Information Architects: Using Community-Engaged and Qualitative Methods to Design a Technology-Based Nutrition and Cancer Risk Intervention for Rural Adults.

BACKGROUND: Nearly half of all cancer deaths are preventable through modification or avoidance of key risk factors. As such, there is a growing urgency to identify effective, low-resource, and scalable technologies that support clinical care and patient self-management of health behaviors. PURPOSE: Informed by theories of cognitive load and user-centered design approaches, we develop a culturally tailored, multicomponent digital intervention to engage rural adults between 50-73 years old with their personalized nutrition risk factors for colorectal cancer (CRC) prevention. METHOD: A total of 48 adults tested a Virtual Health Assistant (VHA) prototype during focus groups in individual think-aloud interviews to facilitate iterative adaptations to a web-based CRC prevention intervention. Qualitative data was analyzed to identify user needs and preferences related to information and with a focus on avoiding cognitive overload. RESULTS: The VHA serves as a conceptual pre-training for users helping them understand CRC prevention key concepts and engendering motivation to act on the promoted behavior. A website was identified as a strategy to fill information gaps and present actionable information, after the VHA interaction. Cognitive load reducing strategies were used including segmenting where information is presented in learner-controlled segments rather than continuously. CONCLUSIONS: Findings indicate potential benefits of designing CRC prevention information technologies with the rural older adults. Integrating patient-centered needs before launching health information web content will be important as the rapid growth of telemedicine aims to reach traditionally marginalized and underserved populations. Theoretically informed considerations for potential adverse outcomes (eg, information overload) are discussed.

What did the pandemic teach us about effective health communication? Unpacking the COVID-19 infodemic.

BACKGROUND: The spread of unvetted scientific information about COVID-19 presents a significant challenge to public health, adding to the urgency for increased understanding of COVID-19 information-seeking preferences that will allow for the delivery of evidence-based health communication. This study examined factors associated with COVID-19 information-seeking behavior. METHODS: An online survey was conducted with US adults (N = 1800) to identify key interpersonal (e.g., friends, health care providers) and mediated (e.g., TV, social media) sources of COVID-19 information. Logistic regression models were fitted to explore correlates of information-seeking. RESULTS: Study findings show that the first sought and most trusted sources of COVID-19 information had different relationships with sociodemographic characteristics, perceived discrimination, and self-efficacy. Older adults had greater odds of seeking information from print materials (e.g., newspapers and magazines) and TV first. Participants with less educational attainment and greater self-efficacy preferred interpersonal sources first, with notably less preference for mass media compared to health care providers. Those with more experiences with discrimination were more likely to seek information from friends, relatives, and co-workers. Additionally, greater self-efficacy was related to increased trust in interpersonal sources. CONCLUSION: Study results have implications for tailoring health communication strategies to reach specific subgroups, including those more vulnerable to severe illness from COVID-19. A set of recommendations are provided to assist in campaign development.

A Subjective Culture Approach to Cancer Prevention: Rural Black and White Adults' Perceptions of Using Virtual Health Assistants to Promote Colorectal Cancer Screening.

In the US, Black adults are less likely than White adults to be screened for colorectal cancer (CRC). This study uses a subjective culture approach to describe and compare perceptions of a CRC screening intervention delivered via virtual health assistants (VHAs) among rural Black and White study participants. We analyzed 28 focus groups with Black (n = 85) and White (n = 69) adults aged 50-73. Participants, largely recruited through community engagement efforts, tested the VHA intervention on mobile phones provided by the research team. Moderated discussions were recorded, transcribed, and analyzed using thematic analysis. All groups preferred the VHA to be friendly. Other important cues included trustworthiness, authority, and expertise. Black participants expressed a preference for receiving information about their CRC risk from the VHA compared with White adults. Black participants also expressed the importance of sharing the intervention and the CRC screening messages with younger members of their networks, including family members who could benefit from screening messages before reaching the recommended age for screening. The key similarities and differences between Black and White adults' perceptions of the intervention that were identified in this study can help inform future efforts to develop effective communication strategies and reduce cancer screening inequities.

Key changes to improve social presence of a virtual health assistant promoting colorectal cancer screening informed by a technology acceptance model.

BACKGROUND: Understanding how older, minoritized patients attend to cues when interacting with web-based health messages may provide opportunities to improve engagement with novel health technologies. We assess acceptance-promoting and acceptance-inhibiting cues of a web-based, intervention promoting colorectal cancer (CRC) screening with a home stool test among Black women. MATERIALS AND METHODS: Focus group and individual interview data informed iterative changes to a race- and gender-concordant virtual health assistant (VHA). A user-centered design approach was used across 3 iterations to identify changes needed to activate cues described as important; such as portraying authority and expertise. Questionnaire data were analyzed using non-parametric tests for perceptions of cues. Analysis was guided by the Technology Acceptance Model. RESULTS: Perceptions of interactivity, social presence, expertise, and trust were important cues in a VHA-delivered intervention promoting CRC screening. Features of the web-based platform related to ease of navigation and use were also discussed. Participant comments varied across the 3 iterations and indicated acceptance of or a desire to improve source cues for subsequent iterations. We highlight the specific key changes made at each of three iterative versions of the interactive intervention in conjunction with user perception of changes. DISCUSSION: Virtual agents can be adapted to better meet patient expectations such as being a trustworthy and expert source. Across three evolving versions of a Black, VHA, cues for social presence were particularly important. Social presence cues helped patients engage with CRC screening messages delivered in this novel digital context. CONCLUSIONS: When using a VHA to disseminate health information, cues associated with acceptability can be leveraged and adapted as needed for diverse audiences. Patient characteristics (age, identity, health status) are important to note as they may affect perceptions of a novel health technologies ease of use and relevancy according to the leading models.

Tailoring virtual human-delivered interventions: A digital intervention promoting colorectal cancer screening for Black women.

OBJECTIVE: Despite efforts to reduce cancer disparities, Black women remain underrepresented in cancer research. Virtual health assistants (VHAs) are one promising digital technology for communicating health messages and promoting health behaviors to diverse populations. This study describes participant responses to a VHA-delivered intervention promoting colorectal cancer (CRC) screening with a home-stool test. METHODS: We recruited 53 non-Hispanic Black women 50 to 73 years old to participate in focus groups and think-aloud interviews and test a web-based intervention delivered by a race- and gender-concordant VHA. A user-centered design approach prioritized modifications to three successive versions of the intervention based on participants' comments. RESULTS: Participants identified 26 cues relating to components of the VHA's credibility, including trustworthiness, expertise, and authority. Comments on early versions revealed preferences for communicating with a human doctor and negative critiques of the VHA's appearance and movements. Modifications to specific cues improved the user experience, and participants expressed increased willingness to engage with later versions of the VHA and the screening messages it delivered. Informed by the Modality, Agency, Interactivity, Navigability Model, we present a framework for developing credible VHA-delivered cancer screening messages. CONCLUSIONS: VHAs provide a systematic way to deliver health information. A culturally sensitive intervention designed for credibility promoted user interest in engaging with guideline-concordant CRC screening messages. We present strategies for effectively using cues to engage audiences with health messages, which can be applied to future research in varying contexts.

Prevalence and correlates of food insecurity among U.S. college students: a multi-institutional study.

BACKGROUND: College students may be vulnerable to food insecurity due to limited financial resources, decreased buying power of federal aid, and rising costs of tuition, housing, and food. This study assessed the prevalence of food insecurity and its sociodemographic, health, academic, and food pantry correlates among first-year college students in the United States. METHODS: A cross-sectional study was conducted among first-year students (n = 855) across eight U.S. universities. Food security status was assessed using the U.S. Department of Agriculture Adult Food Security Survey Module. Cohen's Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Eating Attitudes Test-26 were used to assess perceived stress, sleep quality, and disordered eating behaviors, respectively. Participants self-reported their grade point average (GPA) and completed questions related to meal plan enrollment and utilization of on-campus food pantries. RESULTS: Of participating students, 19% were food-insecure, and an additional 25.3% were at risk of food insecurity. Students who identified as a racial minority, lived off-campus, received a Pell grant, reported a parental education of high school or less, and did not participate in a meal plan were more likely to be food-insecure. Multivariate logistic regression models adjusted for sociodemographic characteristics and meal plan enrollment indicated that food-insecure students had significantly higher odds of poor sleep quality (OR = 2.32, 95% CI: 1.43-3.76), high stress (OR = 4.65, 95% CI: 2.66-8.11), disordered eating behaviors (OR = 2.49, 95% CI: 1.20-4.90), and a GPA < 3.0 (OR = 1.91, 95% CI: 1.19-3.07) compared to food-secure students. Finally, while half of the students (56.4%) with an on-campus pantry were aware of its existence, only 22.2% of food-insecure students endorsed utilizing the pantry for food acquisition. CONCLUSIONS: Food insecurity among first-year college students is highly prevalent and has implications for academic performance and health outcomes. Higher education institutions should screen for food insecurity and implement policy and programmatic initiatives to promote a healthier college experience. Campus food pantries may be useful as short-term relief; however, its limited use by students suggest the need for additional solutions with a rights-based approach to food insecurity. TRIAL REGISTRATION: Retrospectively registered on ClinicalTrials.gov , NCT02941497.

Income differences in social control of eating behaviors and food choice priorities among southern rural women in the US: A qualitative study.

The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities.

Rural adults' perceptions of nutrition recommendations for cancer prevention: Contradictory and conflicting messages.

Despite robust evidence linking alcohol, processed meat, and red meat to colorectal cancer (CRC), public awareness of nutrition recommendations for CRC prevention is low. Marginalized populations, including those in rural areas, experience high CRC burden and may benefit from culturally tailored health information technologies. This study explored perceptions of web-based health messages iteratively in focus groups and interviews with 48 adults as part of a CRC prevention intervention. We analyzed transcripts for message perceptions and identified three main themes with subthemes: (1) Contradictory recommendations, between the intervention's nutrition risk messages and recommendations for other health conditions, from other sources, or based on cultural or personal diets; (2) reactions to nutrition risk messages, ranging from aversion (e.g., "avoid alcohol" considered "preachy") to appreciation, with suggestions for improving messages; and (3) information gaps. We discuss these themes, translational impact, and considerations for future research and communication strategies for delivering web-based cancer prevention messages.

Obstacles to university food pantry use and student-suggested solutions: A qualitative study.

BACKGROUND: In the absence of federal programs and policies to alleviate college student food insecurity, the number of food pantries has grown rapidly in the United States. Yet, no studies, to date, have qualitatively examined students' experiences with this resource. OBJECTIVE: To explore college students' perspectives on barriers to using an on-campus food pantry and provide insights into student-suggested solutions. METHODS: In this qualitative study, 41 college students were recruited from a large public university in the southeastern US with a campus food pantry. Students participated in one-on-one, in-person, semi-structured interviews. All interviews were audio-recorded, transcribed verbatim, managed using NVivo 12, and analyzed using inductive, semantic thematic analysis. RESULTS: Most students were classified as food insecure (n = 33, 82.5%), and two-thirds identified as pantry users (at least once). The students' reasons for not using the food pantry indicated resistance and access barriers. Students either 'chose not to use' the campus food pantry due to (i) stigma and shame, (ii) perceived insufficient need, (iii) and unsuitable food or they experienced 'barriers' due to (i) lack of knowledge and (ii) limited food access. The main reason reported by food insecure non-pantry users was feelings of stigma and shame while that of food insecure pantry users was limited food access. Students suggested three solutions to minimize barriers experienced when utilizing the campus food pantry. These included (i) spreading awareness about the pantry through positive marketing messages that de-stigmatize use, (ii) improving accessibility of fresh produce and protein options, and (iii) improving access through satellite locations and online ordering systems. CONCLUSION: These barriers need to be systematically addressed to normalize food pantry use. Consideration of student recommendations by university program developers and policymakers may be of added value to expand access to food by college students with food insecurity.

Telehealth and racial disparities in colorectal cancer screening: A pilot study of how virtual clinician characteristics influence screening intentions.

Introduction: Racial disparities in colorectal cancer (CRC) can be addressed through increased adherence to screening guidelines. In real-life encounters, patients may be more willing to follow screening recommendations delivered by a race concordant clinician. The growth of telehealth to deliver care provides an opportunity to explore whether these effects translate to a virtual setting. The primary purpose of this pilot study is to explore the relationships between virtual clinician (VC) characteristics and CRC screening intentions after engagement with a telehealth intervention leveraging technology to deliver tailored CRC prevention messaging. Methods: Using a posttest-only design with three factors (VC race-matching, VC gender, intervention type), participants (N = 2267) were randomised to one of eight intervention treatments. Participants self-reported perceptions and behavioral intentions. Results: The benefits of matching participants with a racially similar VC trended positive but did not reach statistical significance. Specifically, race-matching positively influenced screening intentions for Black participants but not for Whites (b = 0.29, p = 0.10). Importantly, perceptions of credibility, attractiveness, and message relevance significantly influenced screening intentions and the relationship with race-matching. Conclusions: To reduce racial CRC screening disparities, investments are needed to identify patient-focused interventions to address structural barriers to screening. This study suggests that telehealth interventions that match Black patients with a Black VC can enhance perceptions of credibility and message relevance, which may then improve screening intentions. Future research is needed to examine how to increase VC credibility and attractiveness, as well as message relevance without race-matching.

Can virtual human clinicians help close the gap in colorectal cancer screening for rural adults in the United States? The influence of rural identity on perceptions of virtual human clinicians.

Rural adults experience disparities in colorectal cancer screening, a trend even more distinct among rural Black adults. Healthcare disruptions caused by COVID-19 exacerbated inequities, heightening attention on virtual communication strategies to increase screening. Yet little is known about how rural adults perceive virtual human clinicians (VHCs). Given that identifying as rural influences perceived source credibility often through appearance judgments, the goal of this pilot was to explore how to develop VHCs that individuals highly identified with rurality find attractive. Between November 2018 and April 2019, we tested a culturally tailored, VHC-led telehealth intervention delivering evidence-based colorectal cancer prevention education with White and Black adults (N = 2079) in the United States recruited through an online panel who were non-adherent to screening guidelines and between 50 and 73 years of age. Participants were randomized on three factors (VHC race-matching, VHC gender-matching, Intervention type). Ordinal logistic regression models examined VHC appearance ratings. Participants with a high rural identity (AOR = 1.12, CI = [1.02, 1.23], p =.02) rated the VHCs more attractive. High rural belonging influenced VHC attractiveness for Black participants (AOR = 1.22, CI = [1.03, 1.44], p =.02). Also, Black participants interacting with a Black VHC and reporting high rural self-concept rated the VHC as more attractive (AOR = 2.22, CI = [1.27, 3.91], p =.01). Findings suggest adults for whom rural identity is important have more positive impressions of VHC attractiveness. For patients with strong rural identities, enhancing VHC appearance is critical to tailoring colorectal cancer prevention interventions.

Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study.

BACKGROUND: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one's home. OBJECTIVE: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. METHODS: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user's psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. RESULTS: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as "brother-doctor," and participants stated "wanting to interact with ALEX over their regular doctor." CONCLUSIONS: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.

A Pilot Study Examining the Efficacy of Delivering Colorectal Cancer Screening Messages via Virtual Health Assistants.

INTRODUCTION: Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening. It also examines the influence of animation and race concordance on intentions to complete colorectal cancer screening. METHODS: White and Black adults (N=1,363) aged 50-73 years and not adherent to colorectal cancer screening guidelines were recruited from Qualtrics Panels in 2018 to participate in a 3-arm (animated virtual healthcare assistant, static virtual healthcare assistant, attention control) message design experiment. In 2020, a probit regression model was used to identify the intervention effects. RESULTS: Participants assigned to the animated virtual healthcare assistant (p<0.01) reported higher intentions to talk to their doctor about colorectal cancer screening than participants assigned to the other conditions. There was a significant effect of race concordance on colorectal cancer screening intentions but only in the static virtual healthcare assistant condition (p=0.04). Participant race, age, trust in healthcare providers, health literacy, and cancer information overload were also significant predictors of colorectal cancer screening intentions. CONCLUSIONS: Animated virtual healthcare assistants were efficacious compared with the static virtual healthcare assistant and attention control conditions. The influence of race concordance between source and participant was inconsistent across conditions. This warrants additional investigation in future studies given the potential for virtual healthcare assistant‒assisted interventions to promote colorectal cancer screening within guidelines.

Promoting community health collaboration between CTSA programs and Cooperative Extension to advance rural health equity: Insights from a national Un-Meeting.

Addressing rural health disparities has unique challenges that require cross-sector collaborations to address social determinants of health and help those in need to get connected to care continuum. We brought the Clinical and Translational Science Award, Institutional Development Award Program Infrastructure for Clinical and Translational Research, and Cooperative Extension System Programs together for a one-day semi-structured meeting to discuss collaborative opportunities to address rural health disparities. Session notes and event materials were analyzed for themes to facilitate collaboration such as defining rural, critical issues, and organizational strengths in support of collaboration. Across 16 sessions, there were 26 broad topics of discussion. The most frequent topics included "barriers and challenges," "strategies and opportunities," and "defining rural." There is a growing understanding of the opportunity that collaboration between these large programs provides in addressing rural health disparities.

Lifestyle Factors Associated With Sunscreen Use Among Young Adults.

Background. Skin cancer is the most common cancer in the United States with melanoma rates increasing. Sunscreen use is an effective way to protect the skin and reduce skin cancer risk. Limited research has been conducted examining the relationship between sunscreen use and other lifestyle factors. Interventions aimed at multiple lifestyle factors have shown promise for prevention and reduced health care costs. Objective. This study explores the relationship between sunscreen use and lifestyle factors associated with mortality and morbidity among young adults. Lifestyle factors examined included physical activity, substance abuse, smoking, sexual behavior, unintentional injury, and mental well-being. Methods. A convenience sample of 747 college students was surveyed about sunscreen use and other health risks. Data were analyzed using SPSS 19. Results. White, female students older than 21 years were more likely to use sunscreen. Texting while driving, low life satisfaction, and binge drinking were associated with inadequate sunscreen use. Limitations. Convenience sampling limits generalizability and surveys are subject to recall, self-report, and self-selection bias. Conclusions. The findings provide the framework to develop multiple risk factor interventions.

Food Choice Priorities Change Over Time and Predict Dietary Intake at the End of the First Year of College Among Students in the U.S.

This study assessed food choice priorities (FCP) and associations with consumption of fruits and vegetables (FV), fiber, added sugars from non-beverage sources, and sugar-sweetened beverages (SSB) among college students. Freshmen from eight U.S. universities (N = 1149) completed the Food Choice Priorities Survey, designed for college students to provide a way to determine the factors of greatest importance regarding food choices, and the NCI Dietary Screener Questionnaire. Changes in FCP and dietary intake from fall 2015 to spring 2016 were assessed. Multiple regression models examined associations between FCP and log-transformed dietary intake, controlling for sex, age, race, and BMI. Participant characteristics and FCP associations were also assessed. FCP importance changed across the freshmen year and significantly predicted dietary intake. The most important FCP were price, busy daily life and preferences, and healthy aesthetic. Students who endorsed healthy aesthetic factors (health, effect on physical appearance, freshness/quality/in season) as important for food choice, consumed more FV and fiber and less added sugar and SSB. Busy daily life and preferences (taste, convenience, routine, ability to feel full) predicted lower FV, higher added sugar, and higher SSB consumption. Price predicted lower FV, higher SSB, and more added sugar while the advertising environment was positively associated with SSB intake. FCP and demographic factors explained between 2%⁻17% of the variance in dietary intake across models. The strongest relationship was between healthy aesthetic factors and SSB (B = -0.37, p < 0.01). Self-rated importance of factors influencing food choice are related to dietary intake among students. Interventions that shift identified FCP may positively impact students' diet quality especially considering that some FCP increase in importance across the first year of college.

More than Fast Food: Development of a Story Map to Compare Adolescent Perceptions and Observations of Their Food Environments and Related Food Behaviors.

The purpose of this convergent, multiphase, mixed methods study was to better understand the perceptions of adolescents' food environments and related food behaviors using grounded visualization and story mapping. Adolescents from one high school (13⁻16 years) in the southeastern United States were evaluated via data from health behavior surveys (n = 75), school environment maps, focus groups (n = 5 groups), and Photovoice (n = 6) from October 2016 to April 2017. Data from each phase were integrated using grounded visualization and new themes were identified (n = 7). A story map using ArcGIS Online was developed from data integration, depicting the newly identified themes. Participants failed to meet national recommendations for fruit and vegetable intake (2.71 cups). Focus group and Photovoice findings indicated the need for convenience food items in all environments. The story map is an online, interactive dissemination of information, with five maps, embedded quotes from focus groups, narrative passages with data interpretation, pictures to highlight themes, and a comparison of the participants' food environments. Story mapping and qualitative geographic information systems (GIS) approaches may be useful when depicting adolescent food environments and related food behaviors. Further research is needed when evaluating story maps and how individuals can be trained to create their own maps.

Health Behaviors of Student Community Research Partners When Designing and Implementing a Healthy Lifestyle Intervention on College Campuses.

Few studies work with college students as equal partners in all aspects of Community-Based Participatory Research (CBPR) and even less evaluate behaviors of those college partners. The current study aimed to examine health behaviors of students by designing and implementing a peer-led, social marketing campaign (Get Fruved) to promote healthier lifestyles on their campuses. Enrolled students (n = 376) were trained to either design and implement a health promotion intervention (Social Marketing and Environmental Interventionists; SMEI, n = 78), be peer mentors (PM; n = 205), or serve as control participants (n = 93). Students' behaviors (dietary, activity, and stress) and anthropometrics were assessed at baseline, 6 months, and 12 months. The population was predominately Caucasian, female, and between 19 and 20 years old. On average, fruit and vegetable consumption slightly decreased across all time points for each group with control at a larger decline. Students International Physical Activity Questionnaire (IPAQ) scores showed students met recommended amounts of activity throughout the intervention, with males reporting higher activity levels. Cohen's Perceived Stress Scale (PSS) analyses indicated 19 year olds had higher stress along with females had higher than males. Students involved in a CBPR approach to be trained, design, and implement a lifestyle intervention can achieve maintenance of health behaviors throughout a college year when compared to control students.

Skin Cancer Risk and Other Health Risk Behaviors: A Scoping Review.

Purpose. To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Methods. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Results. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Conclusions. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.