Social Determinants of Physical Activity Among Adult Asian-Americans: Results from a Population-Based Survey in California.

The objective of this study was to evaluate the key social determinants of physical activity among six Asian-American subgroups using public access 2007 California Health Interview Survey data. Physical activity was defined as meeting the American College of Sports Medicine recommendation of 450 metabolic equivalent-minutes per week. Factors positively associated with meeting physical activity recommendations included being bilingual among Chinese and Vietnamese, and increasing age for Chinese only. On the other hand, being middle aged, currently married, and low neighborhood safety were significantly associated with lower odds of meeting physical activity recommendations, as were being female for Japanese and Koreans, and living above the poverty level for Vietnamese. Such results highlight the heterogeneity among Asian-Americans and need for health messages targeted at specific subgroups. Additionally, the role of built environment, particularly in areas with high Filipino residents, should be a public health priority for increasing physical activity outcomes.

Religious involvement and health-related behaviors among Black Seventh-Day Adventists in Canada.

BACKGROUND: Most studies that involve Black Seventh-Day Adventists (SDAs) have been conducted in the United States. We sought to examine the association between religious involvement and lifestyle practices among Black SDAs in Canada. METHOD: A convenience sample of 509 Black SDA church members 18 years and older completed a self-administered questionnaire, assessing religious involvement and seven lifestyle practices promoted by the SDA church: diet, physical activity, water intake, exposure to sunlight, alcohol use, caffeine and tobacco use, and rest. RESULTS: Compliance with lifestyle practices ranged from a low of 10% meeting fitness guidelines to a high of 99% abstaining from tobacco products. Religious involvement and lifestyle were positively related (rs = .11, p < .05). Multivariate analyses indicated that private religious practice (ß = .16, p =.003), importance of the health principles (ß = .17, p = .003), and acceptance of health principles (ß = .65, p = .00001) significantly predicted the number of behaviors practiced. CONCLUSION: Greater religious involvement is associated with positive lifestyle practices but is not an independent predictor of lifestyle practices for Black Canadian SDAs.

Generational differences in fast food intake among South-Asian Americans: results from a population-based survey.

The goal of this study was to evaluate the association between generational status and fast food consumption among South-Asian Americans. We conducted a secondary analysis of data from the California Health Interview Survey for 2007, 2009, and 2011. After adjusting for control variables, South-Asian Americans of the third generation or more had a fast food intake rate per week 2.22 times greater than first generation South-Asian Americans. Public health practitioners must focus on ways to improve dietary outcomes among this fast-growing ethnic population in the United States.

Using the theory of planned behavior to explore attitudes and beliefs about dietary supplements among HIV-positive Black women.

BACKGROUND: This cross-sectional study investigated whether the theory of planned behavior (TPB) constructs: attitudes, subjective norms, and perceived behavioral control were related to intention of dietary supplements use among African-American women living with Human Immunodeficiency Virus and/or Acquired Immune Deficiency Syndrome (HIV/AIDS). METHODS: A closed-ended questionnaire based on the TPB was utilized to explore the use of dietary supplements among a cohort of 153 HIV-positive African-American women. RESULTS: Overall, 45% of the respondents used dietary supplements to manage/control their HIV. Combined, attitudes, subjective norms and perceived behavioral control were significant predictors of intention toward dietary supplement use (69% of the variance explained, p<0.0001). Attitudes (ß=0.23, p<0.001) and perceived behavioral control (ß=0.45, p<0.0001) were found to be significant independent predictors of intention. Behavioral intention and proximal TPB constructs (attitudes, subjective norms, and perceived behavioral control), as well as their underlying beliefs about dietary supplements use, were all found to be significantly more positive in users of dietary supplements compared to non-users (p<0.001). CONCLUSIONS: Results showed that attitudes, subjective norms and perceived behavioral control are important predictors in the intention to use dietary supplements for control of HIV among African-American women. Implications from this study suggest that the TPB can be used to better identify and understand salient beliefs that surround intentions to use alternative therapies for management of disease. These beliefs can be used to develop interventions surrounding HIV treatment and care.

Exploring HIV-testing intentions in young Asian/Pacific Islander (API) women as it relates to acculturation, theory of gender and power (TGP), and the AIDS risk reduction model (ARRM).

While HIV rates are low for Asian/Pacific Islanders (APIs), they have been increasing, especially for API women in the USA. We conducted a cross-sectional study with 299 young API women (18-24 years old) in the Inland Empire region of Southern California to better understand their intention for HIV testing and their perceptions about HIV/AIDS. Data analyses included descriptive statistics, bivariate exploration for model building and multivariate analyses to determine variables associated with HIV-testing intentions. Results suggest that more lifetime sexual partners, greater perceived gender susceptibility, higher HIV/AIDS knowledge, sexually active, more positive attitudes about HIV testing and higher self-perceptions/experiences related to risk contribute to stronger intentions for HIV testing in young API women. Findings from this study will contribute to the limited literature on HIV/AIDS in API women and provide information that can be used for developing and implementing culturally appropriate programs that encourage HIV prevention and testing in this population.

Building capacity for community disaster preparedness: a call for collaboration between public environmental health and emergency preparedness and response programs.

Partnerships among local public environmental health (EH), emergency preparedness and response (EPR) programs, and the communities they serve have great potential to build community environmental health emergency preparedness (EHEP) capacity. In the study described in this article, the beliefs and organizational practices pertaining to community EHEP outreach and capacity were explored through key informant (KI) interviews (N = 14) with a sample of governmental EH and EPR administrators and top-level managers from Riverside and San Bernardino counties in Southern California. The results indicate that KIs were highly confident in their workforces' efficacy, ability, willingness, and motivation to directly engage local communities in EHEP. Best practices to combat organizational and systematic barriers to community EHEP outreach were identified. Based on the authors' results, training in participatory methods is needed to bridge technical knowledge in emergency management to daily practice. The lessons learned will form the basis of future interventions aimed to prepare EH and EPR professions to implement community-focused emergency preparedness strategies.

Provision of emergency contraception at student health centers in California community colleges.

BACKGROUND: Approximately half of all pregnancies in the United States are unintended, with the highest rates reported among college-age women. The availability of emergency contraception (EC) pills can be an important component of efforts to reduce unintended pregnancy. Student health centers at community colleges can uniquely support student retention and academic achievement among college students by making EC available to reduce the rate of unintended pregnancy and prevent college drop-out. This article highlights findings from an assessment of EC provision in student health centers within the California community college system (n = 73). METHODS: A web-based survey was used to explore the provision of EC, challenges and barriers of EC administration, promotion of EC availability, and attitudes toward EC. FINDINGS: Descriptive statistics conducted revealed that more than 6 out of 10 (62%) student health centers provided EC, 77% of which dispense EC on site during clinic visits. The most common EC promotion methods were providing brochures at the health center (80%) and through information provided at family planning or primary care visits (73%). Challenges to EC administration included a perceived lack of awareness of EC among students (71%), followed by the notion that some students may overutilize EC (40%). Attitudes toward EC provision were more favorable among health center staff whose campuses offered EC than those who did not (p < .05). CONCLUSION: This article provides recommendations for community college health centers to improve access and delivery of EC by addressing issues such as cost and offering more novel EC promotion methods.

Closing the gap in mammogram screening: an experimental intervention among low-income Hispanic women in community health clinics.

A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received targeted cancer prevention education (n = 105) had a significantly greater perceived threat of breast cancer, greater benefits and lower barriers to screening, and stronger intentions to obtain mammograms compared to a control group (n = 105). Intervention participants reported significantly greater perceived benefits, self-efficacy, and mammogram screening intentions than the control group. Predictors of mammogram screening intentions, when controlling for covariates, included receiving the intervention, and having greater perceived benefits, self-efficacy, and lower barriers. Results demonstrate the effectiveness of a low-cost, theory-based intervention aimed at increasing mammogram screening to assist in the monitoring of Healthy People 2020 objectives.

Partner communication and HIV testing among US Chinese college students.

OBJECTIVES: To explore the role of partner communication and relationship status on HIV testing among Chinese/Chinese American college students in northern California. METHODS: We used a cross-sectional study design to conduct focus groups and an online or paper-pencil questionnaire (N = 230). RESULTS: The majority (60%) of respondents were in committed partnerships, with 21% in casual partnerships. Less than one third (30%) of respondents had ever obtained an HIV test. History of HIV tested was associated with relationship status and partner communication. CONCLUSIONS: Interventions to increase partner communication skills while taking into account sociocultural factors among this population and their partners are needed.

Postpartum follow-up: can psychosocial support reduce newborn readmissions?

PURPOSE: To determine whether there was a relationship between postpartum psychosocial support from healthcare providers and the rate of normal newborn readmissions (NNRs), and whether there was a cost benefit to justify an intervention. STUDY DESIGN AND METHODS: Data were abstracted for all normal newborn births from 1999 to 2006 (N = 14,786) at a community hospital in southern California at three different time periods: (1) at baseline prior to any intervention (1999-2000), (2) the 4 years during the comprehensive psychosocial support intervention (2001-2004), and (3) the 2 years during a limited psychosocial support intervention (2004-2006). A cost-benefit analysis was performed to analyze whether the financial benefits from the intervention matched or exceeded the costs for NNRs. RESULTS: There was a significantly lower readmission rate of 1.0% (p = < .001) during the comprehensive intervention time period compared to baseline (2.3%) or to the limited intervention time period (2.3%). Although there was no significant difference in the average cost per newborn readmitted across the three study time periods, during the comprehensive intervention time period the average costs of a NNR were significantly lower ($4,180, p = .041) for the intervention group compared to those who received no intervention ($5,338). There was a cost benefit of 513,540 dollars due to fewer readmissions during the comprehensive time period, but it did not exceed the cost of the intervention. CLINICAL IMPLICATIONS: Providing comprehensive follow-up for new mothers in the postpartum period can reduce NNRs, thus lowering the average newborn readmission costs for those who receive psychosocial support. Followup for new mothers should be an accepted norm rather than the exception in postpartum care, but NNRs should not be considered the sole outcome in such programs.

Acculturation and gender: influence on healthy dietary outcomes for Latino adolescents in California.

OBJECTIVE: Examine acculturation and gender on intention to eat a healthful diet among Latino adolescents using the Theory of Planned Behavior. DESIGN: Secondary analysis of data set and condensed version of the Short Acculturation Scale for Hispanics (SASH). SETTING: Data collected from 34 randomly selected high schools in San Bernardino, CA. PARTICIPANTS: 265 Latino high school adolescents. MAIN OUTCOME MEASURES: Effects of acculturation and gender on variables of the Theory of Planned Behavior on intention to eat a healthful diet. ANALYSIS: Multiple regression analysis examined acculturation/gender differences, and modifications on the prediction of intention. General linear modeling determined differences across gender and acculturation groups. RESULTS: Females had stronger intention, more positive attitude, and greater subjective normative influence. Females indicated feeling healthy and looking good and males indicated good athletic performance as contributors to eating healthfully. Mother was influential for both genders, and stronger for females. Siblings were influential for less acculturated males, and friends were influential for highly acculturated females. Less acculturated adolescents had stronger intention to eat healthfully, more tolerance to give up liked food items, and more support and encouragement. CONCLUSIONS AND IMPLICATIONS: Professionals need to take into account gender and acculturation differences when making dietary recommendations for Latino adolescents.

Health beliefs and the prevention of hypertension in a black population living in London.

In the United Kingdom, the morbidity and mortality associated with hypertension is much higher in Blacks than in Whites. We studied a convenience sample of 312 persons aged 25-79 years from 17 predominantly Black Seventh-Day Adventist churches across London by using the health belief model to examine their beliefs about the prevention of hypertension. A questionnaire was used to collect demographic and anthropometric data, lifestyle practices, and perceptions toward hypertension by using the health belief model constructs of susceptibility, severity, benefits, barriers, and self-efficacy. A relative risk estimate score was developed to assess the presence of several risk factors of hypertension for each participant. Based on multiple regression analyses, the demographic variables were independent predictors of systolic blood pressure (R2 = .195), the combined behavioral variable (risk score) was an independent predictor of diastolic blood pressure (beta = .18, P = .02), and self-efficacy was the only independent variable significantly associated with risk scores (beta = -.21, P = .008). The perception of self-efficacy to perform behaviors that will decrease hypertension risk needs to be effectively harnessed by health educators to decrease the prevalence of hypertension in this population.

Gender differences in perceptions of weight and body image and comparison to recommended weight among adult Bermudians.

The objective of this study was to determine adult Bermudians' perceptions of ideal weight, overweight, and body image and to decide if a discrepancy exists between their perceptions and World Health Organization standards. A cross-sectional survey of body weight perceptions was administered to 462 men (n = 207) and women (n = 255), 18-65 years of age and various body weights, living on the Island of Bermuda. Additionally, measurement of height, and weight was collected. There was a significant difference in mean current body mass index (BMI) between men (M = 28.6, SD = 5.82), and women (M = 30.1, SD = 6.80) (p < .05). Significant gender differences were evident in mean self-perceived BMI, ideal BMI, and perceived body image. The data presented have important implications for understanding perceptions, knowledge, and beliefs concerning body weight and body image. Public health programs must stress to adults the correct definition of overweight and obesity acceptable by medical standards.

Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren.

OBJECTIVES: To determine the prevalence of obesity among sixth- and seventh-grade students in a school-based setting, and to identify lifestyle parameters associated with obesity. METHODS: Sixth- and seventh-grade students (n = 385, 186 boys and 199 girls) from 3 schools participated in a school-based screening study, and 319 completed a short questionnaire. Height and weight were measured, and body fat as a percentage of body weight was obtained using a Tanita bioelectrical impedance scale. RESULTS: Overall, 35.3% of students had a body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) at or above the 85th percentile, and half these students (17.4%) had a BMI at or above the 95th percentile. Rates were higher among Latino and lower among Asian than non-Hispanic white students. Significant associations were found between BMI and hours of television watched per evening and daily soft drink consumption. The mean (SE) BMI z score for those watching less than 2 hours per night (0.34 [0.09]) was lower than for those watching 2 or more hours per night (0.82 [0.08]; P<.001). The mean (SE) BMI z score for those consuming less than 3 soft drinks per day (0.51 [0.07]) was lower than for those consuming 3 or more soft drinks per day (1.02 [0.13]; P =.003). Latino students watched more television (2.4 hours per night) than did non-Hispanic white or Asian students (1.3 hours per night; P<.001 for each) and consumed more soft drinks (1.6 per day) than non-Hispanic white students (1.1 per day; P =.004) or Asian students (0.7 per day; P<.001). CONCLUSIONS: Time spent watching television and the number of soft drinks consumed were significantly associated with obesity. Latinos spent more time watching television and consumed more soft drinks than did non-Hispanic white or Asian students. These findings will be beneficial in developing preventive measures for these children.

Smoke-free parks: a 12-year-old made it happen.

This case study examines how a 12-year-old in the City of Grand Terrace, California was able to get the city council to adopt a resolution making city parks smoke-free/tobacco-free zones in his community. Over a three-month period of time, this 12-year-old (with tremendous support from his parents and sister) applied for and received a mini-grant from the Tri-County SOUTH Regional Tobacco-Free Project and implemented "The Terrace is GRAND with Smoke-Free Parks" activities. This young man recruited 11 youth and 9 adults, trained them in the basics of tobacco prevention called Tobacco 101, and collected 100 surveys and 809 petition signatures supporting smoke-free parks from residents in Grand Terrace. They also collected trash in their parks and separated it into two groups: tobacco-related trash and all other trash. This 12-year-old met with the mayor of Grand Terrace to ask for support for this issue and scheduled a time to present his group's findings to the city council. On June 22, 2000, the youths presented council members with the tobacco-trash collected, the petition signatures, taped end-to-end, that stretched across the council chambers, and asked the city council to make their parks smoke/tobacco-free. Council members acknowledged the excellent work implemented by these youths, adopted a resolution making all parks (except one senior park) tobacco-free, and agreed to place signage in the parks. On August 24, 2000, the city council presented him with his own "Tobacco-Free Zone" sign as an acknowledgment for his hard work in making parks safe places for youths in Grand Terrace.

Identifying intimate partner violence at entry to prenatal care: clustering routine clinical information.

Intimate partner violence (IPV) is the greatest trauma-related risk to American women. Pregnant women are no exception, and escalation of IPV frequently occurs during pregnancy. Many studies have linked IPV during pregnancy to adverse maternal and fetal outcomes. This study examined IPV at the beginning of prenatal care to identify correlates of routine entry-to-care information with responses on a validated IPV screening tool, the Abuse Assessment Screen. The purpose of the study was to identify specific data from routine, standard intake information, which could alert clinicians to the potential of violence even in the presence of a negative IPV score or no formally administered screening tool. The point prevalence of abuse, as measured by the Abuse Assessment Screen at entry to care, was slightly in excess of the national mean, reinforcing the need for continual assessment throughout pregnancy. Abused women in this study were more likely to be young, single, and without family or partner support. These women relied on friends for support, admitted to depression, and desired their pregnancies. The findings are consistent with previous studies. Further research needs to be conducted to determine if this cluster of findings at entry to care, with or without a positive score on an IPV screening tool, are consistent markers for an increased risk of IPV.