In Briefs

Paul E. Terry	8	Editorial Ken the Movie: Allyship and when KENough is not enough This editorial reviews Barbie the Movie in the context of workplace and community health and well-being. Issues of gender equity, patriarchy, and the role of women in empowering women were all factors that were dealt with thoughtfully and poignantly in the movie’s script. A missed opportunity in the movie related to the role men could play as allies in the gender equity movement. Hence, I set out to reconcile this omission by proposing a story line for Ken the Movie. I present gender and health disparities as problems that will require leadership in, and best thinking about, gender equality from both men and women.
the Science of individual and collective Well-Being
Lauren Alexandra Pettitt, Raaj Kishore Biswas, and Jahar Bhowmik	12	Quantitative Research Women’s Attitudes Toward Intimate Partner Violence in Low- and Middle-Income Countries of Southern Asia Purpose: The present study identified the vulnerable IPV cohorts of South Asian women, and the prevalence of and predictors of the women’s IPV acceptance. Design: Cross-sectional survey - the United Nations Children’s Fund multiple index cluster survey. Setting: Many South Asian women are accepting of IPV. Studies mostly focus on individual countries. Subject: 103 139 ever-married women from Bangladesh, Laos and Nepal. Measures: Women’s attitudes toward IPV were measured using a set of five, fixed, binary responses. Analysis: Following bivariate analysis, complex survey weight adjusted logistic regression models were fitted for individual country data, and the pooled sample. Results: Of the sampled South Asian women 27.8% accepted IPV, and no major variation among countries in IPV acceptance. Education was the most reliable protector against IPV acceptance whereby, higher educational attainment systematically reduced IPV acceptance (OR = .61 [.56-.83]). Other significant protective factors were being un-married (Married OR =1.34 [1.28-1.42]), having increased wealth (OR = .71 [.56-.83]), and being over 24 years old (OR = .88 [.83-.97]). Conclusion: Only education produced absolute consistency at the country and region level; there seems to be no blanket solution for regionally reducing women’s IPV acceptance rates in Southern Asia. Focus on the least educated women and making education more accessible should be prioritised. Future IPV studies can consider measurement methods for women’s direct exposure to patriarchal standards and within community interaction.
Alyssa Lozano, Elliott R. Weinstein, Alejandra Fernandez, Sierra Bainter, Pranusha Atuluru, Abigail Hurtado, Vanessa Morales, Guillermo Prado, Steve A. Safren, and Audrey Harkness	19	Quantitative Research Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men Purpose: The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). Design: Cross-sectional measure validation. Setting: Participants from Miami, FL. Subjects: 290 LSMM from the D´IMELO study. Measures: Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. Analysis: All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. Results: Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. Conclusion: Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM.
Asos Mahmood, Hyunmin Kim, Cyril F. Chang, Satish Kedia, Hassan Arshad, and Patrick J. Dillon	40	Quantitative Research mHealth Apps Use and Their Associations With Healthcare Decision-Making and Health Communication Among Informal Caregivers: Evidence From the National Cancer Institute’s Health Information National Trends Survey Purpose: The current study investigates associations between mHealth apps and healthcare decision-making and health communication among informal caregivers in the US. Design: Cross-sectional study employing secondary data. Setting: The Health Information National Trends Survey (HINTS5, Cycles 2 through 4, 2018 – 2020). Sample: Self-identified informal caregivers (n = 1386; had mHealth apps = 61.3%, female = 63.2%, some college or more in education = 80.3%) who reported owning at least a smartphone or a tablet computer (i.e., ownership of a “smart device”). Measures: Sociodemographic characteristics, reports of having mHealth apps, smart device utilization in healthcare decisionmaking and health communication. Analysis: Accounting for the complex design features of the HINTS data, we constructed multiple hierarchical logistic regressions to compute adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Compared to caregivers without mHealth apps, those with the apps had higher odds of utilizing their smart devices to make a health-related decision, such as how to treat a disease or a medical condition (aOR = 1.65; 95% CI: 1.13-2.39, P < .01), or engage in health-related discussions with a healthcare provider (aOR = 2.36; 95% CI: 1.54-3.61, P < .001). Conclusion: Having mHealth apps was associated with a higher likelihood of using smart devices in healthcare decision-making and health communication by informal caregivers. Empowering caregivers to make informed health-related decisions and communicate effectively with healthcare providers are both crucial to health promotion and well-being. Future studies should investigate facilitators as well as barriers to using mHealth apps and smart devices in health-promoting strategies involving informal caregivers.
Krista Pattison, Erik Lehman, Alissa Molinari, Heather Costigan, Francesca Pileggi, Heather Stuckey, and Deepa Sekhar	53	Quantitative Research Evaluating the Impact of Aevidum on Mental Health Knowledge, Attitudes, and Help-Seeking Behaviors in High School Students: A Mixed-Methods Study Purpose: To compare Aevidum’s school mental health curriculum vs the curriculum plus Aevidum clubs in a mixed-methods study including pre/post surveys, a randomized clinical trial, and qualitative interviews. Design: Concurrent mixed-methods: Aim 1) pre-post surveys evaluated curriculum only vs curriculum plus club schools separately regarding changes in knowledge, help-seeking, and school culture; Aim 2) randomized clinical trial compared curriculum only to curriculum plus club schools; Aim 3) qualitative school staff interviews enhanced understanding of school culture changes. Setting: Curriculum delivered to 9th graders at ten Pennsylvania high schools; 5 schools randomized to start clubs. Subjects: Students (surveys), staff (interviews). Intervention: Aevidum curriculum plus/minus club. Measures: Aim 1, mixed effects linear and logistic regression models for longitudinal data were used to analyze survey items at each time point. Aim 2, the same regression models were used, except models included a fixed-effect for group and group by time interaction effect. Aim 3, interviews were transcribed; a codebook was developed followed by thematic analysis. Results: Pre-survey 2557 respondents; 49% female, 86% non-Hispanic white. Post-survey 737 (29% response rate). Aim 1, prepost (Likert responses, larger numbers favorable) demonstrated increased student knowledge to identify depression (4.26 [4.19-4.33] to 4.59 [4.47-4.71], P < .001) and help a friend access support (4.30 [4.21-4.38] to 4.56 [4.40-4.71], P = .001). Help-seeking increased for phone helplines (1.61 [1.57-1.66] to 1.78 [1.70-1.86], P < .001), crisis textlines (1.60 [1.55-1.64] to 1.78 [1.70-1.86], P < .001), internet/websites (1.80 [1.75-1.85] to 1.99 [1.90-2.08], P < .001), school counselors (P = .005) and teachers (.013). Aim 2, no significant differences in knowledge, help-seeking or culture between curriculum only vs curriculum plus club schools. Aim 3, staff (n = 17) interviews supported reduced stigma and increased mental health referrals. Conclusions: Aevidum’s curriculum improved mental health knowledge and help-seeking; adding the club did not significantly change responses. Staff identified positive school culture impacts. Limitations include the lower post-survey response.
Rainier Masa, Sylvia Shangani, Dicky Baruah, and Don Operario	68	Quantitative Research The Association of Food Insecurity, Mental Health, and Healthcare Access and Use among Lesbian, Gay, and Bisexual Adults in the United States: Results from the 2021 National Health Interview Survey Purpose: We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting: We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample: The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. Measures: Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis: Descriptive statistics and linear and generalized linear regressions. Results: The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). Conclusion: Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food.
Natalicio Serrano, Laurel Schmidt, Amy Eyler, and Ross C. Brownson	80	Qualitative Research Perspectives from public health practitioners and advocates on community development for active living: What are the lasting impacts? Purpose: Evidence suggests differential impacts of community development, including gentrification and displacement. Public health practitioners and advocates are key stakeholders involved in the community development process related to active living, yet little is known about their perceptions of its impacts. We explored the perspectives of relevant leaders of public health departments and key community and advocacy organizations on community development, gentrification, and displacement. Approach: Purposive key informant interviews. Setting: CDC State Physical Activity and Nutrition (SPAN) funding recipients. Participants: CDC SPAN recipient leadership (n = 10 of 16) and advocacy organizations they partnered with (n = 7 of 16). Method: Interviews were recorded, transcribed, coded, and thematically analyzed with direct quotes representing key themes. Results: Both groups felt community development held important benefits, specifically by creating healthy living opportunities, but also potentially leading to the displacement of long-time residents. Practitioners reported the benefits were for all community members, whereas advocates noted the benefits were seen in those with privilege, and the consequences were disproportionately seen in disadvantaged communities. Both mentioned the importance and difficulty of getting diverse representation for community engagement. Conclusions: Learning how key stakeholders perceive and navigate the community development process can help inform recommendations for better equity in active living community improvements. More work is needed to further elucidate best practices for health and social equity in the community development process.
Yuae Park, Jennifer King, Molly M. Eggleston, and Thistle I. Elias	90	Qualitative Research Critical lessons in tailoring interventions: Listening to WISEWOMAN participants Purpose: To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. Approach: Researchers conducted this 2 year qualitative data collection as one component of a broader, 5 year PA-WISE process and outcome evaluation. Setting: Women from across Pennsylvania, primarily from rural communities. Participants: Interviewees were low-income, un-/under-insured women aged 40-64 years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). Methods – data collection and analysis: Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4 time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. Results: Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. Conclusion: The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond.
Kesia Karina Garibay, Nancy Burke, A Susana Susana Ramírez, and Denise Diaz Payán	101	Qualitative Research Examining the role and strategies of advocacy coalitions in California's statewide sugar-sweetened beverage tax debate (2001-2018) Purpose: California’s failed attempts to enact a statewide sugary beverage tax presents an opportunity to advance understanding of advocacy coalition behavior. We investigate the participation of advocacy coalitions in California’s statewide sugarsweetened beverage (SSB) tax policy debate. Design: Document analysis of legislative bills and newspaper articles collected in 2019. Setting: California. Method: A total of 11 SSB tax-related bills were introduced in California’s legislature between 2001-2018 according to the state’s legislative website. Data sources include legislative bill documents (n = 94) and newspaper articles (n = 138). Guided by the Advocacy Coalition Framework (ACF), we identify advocacy coalitions involved in California’s SSB tax debate and explore strategies and arguments used to advance each coalitions’ position. Results: Two coalitions (public health, food/beverage industry) were involved in California’s statewide SSB tax policy debate. The public health coalition had higher member participation and referred to scientific research evidence while the industry coalition used preemption and financial resources as primary advocacy strategies. The public health coalition frequently presented messaging on the health consequences and financial benefits of SSB taxes. The industry coalition responded by focusing on the potential negative economic impact of a tax. Conclusion: Multiple attempts to enact a statewide SSB tax in California have failed. Our findings add insight into the challenges of enacting an SSB tax considering industry interference. Results can inform future efforts to pass evidence-based nutrition policies.
Nathan T. West, Brook E. Harmon, Talsi Case, Madelyn Huey, Benjamin L. Webb, John Nelson, Karen H. Webster, Travis A. Webster, and Charolette H. Leach	112	Literature Review A scoping review of self-care within the context of obesity-related outcomes among faith leaders Objective: Faith leaders often serve as health-related role models yet many struggle with obesity and self-care engagement. The purpose of this scoping review was to examine how the faith leader literature has defined self-care and examined obesity and obesity-related chronic disease. Data Source: Studies were identified through database (eg, PubMed, CINAHL, PsycINFO), backward, and grey literature (eg, dissertations) searches. Inclusion/Exclusion Criteria: Studies published in English with participants who were 18 years or older and examined leaders across all faiths. Studies also included an examination of self-care behaviors among faith leaders within the context of obesity or obesity-related chronic diseases. Data Extraction/Synthesis: Data synthesis was qualitative and informed by the six-step framework developed by Arksey and O’Malley (2005) as well as updated recommendations by Daudt et al (2013). Of the 418 studies identified and screened, 20 met the eligibility criteria. Results: Studies were primarily cross-sectional and participants Christian faith-leaders in the US. Most studies did not define self-care or incorporate theory, but focused on vegetarian diets and physical activity engagement. Other self-care related behaviors (eg, sleep, days off), some unique to faith leaders (eg, sabbatical), were included but not systematically. Conclusions: Research with more diverse faith leaders and that uses theory is needed to guide development of strategies for engaging this population in self-care to reduce obesity and related chronic diseases.
Knowing Well, Being Well
Jay E. Maddock and Sara S. Johnson	KWBW(124)	Spending Time in Nature: The Overlooked Health Behavior Nature has long played a role in medicine. There has been a resurgence of interest among health promotion practitioners and researchers in the positive impact of spending time in nature, due in part to its numerous benefits for health, well-being, and workplace performance. While efforts are needed to formalize the operational definition and minimum “dose” of time in nature, a consensus around its fundamental role in our lives has emerged.
Matthew H. E. M. Browning, Jared R. Hanley, Christopher R. Bailey, Timothy Beatley, Samantha Gailey, J. Aaron Hipp, Lincoln R. Larson, Peter James, Viniece Jennings, Marcia Pescador Jimenez, Peter H. Kahn, Jr., Dongying Li, Aaron Reuben, Alessandro Rigolon, Naomi A. Sachs, Amber L. Pearson, and Christopher T Minson	KWBW(126)	Quantifying Nature: Introducing NatureScore TM and NatureDose TM as Health Analysis and Promotion Tools This article introduces NatureDose TM , an app that uses smartphone sensors and the NatureScore TM dataset to monitor a person's exposure to nature. We discuss the uses of these technologies to better understand and leverage the benefits of nature for health promotion by researchers, clinicians, and policymakers. We also discuss the limitations and future directions of these technologies. We anticipate that these technologies and similar efforts will chart a path toward a healthier, more nature-rich future.
Jennifer D. Roberts	KWBW(135)	The ‘Natural’ Accord of Dubois and Washington: An Environmentally Radicalized Consciousness The conflict and discord between Booker T. Washington and W.E.B DuBois regarding their premise and approach to racial uplift for Black Americans have been very well documented. While Washington sought equality with accommodation, DuBois functioned through agitation. However, their biophilic accord and unity within the natural environment have been both underrecognized and underappreciated. As an honor to these esteemed racial and social justice giants, this special issue article reveals the universality of their environmental justice ideologies while also celebrating the beauty, power and foresight of their ecological language in script and speech.
Stacy Beller Stryer	KWBW(140)	Using Nature Prescriptions to Reconnect People with the Outdoors and Improve Health and Well Being In recent years, the prevalence of physical and mental health conditions has increased significantly while the amount of time spent in nature has decreased. Many studies have demonstrated that spending time outdoors improves not only health conditions but also social connectedness. Park Rx America, a non-profit organization whose goal is to make outdoor time a daily routine for all, educates health professionals and the public on the benefits of nature for health, provides a no-cost platform to issue nature prescriptions, and works with other groups to develop nature prescription programs in their communities.
Robert Swoap	KWBW(143)	Psychedelic Healing: A Historical, Empirical, and Personal Account This paper examines two psychedelic medicines (psilocybin and ketamine) used as a part of an evidence-based treatment strategy for psychological wellness and healing. The paper includes a report on a current study in which the author served as both external researcher and participant-observer. The paper concludes by examining the interaction between psychedelics, nature, and healing.