themselves to have access to activity facilities, and perceived their neighborhood to be safe reported higher TPA. Women who had more education and whose health information source was radio had lower TPA. CONCLUSIONS: Intrapersonal and environmental factors influence TPA levels among Latinas. Segmenting Latina groups using these factors may promote more involvement in physical activity through targeted programs and messages.

HPV knowledge among HPV+ women.

OBJECTIVE: To assess knowledge and information seeking among women recently receiving an HPV+ diagnosis. METHODS: A 2-phase mixed methods design was used. In both phase I (qualitative) and phase II (quantitative), women with scheduled gynecological exams and Pap smears at clinic sites were approached to participate. RESULTS: Women expressed confusion about HPV, and most could not correctly articulate the meaning of their diagnosis. Women do engage in further information seeking, especially through the Internet. CONCLUSION: Identifying gaps in knowledge among HPV+ women who need clear messages to facilitate their comprehension of the diagnosis is an important public health activity.