Promoting Caregiver Early Childhood Development Behaviors through Social and Behavioral Change Communication Program in Tanzania.

Objectives: Stunting remains a prevalent issue in Tanzania. The consequences of stunting include reduced height, greater susceptibility to disease, and diminished cognitive ability throughout the lifespan. Lack of psychosocial stimulation is associated with increased stunting, particularly in terms of its cognitive impact. The Addressing Stunting in Tanzania Early (ASTUTE) program was a large social and behavior change communication (SBCC) intervention that aimed to reduce childhood stunting in the region by targeting early childhood development (ECD) behaviors. The purpose of this study is to report on the extent to which exposure to ASTUTE might be related to ECD behaviors. Methods: ASTUTE disseminated program messages via a mass media campaign and interpersonal communication (IPC). Logistic regression models were used to explore the relationship between exposure to TV, radio, IPC messages, and key ECD behaviors of female primary caregivers and male heads of household. Results: Among primary caregivers, IPC was positively associated with all ECD behaviors measured. Radio was associated with all behaviors except drawing with their child. TV was associated with all behaviors except playing with their child. Among heads of household, only the radio was positively associated with the ECD behaviors measured. Conclusions for practice: Findings indicate that SBCC interventions that include mass media and IPC components may be effective at promoting parental engagement in ECD behaviors. Significance: We know that ECD is important for a child's development. We know that parents play a critical role in promoting ECD behaviors. We are still exploring ways to influence parents so that they are more involved in ECD behaviors. The results presented here provide evidence for successful mass media and IPC efforts to improve parents' ECD behaviors. We hope this study will add more evidence for large interventions such as these to the literature, and we are very hopeful that governments and large international NGOs will prioritize SBCC approaches in the future, especially in locations where face-to-face interventions may be challenging.

Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access, Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study.

BACKGROUND: Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. OBJECTIVE: The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. METHODS: Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. RESULTS: One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information. CONCLUSIONS: Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.

An interpersonal nutrition campaign and maternal knowledge and childhood feeding practices: a case study from mothers in rural Indonesia.

BACKGROUND: The purpose of this study was to examine the extent to which a national nutrition communication campaign (NNCC) intervention providing interpersonal communication (IPC) was associated with improved knowledge and behaviors related to feeding practices among mothers with children under two years of age in rural Indonesia. METHODS: Data came from a follow-up, cross-sectional survey of 1734 mothers. Key outcomes of interest were minimum meal frequency, minimum dietary diversity and minimum acceptable diet, as defined by the World Health Organization. Associations between exposure to the NNCC intervention and infant and young child feeding (IYCF) knowledge and behaviors were analyzed using adjusted linear and logistic regression, controlling for age, education, and income. RESULTS: A total of 525 mothers reported exposure to IPC interventions (30.3%). Participation in IPC was associated with increased knowledge of feeding practices (p < .0001). Separately, knowledge of feeding practices was related to achieving recommended behavioral practices of minimum meal frequency (p = 0.019), dietary diversity (p = 0.013), adequate diet (p < .001). CONCLUSION: These findings underscore the value of increasing maternal knowledge of IYCF practices through IPC interventions as a way to improve behavioral practices and address stunting in rural Indonesia.

Increasing Active Transportation Through E-Bike Use: Pilot Study Comparing the Health Benefits, Attitudes, and Beliefs Surrounding E-Bikes and Conventional Bikes.

BACKGROUND: The emergence of electric pedal-assist bicycles (e-bikes) presents an opportunity to increase active transportation by minimizing personal barriers of engaging in physical activity. OBJECTIVES: The aim of this study was to assess the beliefs of individuals using e-bikes for active transport and report preliminary biometric measurements while using e-bikes for physical activity compared with conventional bikes. METHODS: Participants used both conventional bicycles and e-bikes to compare energy expenditure while riding on the study route. Apple smart watches were used to track each participant's heart rate, distance, speed, and time while riding both bicycles. A total of 3 survey instruments were used to estimate beliefs: one administered before riding the bicycles, a second administered after riding a conventional bike, and the final survey completed after riding an e-bike. Survey instruments were constructed using constructs from the theory of planned behavior. RESULTS: The study sample (N=33) included adults aged between 19 and 28 years. Paired t test analysis revealed that participants believed a conventional bike was more likely than an e-bike to benefit their physical health (P=.002) and save them money (P=.005), while an e-bike was perceived to be more likely than a conventional bike to save them time (P<.001). Paired t test analysis revealed participants significantly agreed more with the statement that they could ride an e-bike most days (P=.006) compared with a conventional bike. After participants traveled approximately 10 miles on each type of bicycle, participants' mean average heart rate while riding the e-bike was 6.21 beats per minute lower than when riding the conventional bike (P=.04), but both were significantly higher than resting heart rate (P<.001). CONCLUSIONS: This pilot study suggests that e-bikes are an active form of transportation capable of providing much of the cardiovascular health benefits obtained during conventional bike use. E-bikes may help reduce some of the obstacles to conventional bike use, such as increased transportation time, decreased convenience, and physical fatigue.

Mental and Emotional Self-Help Technology Apps: Cross-Sectional Study of Theory, Technology, and Mental Health Behaviors.

BACKGROUND: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health-related behavior change have not been thoroughly examined. OBJECTIVE: The objective of this study was to examine the association between theoretical behavior change mechanisms and use of mental and emotional self-help apps and whether the use of such apps is associated with mental health behaviors. METHODS: This study utilized a cross-sectional survey of 150 users of mental or emotional health apps in the past 6 months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement, and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior after controlling for potentially confounding variables. RESULTS: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. Engagement (P<.001) was positively associated with the reported changes in theory items, whereas perceived behavior change was positively associated with theory (P<.001), engagement (P=.004), frequency of use of apps (P=.01), and income (P=.049). CONCLUSIONS: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. This increase in perceptions, beliefs, and attitudes surrounding their mental and emotional health was considerably associated with perceived change in behavior. There was a positive association between the level of engagement with the app and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field.

How Do Apps Work? An Analysis of Physical Activity App Users' Perceptions of Behavior Change Mechanisms.

BACKGROUND: Physical activity apps are commonly used to increase levels of activity and health status. To date, the focus of research has been to determine the potential of apps to influence behavior, to ascertain the efficacy of a limited number of apps to change behavior, and to identify the characteristics of apps that users prefer. OBJECTIVE: The purpose of this study was to identify the mechanisms by which the use of physical activity apps may influence the users' physical activity behavior. METHODS: This study used a cross-sectional survey of users of health-related physical activity apps during the past 6 months. An electronic survey was created in Qualtrics' Web-based survey software and deployed on Amazon Mechanical Turk. Individuals who had used at least one physical activity app in the past 6 months were eligible to respond. The final sample comprised 207 adults living in the United States. 86.0% (178/207) of respondents were between the ages of 26 and 54 years, with 51.2% (106/207) of respondents being female. Behavior change theory informed the creation of 20 survey items relating to the mechanisms of behavior change. Respondents also reported about engagement with the apps, app likeability, and physical activity behavior. RESULTS: Respondents reported that using a physical activity app in the past 6 months resulted in a change in their attitudes, beliefs, perceptions, and motivation. Engagement with the app (P<.001), frequency of app use (P=.03), and app price (P=.01) were related to the reported impact of the behavior change theory or mechanisms of change. The mechanisms of change were associated with self-reported physical activity behaviors (P<.001). CONCLUSIONS: The findings from this study provide an overview of the mechanisms by which apps may impact behavior. App developers may wish to incorporate these mechanisms in an effort to increase impact. Practitioners should consider the extent to which behavior change theory is integrated into a particular app when they consider making recommendations to others wishing to increase levels of physical activity.

Controlling Your "App"etite: How Diet and Nutrition-Related Mobile Apps Lead to Behavior Change.

BACKGROUND: In recent years, obesity has become a serious public health crisis in the United States. Although the problem of obesity is being addressed through a variety of strategies, the use of mobile apps is a relatively new development that could prove useful in helping people to develop healthy dietary habits. Though such apps might lead to health behavior change, especially when relevant behavior change theory constructs are integrated into them, the mechanisms by which these apps facilitate behavior change are largely unknown. OBJECTIVE: The purpose of this study was to identify which behavior change mechanisms are associated with the use of diet- and nutrition-related health apps and whether the use of diet- and nutrition-related apps is associated with health behavior change. METHODS: A cross-sectional survey was administered to a total of 217 participants. Participants responded to questions on demographics, use of diet and nutrition apps in the past 6 months, engagement and likability of apps, and changes in the participant's dietary behaviors. Regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potential confounding variables. RESULTS: The majority of study participants agreed or strongly agreed with statements regarding app use increasing their motivation to eat a healthy diet, improving their self-efficacy, and increasing their desire to set and achieve health diet goals. Additionally, majority of participants strongly agreed that using diet/nutrition apps led to changes in their behavior, namely increases in actual goal setting to eat a healthy diet (58.5%, 127/217), increases in their frequency of eating healthy foods (57.6%, 125/217), and increases in their consistency of eating healthy foods (54.4%, 118/217). Participants also responded favorably to questions related to engagement and likability of diet/nutrition apps. A number of predictors were also positively associated with diet-related behavior change. Theory (P<.001), app engagement (P<.001), app use (P<.003), and education (P<.010) were all positively associated with behavior change. CONCLUSIONS: Study findings indicate that the use of diet/nutrition apps is associated with diet-related behavior change. Hence, diet- and nutrition-related apps that focus on improving motivation, desire, self-efficacy, attitudes, knowledge, and goal setting may be particularly useful. As the number of diet- and nutrition-related apps continues to grow, developers should consider integrating appropriate theoretical constructs for health behavior change into the newly developed mobile apps.

Evaluation of Diet-Related Infographics on Pinterest for Use of Behavior Change Theories: A Content Analysis.

BACKGROUND: There is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory. OBJECTIVES: The objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT. METHODS: A content analysis was conducted on pins collected from Pinterest identified with the search terms "nutrition infographic" and "healthy eating infographic." The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes=1, no=0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<.05). RESULTS: The mean total theory score was 2.03 (SD 1.2). Perceived benefits were present most often (170/236, 72%), followed by behavioral capability (123/238, 51.7%) and perceived severity (79/236, 33.5%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P=.001), cartoon pictures of food (P=.01), and the presence of references (P=.001). The number of repins (P=.04), likes (P=.01), and comments (P=.01) were positively associated with the inclusion of HBT. CONCLUSIONS: These findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information.

Health Behavior Theory in Popular Calorie Counting Apps: A Content Analysis.

BACKGROUND: Although the Health & Fitness category of the Apple App Store features hundreds of calorie counting apps, the extent to which popular calorie counting apps include health behavior theory is unknown. OBJECTIVE: This study evaluates the presence of health behavior theory in calorie counting apps. METHODS: Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. RESULTS: Each app was given a theory score to reflect the extent to which health behavior theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, My Diet Coach obtained the highest theory score of 15. MapMyFitness and Yumget received the lowest scores of 0. The average theory score among the apps was 5.6. CONCLUSIONS: Most of the calorie counting apps in the sample contained minimal health behavior theory.

A content analysis of precede-proceed constructs in stress management mobile apps.

BACKGROUND: The emergence of Apple's iPhone provides a platform for freelance developers to design third party apps, which greatly expands the functionality and utility of mobile devices for stress management. This study provides a basic overview of the stress management apps under the health and fitness category of the Apple App store and appraises each app's potential for influencing behavior change. METHODS: Data for this study came from a content analysis of health and fitness app descriptions available in the App Store on iTunes. Trained research assistants used the Precede-Proceed Model (PPM) as a framework to guide the coding of paid stress management apps and to evaluate each app's potential for effecting health behavior change. RESULTS: Most apps were rated as being plausible (96.9%) and intending to address stress management (98.5%), but only 63.3% were rated as recommendable to others for their use. Reinforcing apps were less common than predisposing and enabling apps. Less than one percent (0.39%) of apps included all three factors (predisposing, enabling and reinforcing). CONCLUSIONS: Practitioners should be cautious when promoting the use of stress management apps, as most provide only health-related information (predisposing) or suggestions for enabling behavior, but almost none include all three theoretical factors recommended for behavior change.

Victimization among Peruvian adolescents: insights into mental/emotional health from the Young Lives study.

BACKGROUND: Bullying is a global problem among children and adolescents. The purpose of this study was to explore bully victimization in Peru and to identify potential adverse mental health and social outcomes resulting from bully victimization. METHODS: This study analyzed data from an ongoing prospective cohort of children taking part in the Young Lives study. This study assessed bullying consequences on mental and emotional health in the 3 rounds of data collected among Peruvian adolescents at ages 8, 12, and 15. RESULTS: Bullying by peers was negatively related with age. A factor analysis showed that boys were significantly less likely than girls to suffer emotional and relational problems due to victimization. Additionally, bullying in rounds 2 and 3 of the cohort were significantly correlated with adverse emotional and mental health outcomes in round 3. Lastly, emotional status was positively associated with violent incidences in the schools and at home. CONCLUSIONS: This study shows significant problems with emotional and mental stress as early outcomes associated with victimization in Peru. The findings have implications for treating adolescent health issues like peer victimization. Steps should be taken to address bullying and mental/emotional health in Peru in order to combat subsequent mental health problems.

Behavioral functionality of mobile apps in health interventions: a systematic review of the literature.

BACKGROUND: Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. OBJECTIVE: The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior interventions. METHODS: We conducted a review of the literature in September 2014 using key search terms in several relevant scientific journal databases. Only English articles pertaining to health interventions using mobile phone apps were included in the final sample. RESULTS: The 24 studies identified for this review were primarily feasibility and pilot studies of mobile apps with small sample sizes. All studies were informed by behavioral theories or strategies, with self-monitoring as the most common construct. Acceptability of mobile phone apps was high among mobile phone users. CONCLUSIONS: The lack of large sample studies using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals in changing their health behaviors. Of these studies, there is early evidence that apps are well received by users. Based on available research, mobile apps may be considered a feasible and acceptable means of administering health interventions, but a greater number of studies and more rigorous research and evaluations are needed to determine efficacy and establish evidence for best practices.

Predictors of peer victimization among Peruvian adolescents in the young lives cohort.

BACKGROUND: Bully-victimization is a widespread public health issue with significant negative effects on both social function and psychological well-being. Existing research in Peru shows high prevalence of bullying. However, researchers have yet to fully understand the phenomenon of victimization in developing regions. OBJECTIVES: The purpose of this study was to characterize victimization patterns over time, along with the predictors of victimization from a cohort of Peruvian adolescents enrolled in the young lives (YL) study. MATERIALS AND METHODS: This study examined data from YL, a longitudinal study of poverty, health, and development, which examined data from the older cohort of children in Peru across three rounds (ages 8, 12, and 15 years). The sample consisted of 714 children from 74 communities that represent 20 districts in Peru. RESULTS: After adjusting for urban/rural setting, there remained a significantly lower wealth index for children who were bullied at ages 8 and 12 years. Exploratory analysis showed that although those in the lowest quartile of body mass index (BMI) were significantly more likely to be bullied at age 8 years, this association waned over time. A worse caregiver assessment of child's health compared with others was associated with a significantly greater risk of bully-victimization. At age 8 years, caregiver education was significantly lower among those bullied compared with those who were not bullied. CONCLUSION: This study showed several factors as the predictors of victimization in the early years, including being male and having low BMI, low socioeconomic status, and low parental/caregiver education. Further longitudinal studies should be conducted to determine the extent to which these predictors vary in significance over time.

Sexting among Peruvian adolescents.

BACKGROUND: Sexting (sexual messaging via mobile devices) among adolescents may result in increased risky sexual practices, psychological distress and in some cases, suicide. There is very little research on sexting in developing nations, such as Peru. In particular, little is known about gender differences in the correlates of sexting. The purpose of this study was to determine the sexting prevalence and correlates of sexting among adolescent boys and girls in Cusco, Peru. METHODS: The study sample comprised 949 high school aged adolescents from Cusco, Peru. Adolescents responded to questions about demographics, sexting behavior, and risk/protective factors. Separate regression models were constructed to compare correlates of sexting for boys and sexting for girls. RESULTS: Twenty percent of the sample reported engaging in at least one instance of sexting. Boys reported higher rates of sexting than girls (35.17% vs. 13.19%, p = 0.000). Significant correlates for girls' sexting included having been cyberbullied and parental factors. For boys, hypertexting, fighting, parental factors, and parental rules about sexting were significant. CONCLUSIONS: Peruvian health officials with an interest in reducing the effects of sexting among adolescents may choose to target boys differently than girls. These efforts may include advising parents to set clear rules and expectations about sexting and the appropriate use of mobile devices.

Victimization of Peruvian adolescents and health risk behaviors: Young Lives cohort.

BACKGROUND: While extensive research has been conducted on bullying and victimization in western countries, research is lacking in low- and middle-income settings. This study focused on bullying victimization in Peru. It explored the relationship between the caregiver's perception of child victimization and the child's view of selected negative experiences occurring with other children their age. Also, the study examined the association between victimization and adolescent health risk behaviors. METHODS: This study used data from 675 children participating in the Peru cohort of the Young Lives study. Children and caregivers were interviewed in 2002 when children were 8 years of age and again in 2009 when children were 15 years of age. Measures of victimization included perceptions from children and caregivers while measures of health risk behaviors included cigarette smoking, alcohol drinking, and sexual relations among adolescents. RESULTS: Caregivers identified 85 (12.6%) children bullied at ages 8 and 15, 235 (34.8%) bullied at age 8 only, 61 (9.0%) bullied at age 15 only, and 294 (43.6%) not bullied at either age. Children who were bullied at both ages compared with all other children were 1.58 (95% CI 1.00-2.50) times more likely to smoke cigarettes, 1.57 (1.04-2.38) times more likely to drink alcohol, and 2.17 (1.41-3.33) times more likely to have ever had a sexual relationship, after adjusting for gender. The caregiver's assessment of child victimization was significantly associated with child reported bullying from other children their age. Child reported victimization was significantly associated with increased risky behaviors in some cases. CONCLUSION: Long-term victimization from bullying is more strongly associated than less frequent victimization with increased risk of cigarette smoking, alcohol drinking, and sexual relations at age 15. Hence, programs focused on helping children learn how to mitigate and prevent bullying consistently over time may also help reduce risky adolescent health behaviors such as smoking, alcohol consumption, and sexual activity.

Just a fad? Gamification in health and fitness apps.

BACKGROUND: Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps. OBJECTIVE: The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer's health behavior. METHODS: An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements. RESULTS: This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger. CONCLUSIONS: This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors.

Identifying barriers preventing Latina women from accessing WIC online health information.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a program for low-income women and children under age five. The purpose of this study was to identify barriers to accessing online WIC resources among Latina WIC clients. Five focus groups were conducted with Spanish-speaking participants recruited from a single WIC clinic. Two key themes emerged relating to barriers in accessing WIC's online resources. The first theme, access issues, included three subthemes: lack of computer/Internet resources; family barriers to computer use; and computer literacy. The second theme, perceived value of the website, included three subthemes: limited time savings; preference for on-site education; and knowledge about the website. This is the first study to evaluate barriers to accessing online resources among Latina women in the WIC program. WIC sites attempting to increase utilization of online resources may be more successful if they serve clients with easy access to a computer with Internet access. They may also consider strategies to increase the value of the online resources, as compared to their current services offered to clients in a face-to-face setting.

C U L8ter: YouTube distracted driving PSAs use of behavior change theory.

OBJECTIVE: To examine the inclusion of health behavior theory in distracted driving PSAs on YouTube.com. METHODS: Two-hundred fifty PSAs were assessed using constructs from 4 prominent health behavior theories. A total theory score was calculated for each video. Multiple regression analysis was used to identify factors associated with higher theory scores. RESULTS: PSAs were generally lacking in theoretical content. Video length, use of rates/statistics, driving scenario depiction, and presence of a celebrity were positively associated with theory inclusion. CONCLUSION: Collaboration between health experts and PSA creators could be fostered to produce more theory-based distracted driving videos on YouTube.com.

Determinants of better health: a cross-sectional assessment of positive deviants among women in West Bengal.

BACKGROUND: Rural women in West Bengal have been found to have low rates of formal education, poor health knowledge, high rates of malnutrition and anemia, and low levels of empowerment. Despite these difficult circumstances, some women have positive health outcomes compared to women with similarly disadvantaged backgrounds. The purpose of this study is to identify factors associated with positive health outcomes among women with primary education or less. METHODS: Multivariable regression models were built for outcomes of positive deviance to better characterize the factors in a woman's life that most impact her ability to deviate from the status quo. RESULTS: Positive deviants in this context are shown to be women who are able to earn an income, who have access to information through media sources, and who, despite little schooling, have marginally higher levels of formal education that lead to improved health outcomes. CONCLUSIONS: Study findings indicate that positive deviant women in disadvantaged circumstances can achieve positive outcomes amidst a host of contextual barriers that would predict poor health outcomes. Focusing on areas such as enhancing access to media sources, facilitating self-help groups for married women, and promoting prolonged education and delayed marriage for girls may improve health knowledge and behavior among married women with low levels of education.

Correlates of health-related social media use among adults.

BACKGROUND: Sixty percent of Internet users report using the Internet to look for health information. Social media sites are emerging as a potential source for online health information. However, little is known about how people use social media for such purposes. OBJECTIVES: The purpose of this study was two-fold: (1) to establish the frequency of various types of online health-seeking behaviors, and (2) to identify correlates of 2 health-related online activities, social networking sites (SNS) for health-related activities and consulting online user-generated content for answers about health care providers, health facilities, or medical treatment. METHODS: The study consisted of a telephone survey of 1745 adults who reported going online to look for health-related information. Four subscales were created to measure use of online resources for (1) using SNS for health-related activities; (2) consulting online rankings and reviews of doctors, hospitals or medical facilities, and drugs or medical treatments; (3) posting a review online of doctors, hospitals or medical facilities, and drugs or medical treatments, and (4) posting a comment or question about health or medical issues on various social media. Univariate and multivariate logistic regression analyses were performed. RESULTS: Respondents consulted online rankings or reviews (41.15%), used SNS for health (31.58%), posted reviews (9.9%1), and posted a comment, question, or information (15.19%). Respondents with a chronic disease were nearly twice as likely to consult online rankings (odds ratio [OR] 2.09, 95% CI 1.66-2.63, P<.001). Lower odds of consulting online reviews were associated with less formal education (OR 0.49, 95% CI 0.37-0.65, P<.001) and being male (OR 0.71, 95% CI 0.57-0.87, P<.001). Respondents with higher incomes were 1.5 times as likely to consult online rankings or reviews (OR 1.49, 95% CI 0.10-2.24, P=.05), than respondents with a regular provider (OR 2.05, 95% CI 1.52-2.78, P<.001), or living in an urban/suburban location (OR 1.61, 95% CI 1.17-2.22, P<.001). Older respondents were less likely to use SNS for health-related activities (OR 0.96, 95% CI 0.95-0.97, P<.001), as were males (OR 0.70, 95% CI 0.56-0.87, P<.001), whereas respondents with a regular provider had nearly twice the likelihood of using SNS for health-related activities (OR 1.89, 95% CI 1.43-2.52, P<.001). CONCLUSIONS: People are using social media for seeking health information. However, individuals are more likely to consume information than they are to contribute to the dialog. The inherent value of "social" in social media is not being captured with online health information seeking. People with a regular health care provider, chronic disease, and those in younger age groups are more likely to consult online rankings and reviews and use SNS for health-related activities.