November/December 2017



AJHE: American Journal of Health Education

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  November/December 2017 (Volume 48, Issue 6)

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Table of Contents

Free Access Article
/Does an effective theoretically based weight loss treatment for middle-aged women work for young women?
 – Ping H. Johnson & James J. Annesi

Background: Young adults gain weight faster and suffer from chronic diseases at a younger age than their older counterparts. Existing behavioral obesity treatments included few young adults, and their effects on young adults remain unknown.
Purpose: The purpose of this study was to explore whether a behavioral treatment that was effective in weight loss for mostly middle-aged women would be effective for young women.
Methods: One hundred eleven female undergraduates with obesity recruited from a large public university in the Southeastern United States in 2014–2016 received treatment, including 6 individual exercise support sessions over 6 months and 20 biweekly group nutrition sessions. Measurements include weight, waist circumference, physical activity, diet, mood, and exercise- and eating-related self-regulation and self-efficacy at baseline and at months 3 and 6.
Results: Attrition was 65.8% at month 3 and 87.4% at month 6. Paired t tests show significant reductions in weight and significant improvements in weight loss–related behaviors and psychological variables at month 3. More average weight was lost at month 6.
Discussion: Despite high attrition, the treatment demonstrated some positive effects for the young college women who continued attending sessions.
Translation to Health Education Practice: Health Educators should explore reasons for attrition among college students with obesity and develop treatment components to help them lose excess weight.

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A Theoretical Analysis of Health Beliefs of Physical Activity among Women with Previous Gestational Diabetes- A Commentary
Brook T. Alemu, Robert J. Cramer, Kristy L. Carlisle, & Muge Akpinar-Elci
The average annual prevalence rate of gestational diabetes mellitus (GDM) in the United States is 9.2%. This means that about 135 000–200 000 women annually develop GDM, adding to the number of pregnant women already suffering from either type 1 or type 2 diabetes. Additionally, women with previous history of GDM have more than 7-fold increased risk of developing type 2 diabetes in the next 5 to 10 years, and the prevalence may be higher depending on race. This commentary touches on these issues and considers whether specific factors predict intention to engage in PA among women with previous GDM.

Research Articles

Self-Care Activation, Social Support, and Self-care Behaviors among Women Living with Heart Failure
Theresa M.Beckie, Susan M. Campbell, Yukari Takata Schneider, & Everly Macario
Background: Three million U.S. women live with heart failure (HF).
Purpose: This study investigated relationships among self-care activation, social support, and self-care behaviors of women living with HF.
Methods: A 52-item web-based survey was completed by 246 women living with HF.
Results: Women reported a mean body mass index (BMI) of 30.8 ± 7.8 kg/m2, exercising a mean 106.5 ± 141.1 min/week, and consuming 3.25 ± 1.9 mean servings fruit/vegetables each day. Significant predictors of weekly physical activity minutes included self-care activation, activities of daily living (ADLs) total score, and current tobacco use. Low self-care activation, poor self-perceived health, greater ADL limitations, and more years living with HF were statistically significantly associated with having a higher BMI. Self-perceived health status and education and income levels were significant predictors of daily fruit/vegetable servings.
Discussion: Although self-care activation was positively associated with health behaviors among women living with HF, self-care management of health behaviors remained suboptimal. Evaluating self-perceived health status of women with HF may identify appropriate interventions for improving self-care behaviors.
Translation to Health Education Practice: Certified Health Education Specialists are encouraged to tailor their education to raising self-care activation, improving self-perceived health, underscoring the value of tangible physical activities (climbing stairs, walking, carrying groceries), and referring women with HF to cardiac rehabilitation.

The Effect of Cancer Information Seeking on Perceptions of Cancer Risks, Fatalism, and Worry Among a U.S. National Sample
Ann Oyare Amuta, Xuewei Chen, & Rahma Mkuu
Background: Information seeking is crucial in the health behavior context. Cancer information seeking may play a key role in individuals’ perceptions and subsequent health behaviors.
Purpose: The purpose of this study is to investigate the influence of cancer information seeking on perceptions of cancer worry, fatalism and risk.
Methods:Data from the 2014 U.S. Health Information and National Trends Survey were used. Fatality index, lifetime risk perceptions, and cancer worry were dependent variables. Each model included cancer information seeking as the independent variable, controlling for the demographic variables (age, gender, education, income, ethnicity, and marital status), body mass index (BMI), and cancer family history.
Results: A majority were females (59.76%; n = 1856). The mean age was 53 and most participants were white (52.19%). A majority had a bachelor’s degree or higher (40.11%), and 40.2% were actively seeking information on cancer. Results show that information seeking was a significant predictor of lifetime risk perceptions (β = 0.079, R2 = 0.105, P < .001) and cancer worry (β = 0.129, R2 = 0.081, P < .001).
Discussion: Active cancer information-seekers were more likely to worry about getting cancer and perceive that they had a greater chance to get cancer.
Translation to Health Education Practice: Health Educators are encouraged to pay closer attention to how cancer information is framed to ensure that information elicits health-enhancing attitudes and behaviors.

Self-Care Knowledge of Hypertension Prevention and Control among Women in Contemporary Ghana
Emmanuel Ekow Asmah & Emmanuel Orkoh
Background: There has been a growing body of literature on hypertension in many countries, but nonavailability of data hampered empirical research on this issue in Ghana.
Purpose: This article presents new and nationally representative household survey evidence on determinants and benefits of self-care knowledge of hypertension prevention and control among contemporary Ghanaian women.
Methods: TwoThe logistics and double hurdle estimation approaches are employed together with univariate distributions (percentages and means) to analyze the socioeconomic correlates of the risk of hypertension and self-care knowledge among women aged 15–49 from the Ghana Demographic and Health Survey (GDHS) 2014 data.
Results: The results show that knowledge of hypertension, education, and ethnicity significantly influence women’s risk of being hypertensive. In addition, women’s own level of education and that of their partners, ethnicity, age, and wealth are important determinants of their knowledge of hypertension.
Discussion: The results indicate potentials for public education toward self-care to impact positively on the risk of hypertension.
Translation to Health Education Practice: The Ministry of Health must collaborate with other civil society organizations and design policies aimed at educating hypertensive patients, their families, and people who are at high risk for hypertension giving due cognizance to access to information, ethnic and geographical diversity, attitudes, and practices.

The reading level of government and voluntary health organization smoking cessation websites: A descriptive analysis
Christopher M. Seitz, Samantha Shiplo, Taylor Filippini, Zubair Kabir, Jeffrey L. Lennon, & Donald Fowler
Background: The U.S. Department of Health & Human Services (USDHHS) recommends that health material be written at or below a sixth-grade reading level to ensure readability.
Purpose: The aim of this study was to investigate the readability of online smoking cessation materials from several government and voluntary health organizations.
Methods: A purposive sample of publicly accessible governmental and voluntary health organization websites was selected. The readability of the websites’ smoking cessation information was estimated using the previously validated SMOG readability formula, which determined reading level by correlating the number of polysyllabic words.
Results: Of the 55 websites included in the analysis, none had cessation information at the USDHHS’s recommended reading level. The material ranged in reading level from seventh grade to a third year in college.
Discussion: The findings indicate that the online cessation materials need to be modified in order to reach recommended reading levels.
Translation to Health Education Practice: This study can be of practical use to Health Educators when designing, modifying, and evaluating smoking cessation materials. Several free, online government resources are available to assist Health Educators in using simple, non-polysyllable words to ensure that smoking cessation materials are written at the recommended reading levels.

Alcohol Consumption and Factors Associated with Depressive Symptoms Among Older Adults in Mainland China
Yujun Liu, Yimeng Xie, Nancy Brossoie, Karen A. Roberto, & Kerry J. Redican
Background: High levels of alcohol consumption have been shown to be related to cardiovascular disease, cancer, diabetes, and other chronic disease and is an important variable in the global burden of disease.
Purpose: This study explored the relationship between alcohol consumption and depressive symptoms among older Chinese adults in mainland China.
Methods: Participants included 7601 people aged 60 or older who participated in the 2011 China Health and Retirement Longitudinal Study (CHARLS). Hierarchical generalized linear modeling (HGLM) was used.
Results: Findings indicate that men have a decreased risk of experiencing depressive symptoms by 47% when controlling for other independent variables. People living only with a spouse were less likely to experience depressive symptoms compared to people living alone.
Discussion: The findings have important implications in educating Chinese about alcohol and the relationship between alcohol and disease-related variables.
Translation to Health Education Practice: The results of this study may assist those developing and delivering alcohol Health Education and health promotion programs in China to focus on the relevant predisposing, reinforcing, and enabling factors influencing alcohol consumption.