Factors associated with intentions to seek formal and informal mental health help among college students with suicidal thoughts and behaviors.

OBJECTIVE: Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs). PARTICIPANTS: College students with STBs in the 2018-2020 Healthy Minds Study. METHODS: Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions. RESULTS: Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress. CONCLUSIONS: Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study.

PURPOSE: This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). DESIGN: A qualitative, phenomenological approach using semi-structured, one-on-one interviews. SETTING: Interviews conducted on Zoom (n = 28) and in-person (n = 3). PARTICIPANTS: Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States. METHOD: This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. RESULTS: Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. CONCLUSION: Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

COVID-19 Health Education Activities: An Analysis of a National Sample of Certified Health Education Specialists (CHES®/MCHES®) in Response to the Global Pandemic.

The National Commission of Health Education Credentialing, Inc. (NCHEC) created the Category 1 COVID-19 Claim Form Opportunity to document how Certified Health Education Specialists (CHES®) and Master Certified Health Education Specialists (MCHES®) assisted communities during the COVID-19 pandemic. Using data submitted by CHES®/MCHES® (n = 3,098 claim forms), the purpose of this study was to (a) describe the settings where CHES® and MCHES® completed their pandemic work and (b) assess differences in the type of pandemic work completed by CHES® compared with MCHES® based on specific Areas of Responsibility (AOR) for Health Education Specialists. Findings showed that CHES® and MCHES® engaged in seven AOR during the pandemic, with the largest proportion of CHES® (n = 859; 33%) and MCHES® (n = 105; 21.9%, documenting COVID-19-related activities in health departments. CHES® reported higher engagement than MCHES® in activities such as COVID-19 reporting/tracking, χ2 (1, N = 3,098) = 27.3, p < .001; outbreak response, χ2 (1, N = 3,098) = 4.3, p = .039; and vaccination, χ2 (1, N = 3,098) = 5.2, p = .023. Conversely, MCHES® reported higher participation than CHES® in screening/testing, χ2 (1, N = 3,098) = 174.2, p < .001; administration of budgets/operations, χ2 (1, N = 3,098) = 30.1, p < .001; and adapting educational activities at college/universities, χ2 (1, N = 3,098) = 46.1, p < .001. CHES® were more likely than MCHES® to indicate working in all AOR except for Area 2-Plan Health Education/Promotion. Results support that employer-verified health education skills in all AOR were transferable during COVID-19, especially for CHES® employed within state/county health departments.

Practical Advice Regarding the Reliability of the Patient Educational Materials Assessment Tool for Health Educators.

The quality of patient education materials is an important issue for health educators, clinicians, and community health workers. We describe a challenge achieving reliable scores between coders when using the Patient Educational Materials Assessment Tool (PEMAT) to evaluate farmworker health materials in spring 2020. Four coders were unable to achieve reliability after three attempts at coding calibration. Further investigation identified improvements to the PEMAT codebook and evidence of the difficulty of achieving traditional interrater reliability in the form of Krippendorff's alpha. Our solution was to use multiple raters and average ratings to achieve an acceptable score with an intraclass correlation coefficient. Practitioners using the PEMAT to evaluate materials should consider averaging the scores of multiple raters as PEMAT results otherwise may be highly sensitive to who is doing the rating. Not doing so may inadvertently result in the use of suboptimal patient education materials.

Exploration of the Relationship Between Concussions and Depression Symptoms, Anxiety Symptoms, and Hazardous Drinking Among a Sample of College Students.

Objective: In clinical and athlete populations, research has found that experiencing a concussion (or traumatic brain injury) is correlated with experiencing other psychiatric conditions, including depression and alcohol problems. However, less is known about concussion comorbidity in other population segments. The purpose of this study is to examine the relationships between concussions and depression symptoms, anxiety symptoms, and hazardous drinking among a large sample of college students (N = 1776) enrolled in a mandatory health course. Methods: This study used an online health survey to examine concussion frequency (informal and formal diagnoses), sports-related concussions, depression symptoms, anxiety symptoms, and hazardous drinking in the sample. Bivariate and multivariate analyses were conducted to examine comorbid relationships between concussion frequency and the dependent variables of interest (anxiety symptoms, depression symptoms, and hazardous drinking). Results: We found that 691 (39.1%) participants indicated having at least one concussion. Analyses indicated that concussion frequency scores of both formal or informal diagnoses were significantly associated with scores of depression symptoms, anxiety symptoms, and hazardous drinking. When examining concussion frequency scores of only formal diagnoses, only hazardous drinking evidenced a statistically significant relationship. In addition, participants who had a sports concussion had significantly higher concussion frequency scores and hazardous drinking scores than those who have had a concussion that was not sport-related. Conclusions: The comorbid concussion relationships found in this study are consistent with those observed in clinical and athlete populations. It is important for college health professionals to be aware that concussion comorbidity is not limited to the athlete population and can impact the entire student body.

Natural Observation of Alcohol Price and Promotions at Bars: Implications for Alcohol Misuse Prevention.

Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

When minutes matter: A university emergency notification system dataset.

The data presented in this data article were collected at three points in the 2012-2013 academic year; Fall 2012, Spring 2013, and Summer 2013 from undergraduate students enrolled in an introductory health education course at a large university in the United States. The data regarding undergraduate students' perceptions of and experiences with the campus emergency notification system were ascertained using a self-administered online-delivered survey instrument. The data included in the Mendeley Data repository affiliated with this data article encompass closed- and open-ended responses from 746 undergraduate students. Closed-ended questions included items based on central constructs from Technology Acceptance Model research-perceived usefulness, perceived ease of use, attitudes toward use, and behavioral intention. Survey questions also assessed students' actual use of emergency notification messages, students' perceived self-efficacy to respond to future potential emergency notifications, and demographics and technology use characteristics. This research team asked open-ended questions to collect students' ideas for systematic improvement in their own words. Descriptive statistics for demographic variables, participant characteristic variables, and scale variables were conducted in SPSS 27 and are provided in tables. The open-ended question response frequencies were also calculated in SPSS 27 and are provided within a supplemental PDF. To date, no data pertaining to an institution of higher education's emergency notification system are published for open access use. This article provides open access data and surveys that campus emergency planners, researchers, and health education specialists can use to inform emergency communication plans, improve the content of critical campus alert messages, structure future emergency notification studies, and frame future emergency notification system evaluations. This research team anticipates these data will help campus emergency personnel craft more effective messages and optimize their channel mixture to make emergency notifications reach and resonate with students in situations when minutes matter. The data for this article are hosted in a .csv file for widespread access in the following Mendeley Data repository: https://data.mendeley.com/datasets/6jdwfbwzk5/1.

Social Media and Health Promotion.

With over 3 billion users worldwide, social media has become a staple of daily life for people across the globe [...].

The Health Education Research Experience (HERE) program metadata dataset.

Undergraduate subject pools are prevalent across disciplines in the United States. The Health Education Research Experience (HERE) Program was the first known course-based subject pool entirely managed and conducted online for online students enrolled in an introductory health education/health promotion course. The program was conducted within five semesters from Spring 2012 through Summer 2013. The HERE Program encompassed 13 studies embedded in two sections of an undergraduate online course at the University of Florida. The studies were all related to course topics and current research topics in health education/promotion (as identified through the Healthy People 2020 Framework). The topics ranged from the relatively less sensitive health aspects of college life (i.e., technology use) to studies assessing more sensitive health topics (i.e., intimate partner violence and sexual assault). In alignment with a best practice in survey design, the HERE Program's survey instruments included one metadata item embedded in each survey to identify which devices students used to complete the surveys. Understanding which devices students used for survey completion has ramifications for survey designers and survey researchers. In contrast to the relative uniformity of pen and paper surveys and control of the survey completion environment, online surveys may not look identical across personal devices and may be completed in increasingly varied environments. All studies, study procedures and protocols, and metadata collection procedures were approved by the university's Institutional Review Board. The data presented here were extracted from each survey's data files and aggregated. The aggregated metadata are available through Mendeley Data in a.csv file for widespread access. Descriptive statistics are presented in tables. The data provided in this article will benefit researchers interested in survey methodology, questionnaire design, modes of survey collection, and survey metadata. The data are hosted in the following Mendeley Data repository: https://data.mendeley.com/datasets/ht9jmd3cdt/2.

Evolving Role of Social Media in Health Promotion: Updated Responsibilities for Health Education Specialists.

The use of social media in public health education has been increasing due to its ability to remove physical barriers that traditionally impede access to healthcare support and resources. As health promotion becomes more deeply rooted in Internet-based programming, health education specialists are tasked with becoming more competent in computer-mediated contexts that optimize both online and offline consumer health experiences. Generating a better understanding of the benefits and drawbacks to using social media in the field is important, since health education specialists continue to weigh its advantages against potential concerns and barriers to use. Accordingly, this Special Issue aims to explore social media as a translational health promotion tool by bridging principles of health education and health communication that examine (1) the method with which social media users access, negotiate, and create health information that is both actionable and impactful for diverse audiences; (2) strategies for overcoming challenges to using social media in health promotion; and (3) best practices for designing, implementing, and evaluating social media forums in public health. In this commentary, we discuss the updated communication and advocacy roles and responsibilities of health education specialists in the context of social media research and practice.

Facebook Groups on Chronic Obstructive Pulmonary Disease: Social Media Content Analysis.

Facebook Groups facilitate information exchange and engagement for patients with chronic conditions, including those living with Chronic Obstructive Pulmonary Disease (COPD); however, little is known about how knowledge is diffused throughout these communities. This study aimed to evaluate the content that is available on COPD-related Facebook Groups, as well as the communication (self-disclosures, social support) and engagement (agreement, emotional reaction) strategies used by members to facilitate these resources. Two researchers independently searched the "Groups" category using the terms "COPD", "emphysema", and "chronic bronchitis". Twenty-six closed (n = 23) and public (n = 3) COPD Facebook Groups were identified with 87,082 total members. The vast majority of Group members belonged to closed (n = 84,684; 97.25%) as compared to open (n = 2398; 2.75%) groups. Medications were the most commonly addressed self-management topic (n = 48; 26.7%). While overall engagement with wall posts was low, the number of "likes" (an indicator of agreement) was significantly greater for wall posts that demonstrated social support as compared to posts that did not (p < 0.001). Findings from this study showed that COPD Facebook group members share specific disease-related experiences and request information about select self-management topics. This information can be used to improve the quality of self-management support provided to members of popular COPD Facebook groups.

Association Between Health Literacy, Electronic Health Literacy, Disease-Specific Knowledge, and Health-Related Quality of Life Among Adults With Chronic Obstructive Pulmonary Disease: Cross-Sectional Study.

BACKGROUND: Despite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy-related skills that can uniquely influence patients' health-related quality of life (HRQoL) outcomes. OBJECTIVE: The aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD. METHODS: Adults from the COPD Foundation's National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables. RESULTS: After adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R2=21%; F9,164=6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R2=26.4%; F8,161=8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=-.56, SE 0.29, 95% CI -1.22 to -0.004, P<.05) was inversely associated with lung-specific HRQoL. CONCLUSIONS: Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL.

Pregaming: A Field-Based Investigation of Alcohol Quantities Consumed Prior to Visiting a Bar and Restaurant District.

BACKGROUND: Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC). OBJECTIVES: The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker. METHODS: 548 bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior. RESULTS: After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R2 = .323) of the variance of BrAC levels (F(12) = 21.162, p < .001), with 4.30% of the variance explained solely by pregaming (ß = 0.014; p < .001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R2 = .312) of the variance of pregaming behavior (F(18) = 13.276, p < .001), with 4.2% of the variance explained solely by AUDIT-C scores (ß = 0.280; p < .001). CONCLUSION: Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication.

Examination of associations between risky driving behaviors and hazardous drinking among a sample of college students.

OBJECTIVE: Hazardous drinking is associated with other risky behaviors and negative health-related outcomes. This study examined covariation between hazardous drinking scores and the following risky driving behaviors: Falling asleep while driving, texting (receiving and sending) while driving, and driving after consuming alcohol. METHODS: The participants in this study were a sample of undergraduate students (N = 1,298) who were enrolled in an introductory health course at a large Southeastern university in spring 2016 and completed an online health survey that assessed hazardous drinking, falling asleep while driving, texting while driving, and driving after consuming alcohol. We conducted a series of 2-step regression analyses to examine covariation between hazardous drinking scores (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and the risky driving behaviors of interest. RESULTS: We found that the majority of participants did not drink and drive (91.8%), nor did they fall asleep while driving (80.4%); however, the majority did read a text while driving (81.7%) and sent a text while driving (75.3%). In the full multivariable model, hazardous drinking score was positively associated with drinking and driving (step 2 odds ratio [OR] = 1.28, 95% confidence interval [CI], 1.18, 1.38) and sending a text message while driving (step 2 b = 0.19, P = .01). Hazardous drinking score was also positively associated with reading a text while driving (step 1 b = 0.14, P < .001) and falling asleep while driving (step 1 b = 0.02, P = .02) in the model only controlling for demographic characteristics. The analyses also indicated covariability between the following risky driving behaviors: (1) drinking and driving/reading a text message while driving, (2) drinking and driving/falling asleep and driving, (3) reading a text while driving/sending a text while driving, and (4) sending a text while driving/sleeping and driving. CONCLUSION: The findings of this study indicate a need for interventions discouraging both hazardous drinking and risky driving behaviors in college student populations; recommendations to reduce risky driving and hazardous drinking are discussed.

Examining Differences in Breath Alcohol Concentration (BrAC) Levels and Hazardous Drinking by Smoking Status Among a Sample of College Student Bar Patrons.

While the association between current smoking and alcohol consumption is well known, the relationship between social smoking and alcohol consumption is less understood. The purpose of this study was to examine the association between smoking status and two alcohol consumption measures in a sample of college student bar patrons. The data used in this study was collected in fall 2015. Study participants (N = 415) were college student bar patrons who agreed to complete an interview that assessed smoking status (i.e., regular smoker, social smoker, non-smoker) and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels (using a handheld breathalyzer device) and (2) hazardous drinking scores (using the AUDIT-C scale). We conducted one-way ANOVAs with Bonferroni correction to examine differences in BrAC levels and hazardous drinking scores by smoking status. Among sample participants, 25.3% were regular smokers, 14.7% were social smokers, and 60.0% were non-smokers. Smokers had significantly higher BrAC levels than social smokers and non-smokers. Regular smokers also had significantly higher hazardous drinking scores than social smokers and non-smokers. The BrAC levels and hazardous drinking scores of social smokers and non-smokers were not significantly different. The drinking habits of social smokers reflected those of non-smokers and being a regular smoker was associated with higher drinking levels than the rest of the sample. Because of the association found between alcohol consumption and regular smoking, combining efforts to reduce these behaviors in college students might be advantageous.

Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD).

Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients' eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation's National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (ß = 4.15), lower lung-specific health-related quality of life (ß = -0.19), and greater COPD knowledge (ß = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients benefit from web-based self-management support resources.

Concussion History, Hazardous Drinking, and BrAC Levels Among a Sample of Bar Patrons, 2015.

BACKGROUND: Alcohol consumption and experiencing a concussion are positively correlated. Concussion history has not been examined previously in any alcohol field study (i.e., conducted in a natural setting). OBJECTIVE: To better understand the relationship between concussion history and alcohol consumption. METHODS: We conducted two anonymous field studies among a 2015 sample of bar patrons (N = 544; 62.5% males) in a college town to assess concussion history and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels and (2) hazardous drinking scores (based on the AUDIT-C). Next, we conducted a logistic regression analysis to predict concussion history using the two alcohol consumption measures and other potential covariates (i.e., age, gender, race, college student status). RESULTS: Among participants in our sample, the average BrAC level was.070 (SD =.053) and the average hazardous drinking score was 4.7 (SD = 2.5). Less than half of participants indicated that they had experienced a concussion in their lifetime (235; 43.2%). The logistic regression model indicated that hazardous drinking scores were significantly, positively associated with having experienced a concussion, whereas other covariates (i.e., BrAC, age, gender, race, college student status) did not significantly predict concussion history. Conclusions/Importance: Hazardous drinkers were more likely to have experienced a concussion. Therefore, the relationship found in this sample, between hazardous drinking behavior and concussion history, points to hazardous drinking as a possible risk factor for having had a concussion in the past.

Examining the Relationship between Online Social Capital and eHealth Literacy: Implications for Instagram Use for Chronic Disease Prevention among College Students.

BACKGROUND: College students actively seek online health information and use Instagram, an image- and video-based social networking website, to build social networks grounded in trust and behavioral norms (social capital), which have the potential to prevent chronic disease. PURPOSE: This study aimed to: (1) examine how intensity of Instagram use moderates the relationship between eHealth Literacy and online social capital in college students, and (2) discuss how Instagram can be used as a social awareness platform for chronic disease prevention among college students. METHODS: Hierarchical regression analyses were conducted to analyze web-based survey data from a random sample of college students (N=327). RESULTS: Online bridging social capital was associated with greater eHealth Literacy (P<.05) and intensity of Instagram use (P<.001), when controlling for socio-demographic variables. The relationship between eHealth Literacy and online bridging social capital was strongest among respondents' with average (P<.01) and high (P<.01) intensity Instagram use, as compared to low Instagram intensity. DISCUSSION: High intensity of Instagram may strengthen college students' low eHealth Literacy, especially when interacting with heterogeneous connections with weaker ties. TRANSLATION TO HEALTH EDUCATION PRACTICE: Health education specialists should continue to explore how college students' intensity of Instagram use can be strengthened to build bridging online social capital, and ultimately prevent chronic disease.

Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey.

BACKGROUND: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. OBJECTIVE: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. METHODS: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. RESULTS: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than -2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. CONCLUSIONS: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations.