Alliance for a Healthier Generation's Competitive Beverage and Food Guidelines: Do Elementary School Administrators Know About Them and Do They Report Implementing Them?

BACKGROUND: The availability of competitive foods in schools is a modifiable factor in efforts to prevent childhood obesity. The Alliance for a Healthier Generation launched the Healthy Schools Program in 2006 to encourage schools to create healthier food environments, including the adoption of nutritional guidelines for competitive beverages and foods. This study examines nationwide awareness and implementation of the guidelines in US public elementary schools. METHODS: Data were collected from a nationally representative sample of elementary schools using mail-back surveys in 2006-2007, 2007-2008, 2008-2009, and 2009-2010. RESULTS: From 2006-2007 to 2009-2010, awareness of the Alliance's beverage guidelines increased from 35.0% to 51.8% among school administrators (p < .01); awareness of the food guidelines increased from 29.4% to 40.2% (p < .01). By 2009-2010, almost one third of the schools that sold competitive beverages and foods reported having implemented or being in the process of implementing the guidelines. Implementation was higher among schools from Southern states. Schools with a majority of Black or Latino students were less likely to implement the guidelines. CONCLUSIONS: Awareness and implementation of the Alliance's beverage and food guidelines has significantly increased since the 2006-2007 school year, indicating successful diffusion of the guidelines. However, many administrators at schools who sold competitive products were not aware of the guidelines, indicating a need for continued efforts. In addition, lower implementation among schools serving minority students suggests that the Alliance's targeted efforts to provide intensive technical assistance to such schools is warranted and necessary.     

Health-Care Systems and Ethics: What Can We Learn?

Health care systems in different countries and cultures differ and tend toreflect the particular values and, therefore, the particular socialstructure of a given society. Each of these has ethical problems unique toitself. Some of these problems are briefly discussed. So as to have anindividual ethical problem in the context of medical care, access tomedical care needs to be assured. It is argued that individual problems arethe primary issue in societies in which there is fair access whereas theyare of lesser importance in societies which have thus far failed toprovide fair access.     

Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?

Objectives. We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs).Methods. We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization.Results. The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment.Conclusions. Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.Community health workers (CHWs) play a critical role in primary health care delivery, particularly in low- and middle-income countries (LMICs). Also known in some contexts as village health workers, community health promoters, lay health workers, or promotores, CHWs provide basic public health services and medical care and are typically members of the communities in which they work.1,2 Activities of CHWs may include educating community members about health risks, promoting healthy behaviors, or linking community members with providers at formal health care facilities. Community health workers can range from volunteers working without material compensation to paid employees of a country’s public health system; in some cases, even when CHWs do not receive a salary, they may receive other material benefits such as periodic training stipends, financial incentives, or preferential access to health care or microcredit.1,2 Community health workers lack a professional health care certification, which distinguishes them from other health care providers such as doctors or nurses.3 Because of their ability to reach community members at relatively low cost, CHWs have been proposed and deployed as a means for achieving a wide range of disease prevention and health system strengthening objectives.4,5The positive impact of CHWs on disease prevention, healthy behavior adoption, and access to care has been documented in diverse contexts.2,3,6 In LMICs, CHWs have been found to be effective in reducing neonatal mortality,7 child mortality attributable to pneumonia,8 and mortality caused by malaria.9,10 In addition, CHWs have been successful in promoting improved health behaviors including exclusive breastfeeding,11 adherence to HIV antiretroviral therapy and counseling,5,12 childhood immunization,3 early prenatal care usage,13 and tuberculosis treatment completion.14 They have also been a central component in the implementation of Integrated Management of Childhood Illness strategies, which have succeeded in reducing child mortality in multiple LMICs.1,15Despite the substantial evidence about the positive impact of CHWs as a model of care, less is known about effective approaches to scaling up and sustaining CHW programs. One challenge in synthesizing this evidence is the absence of explicit definitions for scale-up and sustainability in the empirical literature about CHW programs. Previous definitions of health program scale-up have focused on either the process of a program expanding from a smaller to a larger implementation arena or the state of a program being implemented in a widespread manner.16,17 Sustainability of health programs has been defined in previous literature as “the continued use of program components and activities for the continued achievement of desirable program and population outcomes,”^18(p2060) and it has been measured in diverse ways such as a program’s duration, the resources required to enable the program to survive, or the duration of the program’s benefits.19–22 A related challenge is one of comparability across CHW programs and countries; a program considered large-scale and sustained in one country might be viewed as small-scale or short-term in another setting. Therefore, we sought to develop criteria for identifying cases of scale-up, sustainability, and success of CHW programs and to apply these criteria in a systematic review of the existing empirical literature on scaling up and sustaining the CHW model in LMICs to extract key enabling factors for success. This information can provide useful guidance to policymakers, practitioners, and researchers seeking to promote CHW models of primary care more broadly.     

Community Severance and Health: What Do We Actually Know?

Community severance occurs where road traffic (speed or volume) inhibits access to goods, services, or people. Appleyard and Lintell’s seminal study of residents of three urban streets in San Francisco found an inverse relationship between traffic and social contacts. The extent of social networks predicts unhealthy behaviors, poor health, and mortality; high rather than low social integration is associated with reduced mortality, with an effect size of similar magnitude to stopping smoking. Although community severance diminishes social contacts, the implications of community severance for morbidity and mortality have not been empirically established. Based on a systematic literature search, we discuss what is actually known about community severance. There is empirical evidence that traffic speed and volume reduces physical activity, social contacts, children’s play, and access to goods and services. However, no studies have investigated mental or physical health outcomes in relation to community severance. While not designed specifically to do so, recent developments in road design may also ameliorate community severance.     

Pre-Screening Age African-American Males: What Do They Know About Prostate Cancer Screening,Knowledge, and Risk Perceptions?

Prostate cancer is the most commonly diagnosed cancer among men and the second most common cause of cancer mortality among men in America. African-American men have a mortality rate from prostate cancer twice that of Caucasian men. Although prostate screening remains controversial, it provides an opportunity for the cancer to be detected early when treatment is most effective. Limited research has been conducted regarding prostate cancer awareness and knowledge among African-American men under 50. This article highlights a pilot study assessing the knowledge, attitudes, risk perceptions, and reasons for participating in prostate cancer screening among African-American males between the ages of 30–45. Study findings suggest these participants recognized an awareness of risk factors associated with the disease, yet underestimated their risk of developing the disease. Additionally they present uneven knowledge of the prostate and its function and possess positive perceptions of their general health beliefs and practices. Practice implications and directions for future research regarding prostate cancer among this population are highlighted.     

Nutrition Facts Panels: Who Uses Them,What Do They Use,and How Does Use Relate to Dietary Intake?

Background

Nutrition labels are a low-cost tool with the potential to encourage healthy eating habits.

8 Minutes and 46 Seconds Changed Everything—What are We Doing About It?

The Journal of Behavioral Health Services & Research -     

Vitamin D and Temporomandibular Disorders: What Do We Know So Far?

Background and aims. Vitamin D is synthesized in the skin with the aid of ultraviolet-B radiation, playing a variety of roles in the body. Temporomandibular disorders (TMDs) are a group of pathological conditions involving the temporomandibular joints as well as the masticatory muscles and othersurrounding tissues. In the present narrative review, we investigated the potential role of vitamin D in the etiology of temporomandibular disorders in order todetermine whether the current knowledge supports 25-hidroxyvitamin D (25-OHD) supplementation in temporomandibular disorders associated with insufficient or deficient levels of vitamin D. Methods. A literature research was performed in PubMed, Scopus, Science Direct, and Google Scholar databases, and a total of 10 articles were included for analysis. Results.Among the observational studies published to date, investigating the role for vitamin D in the etiology of TMDs, six of them suggest that there is a connection between the two aspects. In this context, patients suffering from TMD, with deficient levels of vitamin D (<30 ng/mL), are most likely to benefit from supplementation, whereas individuals with vitamin D level >50ng/mL probably have little benefit from supplementation.Conclusion.Vitamin D might be a safe, simple, and potentially beneficial way to prevent TMDs or to reduce pain; however, more randomized and placebo-controlled trials are required before any firm conclusions can be drawn.     

Talking About Antismoking Campaigns: What Do Smokers Talk About,and How Does Talk Influence Campaign Effectiveness?

Campaign-stimulated conversations have been shown to increase the effectiveness of antismoking campaigns. In order to explore why such effects occur, in the current study we coded the content of naturally occurring conversations. We also examined whether the short-term effects of talking, and of different types of talk, on quitting intentions were mediated through intrapersonal message responses. Using the Natural Exposure^SM methodology, we exposed 411 smokers to 1 of 6 antismoking advertisements while they were watching television at home. Responses to the advertisement—conversation participation and content, emotional responses, personalized perceived effectiveness, and changes in intentions to quit—were measured within 3 days of exposure. Conversations were coded for appraisal of the advertisement (favorable, neutral, or unfavorable) and the presence of quitting talk and emotion talk. Mediation analyses indicated that the positive effects of talking on intention change were mediated through personalized perceived effectiveness and that the positive effects were driven by conversations that contained a favorable appraisal and/or quitting talk. Conversely, conversations that contained an unfavorable appraisal of the advertisement were negatively associated with campaign effectiveness. These findings highlight the importance of measuring interpersonal communication when evaluating campaigns and the need for further research to identify the message characteristics that predict when smokers talk and when they talk only in desirable ways.     

Who Are the Medical Travelers and What Do They Want?: A Qualitative Study

The ongoing debate on U.S. healthcare reform fueled by increasing cost and poor access to quality healthcare is spurring interest in medical travel. The topic of medical travel—going abroad to seek medical care—has been widely reported in various news outlets. This issue even resulted in a Senate Hearing before the Special Committee on Aging. Despite this popularity, very little empirical research has been conducted to describe and understand medical travelers. To fill this gap, the present study involves in-depth interviews of medical travel facilitators with extensive exposure to and communication with medical travelers. This article has multiple objectives. It aims to develop a demographic and psychographic profile of medical travelers and identify their underlying motives to seek medical care overseas. Based on these insights, it presents a list of propositions to be tested in further research. Finally, it offers practical implications for the healthcare industry.