A Pilot Evaluation of a University Health and Wellness Coaching Program for College Students.

Poor mental well-being has been associated with negative student success outcomes among college students. Health and wellness coaching programs have been implemented in college campuses to address gaps in well-being support services. This pilot study evaluated a health and wellness coaching program at a large, urban university. A total of 499 students expressed interest in the program with 120 responding to a retrospective survey about their experience. Findings revealed that most students attended coaching for issues related to time and stress management or factors that commonly influence stress. Overall, students who participated in coaching were successful at improving their self-efficacy toward behavior change, changing their behavior, and achieving their goals. Students reported attending an average of four sessions with number of sessions attended being associated with increased confidence and motivation. In addition, autonomy, competence, and relatedness felt within the relationship with the coach were correlated with increased motivation, confidence, and readiness for behavior change. There was some relapse in terms of goal attainment observed with 17.4% of students who met their goals being unable to maintain progress. The program participants appeared to have enjoyed the process with 96% of students saying they would recommend the program to a friend. Health and wellness coaching programs may alleviate the burden of stress and other subclinical mental health concerns as well as decrease the number of students requiring services from more intensive mental health resources on campus.

Knowledge of and satisfaction with a behavioral intervention team at a large urban southeastern university.

Background: Campus behavioral intervention teams (BITs) provide early identification of students and/or situations that may be a risk to the community, as well as determine and implement intervention plans for a safe resolution. Methods: An evaluation of 529 faculty and staff was conducted at a large urban, southeastern research university to assess BIT knowledge, triggers for referral, referral self-efficacy, referrals, and satisfaction regarding said university's BIT (Students of Concern Assistance Team, otherwise known as SOCAT). Results: Findings revealed low levels of knowledge, self-efficacy, and referrals among faculty and staff. Utilization of SOCAT resulted in high levels of satisfaction among the process and follow-up outcomes. Discussion: Findings from this study will guide future implementation by highlighting strategies to enhance the referrals to and utility of BITs on college campuses and identifying best practices in improving faculty and staff satisfaction with the referral system process for BITs.

A qualitative assessment of mental health literacy and help-seeking behaviors among male college students.

Although the number of students receiving care from college counseling centers has increased, engaging male college students to seek help presents a unique challenge. This qualitative study explored mental health literacy and help-seeking behaviors among undergraduate college men. Semi-structured interviews (n = 26) based on three vignettes (anxiety, depression, stress) were employed to assess mental health literacy. Analysis revealed three general themes and associated sub-themes: (a) knowledge of signs and symptoms (physiological, behavioral, and emotional); (b) recommended help-seeking behaviors (do nothing, self-care, seek help); and (c) barriers to help-seeking (social stigma, self-stigma, masculinity). Findings present a triadic interplay between the person, help-seeking behavior, and environment. Future research should explore this dynamic relationship to inform interventions aimed at improving college male mental health help-seeking behavior.

Hormonal Contraception, depression, and Academic Performance among females attending college in the United States.

Associations between Hormonal Contraception (HC) and Depression have been previously reported, and indicate increased risk to younger women. These relationships need be explored and expanded to include measures of impact on Academic Performance (AP). Data was acquired from the National College Health Assessment (NCHA), administered from Fall 2008 to Spring 2015 across 370 schools nationwide. The most popular HC method was oral, followed by an IUD, and vaginal ring. HC use increased across all ages groups 18-29, and then decreased in the 30-34 age group. HC use significantly increased the odds of ever being diagnosed with depression in all age groups. HC use was found to have significantly increased odds of reporting AP issues in the 18-19 age group and to have significantly decreased odds of reporting AP issues in the 25-29 age group. Adding depression as a moderator, HC use continued to significantly increase the odds of AP issues. Women and their providers should balance the risks and benefits of initiating HC. Specifically, younger women, and be advised of the risks that HC presents in terms of a potential association with depression. Efforts to develop standardized protocols for discussing the risk-benefits for HC therapy should be pursued.

NOURISH-T: Targeting caregivers to improve health behaviors in pediatric cancer survivors with obesity.

BACKGROUND: Obesity rates in pediatric cancer survivors (PCS) are alarmingly high. Although healthy lifestyle changes may prevent future health complications, promoting healthy behaviors in PCS is challenging, and few interventions have successfully addressed this issue. PROCEDURE: This randomized control trial evaluated the feasibility and preliminary effectiveness of a parent-focused six-session intervention, NOURISH-T (Nourishing Our Understanding of Role Modeling to Improve Support and Health for Healthy Transitions), compared with enhanced usual care (EUC) on the outcomes of caregiver and PCS anthropometric measurements, eating behaviors, and physical activity. Behavioral and self-report assessments of caregivers and PCS in both conditions were conducted at baseline, postintervention, and at a 4-month follow-up. RESULTS: In comparison to no change among EUC caregivers, NOURISH-T caregivers showed small yet significant decreases from baseline through follow-up on BMI, waist-hip ratio, and total daily caloric intake. However, there was no change with regard to daily fat and sugar intake. NOURISH-T caregivers also showed positive changes in their child feeding behaviors, including decreases in pressuring their child to eat and restricting their child's eating and increased eating together as a family. Similarly, decreases in BMI percentile, waist-hip ratio, and sugary beverage consumption were found for NOURISH-T PCS from baseline to postintervention. NOURISH-T PCS also significantly increased their daily steps, whereas EUC PCS decreased their daily steps. CONCLUSIONS: Results suggest that an intervention targeting parents is feasible and demonstrates preliminary effectiveness. NOURISH-T showed a longer term effect on caregivers, and, although shorter term effect, a positive impact on the PCS themselves. Implications for ways to improve NOURISH-T as an intervention for increasing healthy behaviors of PCS are discussed.

Using Intervention Mapping to Develop an Oral Health e-Curriculum for Secondary Prevention of Eating Disorders.

Preventing oral-systemic health issues relies on evidence-based interventions across various system-level target groups. Although the use of theory- and evidence-based approaches has been encouraged in developing oral health behavior change programs, the translation of theoretical constructs and principles to behavior change interventions has not been well described. Based on a series of six systematic steps, Intervention Mapping provides a framework for effective decision making with regard to developing, implementing, and evaluating theory- and evidence-informed, system-based behavior change programs. This article describes the application of the Intervention Mapping framework to develop the EAT (evaluating, assessing, and treating) evidence-based intervention with the goal of increasing the capacity of oral health providers to engage in secondary prevention of oral-systemic issues associated with disordered eating behaviors. Examples of data and deliverables for each step are described. In addition, results from evaluation of the intervention via randomized control trial are described, with statistically significant differences observed in behavioral outcomes in the intervention group with effect sizes ranging from r=0.62 to 0.83. These results suggest that intervention mapping, via the six systematic steps, can be useful as a framework for continued development of preventive interventions.

Adolescent and Young Adult Patients with Cancer: Perceptions of Care.

BACKGROUND: Adolescent and young adults with cancer (AYACs) face unique medical, psychosocial, and supportive care needs. The purpose of this study was to identify AYACs perceptions and expectations of cancer care services on and off treatment. METHODS: Semistructured interviews were conducted with 23 AYACs aged 19-38 years (13 on and 10 off treatment), who were receiving care at a comprehensive cancer center. Verbatim transcripts were created from audiotaped interviews and hand coded using inductive content analysis methodology. RESULTS: Perceptions of optimal care were reported by AYACs through two main themes as follows: perceived barriers and facilitators during treatment. Within each main theme were three subthemes, including perceived facilitators reported as the provision of social support, the website and patient portal, and the educational information provided by the cancer center. Younger female AYACs (age 19-31) on active treatment reported perceived barriers to optimal care related to the management of physical and mental health symptoms, while older patients (age 32 and up) on active treatment endorsed a fear of cancer returning. The third perceived barrier equally endorsed by patients both on and off treatment and across age ranges included limited assistance with financial issues. CONCLUSIONS: AYACs reported perceived barriers and facilitators to optimal care. Implications for these findings are discussed in the context of the importance of adding a patient navigator to the AYACs care team.

Women's Individual Asset Ownership and Experience of Intimate Partner Violence: Evidence From 28 International Surveys.

OBJECTIVES: To assess the oft-perceived protective relationship between women's asset ownership and experience of intimate partner violence (IPV) in the previous 12 months. METHODS: We used international survey data from women aged 15 to 49 years from 28 Demographic and Health Surveys (2010-2014) to examine the association between owning assets and experience of recent IPV, matching on household wealth by using multivariate probit models. Matching methods helped to account for the higher probability that women in wealthier households also have a higher likelihood of owning assets. RESULTS: Asset ownership of any type was negatively associated with IPV in 3 countries, positively associated in 5 countries, and had no significant relationship in 20 countries (P < .10). Disaggregation by asset type, sole or joint ownership, women's age, and community level of women's asset ownership similarly showed no conclusive patterns. CONCLUSIONS: Results suggest that the relationship between women's asset ownership and IPV is highly context specific. Additional methodologies and data are needed to identify causality, and to understand how asset ownership differs from other types of women's economic empowerment.

Correlates of long-term physical activity adherence in women.

BACKGROUND: Little is known about the factors that may influence women's adherence to moderate-to-vigorous physical activity (MVPA) using longitudinal data. The purpose of this study was to examine the correlates of long-term physical activity (PA) participation among women. METHODS: Female data from Waves I, III, and IV (n = 5381) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used for the analysis. The outcome of PA adherence was operationalized as (1) consistently physically active (at least 5 instances during the week) in both Waves III and IV (during adulthood), and (2) consistently not physically active or only physically active in either Wave III or IV. Predictor variables from Wave I (during adolescence) included race/ethnicity, PA level, self-perception of being physically fit, general health status, attempt to change weight, parents' income level, parents' education, well-being, depression, access to PA resources, days of physical education (PE), and grade level. Crude and adjusted logistic regression models were utilized to estimate the adjusted odds ratio (aOR) and 95% confidence interval (95%CI) for the outcome variable. RESULTS: PA levels during adolescence significantly predicted PA adherence (aOR = 1.67, 95%CI: 1.35-2.05). Additionally, wanting to lose weight (aOR = 1.49, 95%CI: 1.20-1.85), using fitness center in the neighborhood (aOR = 1.29, 95%CI: 1.05-1.58), and having 5 days of PE a week (aOR = 1.48, 95%CI: 1.09-2.02) were significant predictors. Women who did not perceive being physically fit (aOR = 0.65, 95%CI: 0.44-0.95) and Black, non-Hispanics (aOR = 0.60, 95%CI: 0.44-0.82) were less likely to adhere to PA. CONCLUSION: The findings suggested that physically active adolescents were more likely to become active adults. Future research should address interventions (e.g., PE program, community resources) that may promote lifetime PA in women, with the goal of decreasing morbidity and mortality.

Long-Term Association Between Developmental Assets and Health Behaviors: An Exploratory Study.

Introduction Based on internal and external assets, the positive youth development approach aims to increase the capacity among adolescents to overcome challenges as they transition to adulthood. Developmental assets have been found to be positively associated with academic achievement, a variety of health promoting behaviors, and improved physical and mental health. The purpose of this exploratory study was to assess the long-term association between positive youth developmental assets with health risk and promoting behaviors. Method A continuous scale of developmental assets was created using 30 items from Wave I of the National Longitudinal Study of Adolescent to Adult Health, when participants were in 7th to 12th grades. Health behavior outcomes including cigarette use, substance use, fast food consumption, and physical activity were measured at both Wave III (age 18-26) and Wave IV (age 24-32). Path analysis was employed to assess the relationship between these observed measures. Results The well-fitted path model revealed associations between developmental assets with each health behavior at Wave III. Developmental assets indirectly influenced each health behavior and direct associations were observed between assets with substance use and physical activity at Wave IV. Conclusion Findings provide additional support for the developmental assets approach to adolescent health. Implications include Healthy People 2020 objectives related to tobacco and alcohol use and nutrition and physical activity.

Age and Intimate Partner Violence: An Analysis of Global Trends Among Women Experiencing Victimization in 30 Developing Countries.

PURPOSE: Young women are at elevated risk of violence victimization, yet generalizable evidence on age at which abuse first occurs is lacking. This analysis provides new descriptive evidence on age and duration into partnership of women's first intimate partner violence (IPV) victimization. METHODS: Data come from ever married women ages of 15-49 years in nationally representative Demographic and Health Surveys in 30 countries collected from 2005 to 2014 in Africa, Asia, Eastern Europe, and Latin America and the Caribbean. Descriptive analysis is performed. RESULTS: Approximately 29.0% (95% confidence interval [CI]: 28.8, 29.3) of women reported any physical or sexual IPV. Among ever married women who first experienced violence post-union, abuse began, on average, 3.5 years (95% CI 3.4, 3.5), after union formation. Approximately 38.5% (95% CI 37.9, 39.0) and 67.5% (95% CI 67.0, 68.1) of those ever experiencing abuse did so within 1 year and 3 years, respectively, of union formation. Regionally, average years into union of abuse initiation showed little variation and average age at first abuse among once married women is 22.1 years. CONCLUSIONS: Results imply that primary prevention for IPV must take place on average before first union before age 19 years, to capture the most relevant and at risk target population. Resources allocated toward risk factors in childhood and adolescence may be most effective in combating initiation of IPV globally. Despite this finding, there remains a lack of evidence on effective interventions for primary prevention of abuse during women's early years in developing settings.

Do Physical Activity Patterns Across the Lifecourse Impact Birth Outcomes?

The significant impact of physical activity during, or immediately prior to pregnancy on a range of pregnancy and birth outcomes has been established. However, lifecourse theory posits that the antecedents of poor outcomes occur across a larger trajectory of time. The objective of this study was to examine whether physical activity patterns over the lifecourse impact birth outcomes. The sample (n = 1,713) was derived from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health and limited to women who had their first, singleton live birth between Waves III and IV; respondents who had missing data were excluded. Outcome variables included preterm birth (<37 weeks) and low birth weight (<5.5 pounds). Physical activity was categorized as follows: long-term physically active (active at Waves I and III); short-term physically active (active at only Wave I or III); and not physically active (not active at Waves I and III). Survey-weighted logistic regression controlled for socio-demographic and established predictors of poor birth outcomes. Women categorized as long-term physically active had lower rates of preterm births (12.2 vs. 18.7 %) and low birth weight (9.1 vs. 11.1 %) compared to women categorized as not physically active. However, when controlling for covariates, adjusted analysis revealed that physical activity consistency only predicted preterm birth (aOR = 0.55, 95 % CI = 0.33-0.91). Findings suggest that physical activity patterns across the lifecourse may decrease risk of preterm birth. Implications include efforts supporting patterns of physical activity over longer periods of time prior to pregnancy.

Community level predictors of physical activity among women in the preconception period.

Although physical activity is a key behavior targeted during the preconception period given its significant impact on pregnancy/birth outcomes and psychological well-being, few women meet national guidelines. While intrapersonal factors influencing physical activity among this population have been studied, community factors remain unexplored. The objective of this study was to examine community level predictors of physical activity among preconception women. Data from Add Health were limited to women (Wave III; age 18-28; n = 7,596) and excluded respondents who were pregnant, physically disabled, and missing data. The outcome variable was ≥5 instances of moderate-vigorous physical activity (MVPA) in 1 week. Community predictor variables included neighborhood-level structural and social determinants (e.g., socio-demographic composition; landscape diversity; urbanization; access to resources; crime; vehicle availability). Multilevel logistic regression modeling was used to estimate the odds of engaging in ≥5 instances of MVPA. Few women (26 %) reported ≥5 instances of MVPA in 1 week. Adjusted multilevel analysis revealed women in the preconception period were more likely to report high MVPA when living in communities with larger population densities (OR 1.34, 95 % CI 1.02-1.77) and median household income greater than $50,000 (OR 1.33, 95 % CI 1.06-1.66). Additionally, a significant inverse trend was found between high MVPA and proportion of the community without a high school diploma. Findings suggest that neighborhood composition may have an impact on preconception physical activity status. Implications include increased efforts targeting community conditions for facilitating physical activity; ultimately, improving health among women and subsequent offspring.

The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample.

Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.

Knowledge and use of emergency contraception: a multicountry analysis.

CONTEXT: Globally, evidence on knowledge and use of emergency contraception from population-based data is limited, though such information would be helpful in increasing access to the method. We examined knowledge and use of emergency contraception in 45 countries using population-based survey data. METHODS: Demographic and Health Survey (DHS) data on women aged 15-49 were analyzed by country in logistic regressions to identify associations between women's characteristics and their having heard of emergency contraception or having ever used it. Trends were examined, by region and globally, according to individual, household and community descriptors, including women's age, education, marital status, socioeconomic status, and urban or rural location. RESULTS: The proportion of women who had heard of emergency contraception ranged from 2% in Chad to 66% in Colombia, and the proportion of sexually experienced women who had used it ranged from less than 0.1% in Chad to 12% in Colombia. The odds of having heard of or used the method generally increased with wealth, and although the relationship between marital status and knowing of the method varied by region, never-married women were more likely than married women to have used emergency contraception in countries where significant differences existed. In some countries, urban residence was associated with having heard of the method, but in only three countries were women from urban areas more likely to have used it. CONCLUSIONS: Our findings support the need for broader dissemination of information on emergency contraception, particularly among low-income individuals. Variations in use and knowledge within regions suggest a need for programs to be tailored to country-level characteristics.

Randomized trial of two e-learning programs for oral health students on secondary prevention of eating disorders.

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/barriers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-learning programs for improving the skills-based knowledge and self-efficacy necessary for behavior change.

Tip of the iceberg: reporting and gender-based violence in developing countries.

Gender-based violence (GBV) is widespread globally and has myriad adverse health effects but is vastly underreported. Few studies address the extent of reporting bias in existing estimates. We provide bounds for underestimation of reporting of GBV to formal and informal sources conditional on having experienced GBV and characterize differences between women who report and those who do not. We analyzed Demographic and Health Survey data from 284,281 women in 24 countries collected between 2004 and 2011. We performed descriptive analysis and multivariate logistic regressions examining characteristics associated with reporting to formal sources. Forty percent of women experiencing GBV previously disclosed to someone; however, only 7% reported to a formal source (regional variation, 2% in India and East Asia to 14% in Latin America and the Caribbean). Formerly married and never married status, urban residence, and increasing age were characteristics associated with increased likelihood of formal reporting. Our results imply that estimates of GBV prevalence based on health systems data or on police reports may underestimate the total prevalence of GBV, ranging from 11- to 128-fold, depending on the region and type of reporting. In addition, women who report GBV differ from those who do not, with implications for program targeting and design of interventions.

Exploring the co-morbidity of attention-deficit/hyperactivity disorder with eating disorders and disordered eating behaviors in a nationally representative community-based sample.

Emerging evidence signifies the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) with clinical and sub-threshold disordered eating behaviors. However, many existing studies have assessed this co-occurrence among inpatient or intensive outpatient populations. The purpose of this study was to examine the co-occurrence of ADHD with clinical eating disorders and disordered eating behaviors in a nationally representative sample via a secondary data analysis of data from the National Longitudinal Study of Adolescent Health (n = 4,862; 2,243 males; 2,619 females). Results reveal that females have higher rates of co-occurrence of ADHD and diagnosed eating disorders than males (1.05% vs. 0.20%, p < .01). When controlling for age and race, ADHD predicted diagnosed eating disorders in females (incidence rate ratio (IRR): 2.06; 95% CI: 1.09-3.88; p < .05), but did not predict diagnosed eating disorders in males. With regard to disordered eating behaviors, when controlling for age, gender, and race, ADHD significantly predicted disordered eating behaviors (OR: 1.82; 95% CI: 1.21-2.74). When stratifying by type of disordered eating behavior, ADHD predicted binging and/or purging behavior (OR: 2.86; 95% CI: 1.78-4.61), but not restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention efforts in addition to tertiary prevention via patient-specific treatment plans.

A review of global access to emergency contraception.

BACKGROUND: Emergency contraception has been known for several decades, and dedicated products have been on the market for close to 20 years. Yet it is unclear whether women, particularly in low-resource countries, have access to this important second-chance method of contraception. OBJECTIVES: To review relevant policies, regulations, and other factors related to access to emergency contraception worldwide. SEARCH STRATEGY: A wide range of gray literature was reviewed, several specific studies were commissioned, and a number of online databases were searched. MAIN RESULTS: Several positive policies and regulations are in place: emergency contraception products are registered in the majority of countries around the world, listed in many countries' essential medicines lists, included in widely used guidance, and supported by most donors. Yet analysis of demographic data shows that the majority of women in low-income countries have never heard of emergency contraception, and surveys find that many providers have negative attitudes toward providing emergency contraception. CONCLUSIONS: Despite more than a decade of concerted international and country-level efforts to ensure that women have access to emergency contraception, accessibility remains limited.