May/June 2017



AJHE: American Journal of Health Education

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  May/June 2017 (Volume 48, Issue 3)

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Table of Contents


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Lost in the Health Care Reform Discussion: Health Care as a Right or Privilege
Thomas W. O’Rourke

Health care has been an ongoing issue of public concern for decades, well before President Obama took office. Passage of the Affordable Care Act (ACA), also known as Obamacare, in March 2010 and upheld by a Supreme Court in June 2012 focused increased attention on issues such as access and cost. Though current attention is devoted to the repeal and replacement of the ACA, lost in the discussion is the more important and basic question of whether health care is a right or a privilege. Simple question, yes. Easy to answer, less so.

Dance for Your Health: Exploring Social Latin Dancing for Community Health Promotion
Joseph E. Iuliano, Karen Lutrick, Paula Maez, Erika Nacim, and Kerstin Reinschmidt

The goal of Dance for Your Health was to explore the relationship between social Latin dance and health as described by members of the Tucson social Latin dance community. Social Latin dance was selected because of the variety of dances, cultural relevance and popularity in Tucson, and the low-key, relaxed atmosphere. Dance has been prescribed to help manage diseases such as Parkinson’s; however, not much is known about the use of dance for health promotion. Through qualitative methodologies, the project focused on the role dance can play in health promotion and in creating community connections. The project explored personal stories and experiences on the broader impact of health, the meaning of community from the social Latin dancer’s point of view, thoughts on how social Latin dancing could be applied to help people in the community live healthier lives, and how to demystify social Latin dancing for people who are not currently dancing.

Feature Articles

Understanding the Need for Obesity Prevention Counseling among Homeless Patients
Tasha Peart and MaryLou de Leon Siantz

Though many studies have examined the level of physician obesity prevention counseling among the general population, little is known about how homeless patients are advised about healthy eating and physical activity by their health care provider. The homeless are an at-risk population with whom physicians and other health professionals can play a vital role in helping them to be healthy by means of Health Education and involvement in policy development and advocacy. The purpose of this feature article is to review previous work conducted with the homeless that assesses their risk for obesity and other chronic diseases due to limited access to health care, as well as system-level barriers that lead to poor dietary and physical activity behaviors. The article then discusses the need for physician counseling among this population while integrating a socioecological framework and working across multiple systems when counseling homeless populations on nutrition and physical activity topics.

How Research Influences Policy: The Evidence We Need to “speak truth to power”—A Reflection on an AAHE Scholar Address Three Decades on
Lawrence W. Green

Thirty years after expressing concerns about the translation and communication of science to the public and to policy makers, this reflection finds that the same issues face public health education perhaps even more urgently today with the advent of politicians who actively dispute science, and a public that has voted in support of their campaign promises to repeal and replace laws that provided health care and protection from global warming.

Research Articles

Barriers and Facilitators to Adoption of a Lay-Delivered Community-Based Strength Training Program for Women in Rural Areas
Lisa T. Washburn, Carol E. Cornell, LaVona Traywick, Holly C. Felix, and Martha E. Phillips

Limited access to fitness programs for rural older adults make lay or volunteer delivery approaches potentially desirable to extend reach. However, factors affecting adoption of such approaches are not well explored.
Purpose: This study sought to identify barriers and facilitators affecting adoption of a volunteer lay delivery approach for the community-based StrongWomen strength training program conducted through rural county Extension offices.
Methods: Educators implementing the program, identified as adopters (n = 6) and nonadopters (n = 13) of the lay delivery approach, participated in semistructured interviews, which were recorded, transcribed, and coded. The socialecological model (SEM) as an organizing framework revealed barriers and facilitators at the intrapersonal, interpersonal, institutional, and community levels.
Results: Barriers included lack of appropriate facilities, limited time, passive leader recruitment approaches, volunteer training proximity, and perceived lack of confidence among potential volunteers. Retired or part-time employment status, education level, comfort in leadership positions, communication of need for volunteers, and active recruitment approach were facilitators.
Discussion: Barriers and facilitators can be attributed to differences in educator approaches, participant characteristics, and institutional and community factors.
Translation to Health Education Practice: Identification of modifiable factors promoting or inhibiting adoption of lay-led approaches may assist others seeking to implement similar delivery strategies to extend reach.

Marijuana and College Students: A Critical Review of the Literature
Alexis A. Blavos, Tavis J. Glassman, Jiunn-Jye Sheu, Amy Thompson, Faith DeNardo, and Aaron J. Diehr

Marijuana represents the most widely used illicit drug on college campuses. Repeated use can impair students’ academic, emotional, and physical success and can lead to chronic diseases.
Purpose: The purpose of this study was to evaluate existing literature on the associated effects of marijuana use on U.S. college students’ academic success, including conduct/legal issues, negative outcomes, normative perceptions, and physical/mental health.
Methods: A critical review was conducted in January 2015 using the PubMed, Academic Search Complete, Electronic Journal Center, ProQuest, and Google Scholar databases. Studies were included if they focused on epidemiological outcomes of marijuana use on U.S. undergraduate college students aged 17–24.
Results: Overall, studies lacked scientific rigor. In several studies, researchers relied on convenience samples, used small sample sizes, did not report response rates, or did not report the psychometrics of the instrument. The majority of the studies were conducted at single institutions, limiting external validity.
Conclusion: More rigorous and methodically sound research is necessary. Specifically, researchers should employ randomized sampling methods, collect representative response rates, and assess reliability and validity appropriately.
Translation to Health Education Practice: Practitioners should design, implement, and evaluate programs that focus on social norms, acute and chronic health issues, and academic outcomes.

A Systematic Review of Culturally Tailored Obesity Interventions among African American Adults
Wanda Martin Burton, Ashley N. White, and Adam P. Knowlden

African Americans have the highest age-adjusted rates of obesity at 48.1%. High rates of obesity contribute to the disproportionate share of chronic health conditions. In order to reduce these high rates and achieve health equity, intervention programs must address racial health disparities in culturally meaningful ways.
Purpose: The purpose of this investigation was to systematically review culturally tailored interventions conducted between 2005 and 2015 aimed at reducing obesity among African American adults.
Methods: Several databases were used with search terms “African American adults,” obesity,” and “intervention.” Inclusion and exclusion criteria were used.
Results: Several databases were used with search terms “African American adults,” obesity,” and “intervention.” Inclusion and exclusion criteria were used.
Discussion: The interventions focused on individual-level change and most included a primarily female sample. Faith-based settings appear to be an ideal setting. Given the small amount of studies conducted over the past decade, there is a need for more interventions that use culturally appropriate strategies.
Translation to Health Education: Sociocultural and constituent-involving strategies appear to allow meaningful interaction with communities and may help with the high attrition rate. Age and gender should be a focus, in addition to race, when planning interventions.

Associations between the Physical, Sociocultural, and Safety Environments and Active Transportation to School
Allison Ross, Ariel Rodríguez, and Mark Searle

Understanding why youth actively transport to school (ATS) has important health, programming, and policy implications. A growing body of research has revealed that there are common factors that influence this behavior. Collectively, these influences can be categorized into 3 domains: the physical environment (PE), sociocultural environment (SCE), and safety environment (SE).
Purpose: Although researchers largely agree that these constructs affect ATS, it is not clearly understood how they may interact and to what degree they may influence ATS behavior.
Methods: A logistic regression analysis was performed to determine the influence of PE, SCE, and SE on the odds of walking or biking to school.
Results: Both PE and SCE were directly associated with active travel, and the SE had an indirect effect.
Discussion: A combination of elements from the PE and SCE significantly impacted the odds of using ATS. The impact of SE was significant enough to alter the direct influence of factors within both PE and SCE on the decision to walk or bike.
Translation to Health Education Practice: Findings suggest that programming efforts and research should focus on perceptions of safety as a link to overcoming commonly cited barriers.