A Web-Based Intervention for Insufficiently Active College Students: Feasibility and Preliminary Efficacy.

BACKGROUND: One third of college students do not achieve aerobic activity levels recommended for physical and mental health. The web-based "I Can Be Active!" intervention was designed to help college students increase their physical activity. The intervention was grounded in the Multi-Process Action Control (M-PAC) framework which emphasizes translating intention into sustainable action. OBJECTIVE: The primary purpose was to evaluate the feasibility of the intervention with insufficiently active young adult college students. The secondary purposes were to describe the preliminary effects of the intervention on: (1) the M-PAC constructs and (2) physical activity. METHODS: Twenty-one college students, ages 18 to 24, were enrolled in the pre-post quasi-experimental study to test the 8-week intervention during Spring 2021. Data were collected via self-report questionnaires, web-analytics, and interviews. Feasibility outcomes included recruitment, retention, acceptability, practicality, and implementation. Preliminary efficacy outcomes were self-report M-PAC constructs and physical activity. Data analyses included descriptive statistics, t tests, Wilcoxon signed rank tests, Hedge's g, and thematic analysis. RESULTS: Recruitment and retention rates were 70% and 71%, respectively. Participants reacted positively to the program, content, and features, except the manual entry step tracker and private social media group. Positive trends and significant increases were found in the regulatory and reflexive M-PAC constructs (self-regulation, habit, and identity) and physical activity. CONCLUSIONS: Findings support the feasibility and preliminary effects of the intervention for insufficiently active college students and highlight implications for intervention refinement. Future research will test intervention effectiveness using a randomized controlled trial with a larger diverse sample of college students.

Pilot Intervention Using Food Challenges and Video Technology for Promoting Fruit and Vegetable Consumption.

OBJECTIVE: To evaluate the feasibility of a Social Cognitive Theory-based intervention on cognitive, affective, and behavioral outcomes in a college nutrition course. DESIGN: A pre-post quasi-experimental design. SETTING: Large metropolitan university. PARTICIPANTS: College students (n = 138) aged 18-40 years. INTERVENTIONS: Students participated in weekly food challenges during a 15-week nutrition course to apply nutrition knowledge, develop self-efficacy and promote positive behavior change. Food challenges were implemented by a guided goal-setting strategy. Cooking videos, which modeled important nutrition-related skills, accompanied each challenge. Students independently selected 2-goal options to implement weekly and wrote a reflection about their experiences. MAIN OUTCOME MEASURES: Cognitive outcomes (nutrition and cooking self-efficacy), affective outcome (cooking attitudes), and behavioral outcomes (fruit and vegetable consumption). ANALYSIS: Descriptive statistics and paired sample t tests. RESULTS: Analyses showed significant increases in cognitive outcomes (produce consumption self-efficacy [P = 0.004], cooking self-efficacy [P = 0.002], using fruit/vegetables and seasoning self-efficacy [P = 0.001]) and behavioral outcomes (fruit consumption [P < 0.001], and vegetable consumption [P < 0.001]). CONCLUSION AND IMPLICATIONS: This pilot study suggested a framework for behavioral change, grounded in constructs central to Social Cognitive Theory, that simplified the goal-setting process (by using guided goal setting) and used video technology to decrease the cost of implementation.

Application of the IDEAS Framework in Adapting a Web-Based Physical Activity Intervention for Young Adult College Students.

User-centered developmental processes are critical to ensuring acceptability of e-health behavioral interventions, and yet physical activity research continues to be inundated with top-down developmental approaches. The IDEAS (Integrate, Design, Assess, and Share) framework outlines a user-centered process for development of e-health interventions. The purpose of this manuscript is to describe the application of the IDEAS framework in adapting a web-based physical activity intervention for young adult college students. Steps 1-3 emphasized integrating insights from users and theory and Steps 4-7 focused on iterative and rapid design with user feedback. Data were collected via repeat qualitative interviews with young adult college students (N = 7). Resulting qualitative metathemes were engagement, accountability, and cultural fit. Therefore, intervention modifications focused on strategies to foster ongoing engagement with the program (e.g., increase interactivity), support personal and social accountability (e.g., private social media group), and provide a cultural fit within the college lifestyle (e.g., images relevant to student life). The resulting web-based intervention included eight weekly lessons, an expanded resource library, "how-to" videos, step and goal trackers, and a private social media group to be led by a wellness coach. In conclusion, the IDEAS framework guided an efficient, user-centered adaptation process that integrated empirical evidence and behavior change theory with user preferences and feedback. Furthermore, the process allowed us to address barriers to acceptability during the design and build stages rather than at later stages of pilot and efficacy testing.

In the eye of the beholder: Body weight misperceptions among African Americans living in Kentucky.

Body weight status misperception, perceiving one's self to be thinner than one's body mass index (BMI), is growing in the United States. At risk for lifestyle-related disease, African Americans face more dire consequences with respect to this misperception than others. In a sample of African American Kentuckians, we found a moderate level of body weight status misperception. Educational attainment was the strongest predictor of body weight status misperception, with more education associated with less misperception. These findings suggest that health communication for African Americans should address body weight status misperception and be tailored for individuals' level of educational attainment.

Association between Physical Activity and Sport Participation on Hemoglobin A1c Among Children and Adolescents with Type 1 Diabetes.

PURPOSE: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). METHOD: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. RESULTS: Participants consisted of 71 females and 81 males, were 13 ± 3 years old with an average HbA1c level of 8.75 ± 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p < 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p < 0.05). CONCLUSION: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner.

Opposing Discourses Surrounding Type 2 Diabetes in Eastern Appalachian Kentucky.

Type 2 diabetes disproportionately affects individuals in Appalachia. This study investigated discourse among friends and family with different diabetes risk levels in Central Appalachia. Eighteen semistructured, in-depth interviews were conducted with Appalachian Kentuckians. Thematic analysis revealed 2 dialectic tensions centered on disease management (health as a personal problem vs diabetes management requiring social support) and disclosure (openness vs closedness). Health professionals should consider the powerful influence of speech with respect to family relations and support, along with the need to communicate early, clearly, and often in a manner that emphasizes family, friends, and connectedness.

Social Constructions of Stigmatizing Discourse Around Type 2 Diabetes Diagnoses in Appalachian Kentucky.

Type 2 diabetes is a growing problem among Appalachian Kentucky residents. Several issues contribute to diabetes disparities in the region, including lack of access to health care and geographic isolation. Previous studies also indicate that social stigma may be associated with type 2 diabetes. We used 28 semistructured interviews to explore how stigma is socially constructed across health status (diagnosed/undiagnosed). Perceived severity of the disease is high, yet the etiology of diabetes is not well understood. Thus, onset is perceived to occur "out of the blue," and a positive diagnosis is perceived as having life-threatening consequences. Diagnosed participants, who had learned more about the disease's etiology, prevention, and management, expressed intrapersonal stigma. In interpersonal situations, the visible indicators of a diabetes diagnosis (i.e., physical weight, insulin injection), rather than diagnosis status, tended to evoke stigmatizing interactions. These findings form the foundation for our recommendations for prevention messages in the region.

Healthicization and Lay Knowledge About Eating Practices in Two African American Communities.

In this manuscript, we expand upon sociological research in lay knowledge about health and healthicization by examining socially mediated ways in which 40 African American adults in two communities acquired information about eating practices. Participants employed a variety of socially informed information-seeking strategies. Many, but not all, used socially prescribed sources exhorting them to maximize their own health and reported an amalgam of experiences concerning their interpretation of healthist messages. Participants variously accepted messages about healthy eating or engaged in strategies of micro-resistance that decentered and/or reinterpreted health promotion discourse. Furthermore, participants used emic community-based resources including those that prioritized familial engagement over individual responsibility in eating practices or that drew upon alternative health practices. We discuss the implications our work has for further research on healthicization and lay knowledge about eating practices, in which community members are actively engaged in meaning-making within local socio-structural contexts.

Modeling message preferences: an adaptive conjoint analysis of persuasive messaging to increase fruit and vegetable consumption.

Few past studies have used conjoint analysis to assess message design features and even fewer have looked at health issues. This research applies conjoint analysis to the quest to design motivational messages for African Americans at risk for diet-related adverse health outcomes (e.g., heart disease) in Kentucky. African American health in the state of Kentucky can benefit from a diet high in fruit and vegetable consumption, but little past research has been conducted with African American Kentuckians to explore the best message structure for communicating about increased fruit and vegetable consumption. This study reports on the outcome of the final phase of formative campaign research. We use an adaptive conjoint analysis to identify the most important elements of message design for this group of Kentucky residents. Results indicate that the message's source (i.e., the person delivering the message) is the most important design element for creating persuasive health messaging about fruit and vegetables for African Americans in Kentucky, followed by the stated benefit of eating more fruit and vegetables and the manner in which the behavior is described, respectively. To our knowledge, this study is the first to treat campaign message features as the subject of a conjoint analysis in order to identify which combination of features might be most motivating for a specific target audience. Recommendations for future health communication campaign application, as well as future research are discussed.

What's Hoppin' in Hoptown?: Examining Fruit and Vegetable Consumption Among Hopkinsville's African American Community.

Cardiovascular disease is a concern nationwide and disproportionately impacts African Americans residing in the American South. However, this condition can be assuaged by consuming a diet of fruits and vegetables. Utilizing the social ecological model, this study explored the community, interpersonal, and intrapersonal factors that predict fruit and vegetable consumption in Hopkinsville, Kentucky, a small rural city which possesses one of the largest populations of African Americans in the state. Using data from social transect walks and a formative research survey (N=174), this study also sought to discover the best methods to communicate with Hopkinsvillians to improve their diets. Results show that despite some barriers (i.e., cost of quality foods, perceived lack of access to fresh food stores), Hopkinsvillians tend to view fruit and vegetable consumption positively. In addition, family and friends provide interpersonal support to those wanting to eat healthier. The study reveals that communicators must consider all levels of the social ecological model to produce effective health messages.

Psychometric properties of a prediabetes instrument to assess perceived susceptibility and perceived severity in Appalachians.

BACKGROUND AND PURPOSE: The purpose of this study was to develop an instrument that assesses perceived susceptibility and perceived severity for individuals at risk but not yet diagnosed with type 2 diabetes living in Appalachia. METHODS: From 168 surveys, Cronbach's alpha and item-total correlations assessed reliability, confirmatory factor analysis confirmed construct validity (convergent and discriminant), and multiple linear regression determined concurrent criterion-related validity of perceived susceptibility and perceived severity scales. There were 22 in-depth interviews conducted to triangulate meaning of the scales' results. RESULTS: Discriminant validity was demonstrated via low interfactor covariation. Concurrent criterion-related validity was also established via significant regression coefficients and supplemental qualitative data. CONCLUSIONS: This prediabetes screening instrument provides a strong foundation for measuring perceived susceptibility and perceived severity in Appalachian individuals who have prediabetes.

Is there health out there in the afrosphere? An analysis of health-related content posted by black bloggers.

We explored the extent to which Blacks use online blogs to communicate health information. We content analyzed blogs' main pages for: health-related text, badges, subject lists, and tag clouds. Half of the blogs possessed one of the aforementioned items referencing or depicting health. Violence/crime and health/healthcare were referenced most frequently. We also analyzed health-related posts by coding for presumed posting purpose. We found that bloggers most often posted health content in order to share information; very few promoted healthier behavior. We assert that blogs have the potential to be an important health communication tool for reaching Black Americans.

Process evaluation results from an environmentally focused worksite weight management study.

There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively simple, low-cost environmental modifications designed to facilitate healthy eating and physical activity; the intense treatment added elements intended to actively involve and engage management in program efforts. Fidelity varied across the 11 interventions comprising the two treatment conditions but did not vary systematically by treatment condition (moderate vs. intense). Environmental assessments showed improvements in workplace supports for weight management and significant differences by treatment level. Positive shifts in health climate perceptions also occurred, but sites receiving the intense treatment were not perceived as more supportive by employees. Challenges and limitations associated with environmental interventions are discussed with specific reference to activating management support.

What does cancer treatment look like in consumer cancer magazines? An exploratory analysis of photographic content in consumer cancer magazines.

In an exploratory analysis of several highly circulated consumer cancer magazines, the authors evaluated congruency between visual images of cancer patients and target audience risk profile. The authors assessed 413 images of cancer patients/potential patients for demographic variables such as age, gender, and ethnicity/race. They compared this profile with actual risk statistics. The images in the magazines are considerably younger, more female, and more White than what is indicated by U.S. cancer risk statistics. The authors also assessed images for visual signs of cancer testing/diagnosis and treatment. Few individuals show obvious signs of cancer treatment (e.g., head scarves, skin/nail abnormalities, thin body types). Most images feature healthier looking people, some actively engaged in construction work, bicycling, and yoga. In contrast, a scan of the editorial content showed that nearly two thirds of the articles focus on treatment issues. To explicate the implications of this imagery-text discontinuity on readers' attention and cognitive processing, the authors used constructs from information processing and social identity theories. On the basis of these models/theories, the authors provide recommendations for consumer cancer magazines, suggesting that the imagery be adjusted to reflect cancer diagnosis realities for enhanced message attention and comprehension.

Exploring diabetes beliefs in at-risk Appalachia.

PURPOSE: This study quantifies and describes perceptions of susceptibility and severity of diabetes; cultural beliefs, barriers, and knowledge about diabetes; and social stigma associated with diabetes in an Eastern Appalachian Kentucky population. METHODS: A 55-item intercept survey was administered in 2 large retail outlets in Eastern Kentucky. Individuals were screened to ensure an age range of 25-55 and an "at-risk" diabetes status (according to the American Diabetes Association's requirements). Descriptive statistics and t tests were used to describe the data. Differences across demographic variables were tested via an analysis of variance. FINDINGS: Most respondents agreed that diabetes is a growing problem in their community, yet the overall levels of perceived susceptibility and perceived severity were lower than expected (susceptibility = 3.88 on a 5-point scale and severity = 3.5). Women, however, perceived higher susceptibility than men. Social stigma did not emerge as a strong concern or worry. The only group differences noted focused on barriers to care and disease management. Specifically, men without a family history of diabetes were significantly less likely than men with a family history to agree that the community should help persons living with diabetes manage their disease (P= .034). CONCLUSIONS: There appears to be a gap between actual and perceived risk levels for developing diabetes. Additionally, it seems that diabetes is viewed as an intrapersonal issue rather than a community-level problem. Yet, for men, a personal experience with the disease may be enough to change the belief that diabetes is an individual problem.

Management support of workplace health promotion: field test of the leading by example tool.

PURPOSE: This study tested a repeated-measures application of the Leading by Example (LBE) questionnaire, a self-report instrument measuring organizational leadership support for health promotion. DESIGN: The efficacy of the LBE was tested in a quasi-experimental health promotion intervention trial. Twelve worksites were assigned to three intervention conditions (i.e., control, moderate, high intensity). SETTING: The worksites were selected from a large U.S.-based chemical company. SUBJECTS: Baseline data were collected from employees in various job roles in 2005 (N  =  125). Follow-up data were collected in 2006 (N  =  114) and 2007 (N  =  106). Response rates ranged from 54% to nearly three-fourths of potential respondents. INTERVENTION: Worksites assigned to both treatment conditions received changes in the built environment via supports for weight management. Worksites assigned to the intense condition received additional elements designed to impact leadership's support for a positive health promotion climate. MEASURES: Four LBE factors measuring management support for health were assessed over time. ANALYSIS: The Kruskal-Wallis H-test and analyses of variance/covariance were used to compare LBE scores. RESULTS: Significant changes from baseline to 2006 were identified for the four factors (p  =  .000) of the LBE. No significant changes were found from 2006 to 2007. CONCLUSIONS: The LBE effectively captured perceptions of management support for health. Researchers and practitioners alike should consider using the LBE to track and evaluate perceptions of management support for health promotion.

Making work safer: testing a model of social exchange and safety management.

INTRODUCTION: This study tests a conceptual model that focuses on social exchange in the context of safety management. The model hypothesizes that supportive safety policies and programs should impact both safety climate and organizational commitment. Further, perceived organizational support is predicted to partially mediate both of these relationships. METHODS: Study outcomes included traditional outcomes for both organizational commitment (e.g., withdrawal behaviors) as well as safety climate (e.g., self-reported work accidents). Questionnaire responses were obtained from 1,723 employees of a large national retailer. RESULTS: Using structural equation modeling (SEM) techniques, all of the model's hypothesized relationships were statistically significant and in the expected directions. The results are discussed in terms of social exchange in organizations and research on safety climate. IMPACT ON INDUSTRY: Maximizing safety is a social-technical enterprise. Expectations related to social exchange and reciprocity figure prominently in creating a positive climate for safety within the organization.

Explaining fruit and vegetable intake using a consumer marketing tool.

In response to calls to reinvent the 5 A Day fruit and vegetable campaign, this study assesses the utility of VALS, a consumer-based audience segmentation tool that divides the U.S. population into groups leading similar lifestyles. The study examines whether the impact of theory of planned behavior (TPB) constructs varies across VALS groups in a cross-sectional sample of 1,588 U.S. adults. In a multigroup structural equation model, the VALS audience group variable moderated latent TPB relationships. Attitudes, subjective norms, and perceived behavioral control explained 57% to 70% of the variation in intention to eat fruit and vegetables across 5 different VALS groups. Perceived behavioral control and intention also predicted self-reported consumption behavior (R2 = 20% to 71% across VALS groups). Bivariate z tests were calculated to determine statistical differences in parameter estimates across groups. Nine of the bivariate z tests were statistically significant (p < or = .04), with standardized coefficients ranging from .05 to .70. These findings confirm the efficacy of using the TPB to explain variation in fruit and vegetable consumption as well as the validity of using a consumer-based algorithm to segment audiences for fruit and vegetable consumption messaging.

Promoting fruit and vegetable consumption in different lifestyle groups: recommendations for program development based on behavioral research and consumer media data.

Fruit and vegetable consumption affects the etiology of cardiovascular disease as well as many different types of cancers. Still, Americans' consumption of fruit and vegetables is low. This article builds on initial research that assessed the validity of using a consumer-based psychographic audience segmentation in tandem with the theory of planned behavior to explain differences among individuals' consumption of fruit and vegetables. In this article, we integrate the findings from our initial analyses with media and purchase data from each audience segment. We then propose distinct, tailored program suggestions for reinventing social marketing programs focused on increasing fruit and vegetable consumption in each segment. Finally, we discuss the implications of utilizing a consumer-based psychographic audience segmentation versus a more traditional readiness-to-change social marketing segmentation. Differences between these two segmentation strategies, such as the ability to access media usage and purchase data, are highlighted and discussed.