Building Inclusive Excellence: American Academy of Health Behavior Presidential Note

Letter from the American Academy of Health Behavior President, Dr. E. Lisako Jones McKyer

Moving Towards Equity as a Driver of Health Behavior Research

For health behavior researchers, using a health equity lens requires us to more expressly consider multiple contexts in understanding and intervening to improve health-related behaviors and reduce disparities in outcomes. The results of such studies are critical to advancing our knowledge base, and for making meaningful progress toward optimal health and health equity. The selected papers serve as salient examples of how health equity perspectives could and should be integrated into all health behavior research

THE COMPLEXITIES OF CHILDHOOD OBESITY: A QUALITATIVE STUDY AMONG MEXICAN AMERICAN MOTHERS

Introduction: Mothers play an important role in preventing childhood obesity; however, might differ in how they define healthy weight and the associated consequences. Due to the lack of research investigating how Mexican American mothers perceive childhood obesity, the purpose of this paper is to qualitatively assess Mexican-American mothers’ perceptions regarding childhood obesity, its causes and consequences. Methods: Three focus groups, two in Spanish and one in English, were conducted with 23 mothers in Bryan, TX. Thematic analysis was performed by three researchers independently using sentences as the unit of meaning. Findings: Mexican American mothers believed that a child needs to be a healthy weight to be healthy; however, the mothers varied in their methods for determining if their child was at a healthy weight. Mothers identified several underlying causes of childhood obesity including genetics, parenting, household characteristics and culture. Conclusion: Understanding the views of mothers of at-risk of rearing overweight children are important in elucidating effective strategies for preventing childhood obesity. Communication messages for this group might be more effective if they are contextualized within the culture, household and family

African-American fathers’ perspectives on their children’s health education: a qualitative, exploratory study

Purpose: To investigate African-American fathers’ (AAF) perceptions regarding the applicability and need for their involvement as a health connection for their children and describe how participating fathers’ behavior was affected by their attitudes, knowledge, and perceptions of their influence on their children’s health. Methods: This exploratory study gathered data via semi-structured focus groups (n = 3) and thematically analyzed it utilizing a grounded theory approach. Participants included AAF (n = 20) with a mean age of 37 years (SD 11.79), with at least one child between 6 and 18 years old. Results: Four major themes were revealed: (1) appropriate health education for participants’ children (should first and foremost be delivered by parents); (2) participants’ paternal health-related guidance approach (reactive, rather than proactive); (3) participants’ perceived influences on health-related communication with their children (gender roles, efficacy constraints); and (4) paternal definitions of health (most often associated with diet). Conclusion: Understanding AAFs’ perceived and desired role in their children’s health edification can inform initiatives that actively engage these men, and nurture their level of involvement, to promote positive health behaviors among their children; this is necessary to realize their potential to actively improve the health of their children, families, and communities.The open access fee for this work was funded through the Texas A&M University Open Access to Knowledge (OAK) Fund

Perceived barriers to children’s active commuting to school: a systematic review of empirical, methodological and theoretical evidence

Active commuting to school (ACS) may increase children’s daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children’s ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children’s ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child’s ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers’ awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future

Planting the Seed: An Evaluation of a Community Youth Summit

Meaningful youth engagement produces benefits both to youth and to the community in which they live. This paper discusses a day-long youth summit held for 289 middle school students. Youth attended a combination of mass and break-out sessions based on America’s Promise Five Promises. Planners and evaluators assessed proximal student outcomes throughout the day. A two question visual analog scale was developed and utilized to assess students’ perceptions of learning and enjoyment

Planting the Seed: An Evaluation of a Community Youth Summit

Meaningful youth engagement produces benefits both to youth and to the community in which they live. This paper discusses a day-long youth summit held for 289 middle school students. Youth attended a combination of mass and break-out sessions based on America’s Promise Five Promises. Planners and evaluators assessed proximal student outcomes throughout the day. A two question visual analog scale was developed and utilized to assess students’ perceptions of learning and enjoyment

Association Analysis of Reported Attitudes and Culturally Competent Behavior Engagement among Public Health Department Employees

Objective: The purpose of this research is to analyze the association of attitudes and beliefs on engaging in culturally competent behavior. Design: Explorational case study of individuals employed within an urban public health department. Participants: Employees (n=90) from four metropolitan clinical sites of an urban public health department located in the southwest region of the United States were solicited and recruited during a monthly staff meeting. This sample is representative of 84% of the total employees which is comprised of 107 individuals. Main Outcome Measures: The Cultural Competence Assessment is designed to explore individual knowledge, feelings and actions of respondents when interacting with clients in health service environments. The instrument is based on the cultural competence model, and measures cultural awareness and sensitivity; cultural competence behaviors and cultural diversity experience and training. For reporting purposes, participants were divided into subgroups, clinical and non-clinical. This was completed to account for the variation in respondents’ level of education, type of client/patient interaction and opportunities for professional development engagement. Results: Respondents with increased levels of knowledge possessed attitudes which encompass dignity and respect of minority groups, potentially improving clinical interactions. African Americans and Hispanic/Latinos within the non-clinical subgroup displayed more culturally sensitive attitudes compared to their clinical peers within the same race/ethnicity classification. Non-clinical workers with Associate and Bachelors degrees displayed more culturally sensitive attitudes than their clinical counterparts. Clinical staff with graduate or professional degrees scored higher in the culturally sensitive attitudes analysis than non-clinical peers. Conclusions: Knowledgeable individuals have the necessary foundation to develop beliefs and attitudes conducive to creating an effective clinical encounter. Educational programs must include components which increase participant awareness of diversity. In addition, training should encompass lessons to foster self-reflection of one’s own bias and beliefs, and its effect on how workers provide health services

Diet Quality as a Mediator of the Relation between Income-to-Poverty Ratio and Overweight/Obesity among Adults: Moderating Effect of Sex

Poverty status influences obesity and dietary quality, and dietary quality influences obesity. How these relationships differ by sex is unclear. The current study aims were to 1) determine whether dietary quality mediates the relation between income-to-poverty ratio (IPR) and overweight/obesity (OV/OB) among men and women, separately, and 2) determine whether either of the mediated paths differs by sex. Four cycles of NHANES (2007-2014) were merged to obtain an unweighted study sample of 12,768 adults with complete data. Exposure variables included self-reported measures of IPR, Healthy Eating index (HEI) total score to measure diet quality, and sex. Direct assessment of height and weight was used to create OV/OB vs. normal weight categories of interest. A multiple-group moderated mediation model was conducted to evaluate the moderating effect of sex on the association between IPR and OV/OB through HEI. Covariates included age, race, marital status, education, employment, meeting physical activity recommendations, and daily sedentary time. A greater proportion of females experienced OV/OB, lower IPR, and higher HEI. The association between IPR and HEI did not differ by sex. Greater IPR was associated with lower odds of experiencing OV/OB for women and higher odds of experiencing OV/OB among men. For both males and females, HEI partially mediated the relationship between IPR and OV/OB (p \u3c .05). While efforts to improve dietary quality of all adults regardless of income and sex is needed, improving the dietary quality of higher income men may assist with reducing their experiences with OV/OB

Diet Quality as a Mediator of the Relation between Income-to- Poverty Ratio and Overweight/Obesity among Adults: Moderating Effect of Sex

Poverty status influences obesity and dietary quality, and dietary quality influences obesity. How these relationships differ by sex is unclear. The current study aims were to 1) determine whether dietary quality mediates the relation between income-to-poverty ratio (IPR) and overweight/obesity (OV/OB) among men and women, separately, and 2) determine whether either of the mediated paths differs by sex. Four cycles of NHANES (2007-2014) were merged to obtain an unweighted study sample of 12,768 adults with complete data. Exposure variables included self-reported measures of IPR, Healthy Eating index (HEI) total score to measure diet quality, and sex. Direct assessment of height and weight was used to create OV/OB vs. normal weight categories of interest. A multiple-group moderated mediation model was conducted to evaluate the moderating effect of sex on the association between IPR and OV/OB through HEI. Covariates included age, race, marital status, education, employment, meeting physical activity recommendations, and daily sedentary time. A greater proportion of females experienced OV/OB, lower IPR, and higher HEI. The association between IPR and HEI did not differ by sex. Greater IPR was associated with lower odds of experiencing OV/OB for women and higher odds of experiencing OV/OB among men. For both males and females, HEI partially mediated the relationship between IPR and OV/OB (p \u3c .05). While efforts to improve dietary quality of all adults regardless of income and sex is needed, improving the dietary quality of higher income men may assist with reducing their experiences with OV/OB