September / October 2018



AJHE: American Journal of Health Education

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  September/October 2018 (Volume 49, Issue 5)

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Table of Contents

Free Access Article
/Assessing Elementary Health Education: Instrument for School Readiness and Delivery
 – Sarah E. Toth, Marcia R. O'Neal, & Retta R. Evans

Background/Purpose: Although the connection between health behaviors and Health Education is well established, elementary Health Education (EHE) readiness and delivery has been challenging to assess.
Methods: Development occurred in 3 phases: review, pilot study, and case study. Validity was established through quantitative and qualitative jury review, a focus group, and administrator interview. For reliability, the EHE-DAT was piloted in a local school district (n = 31) and case study of a second district (n = 161).
Results: The EHE-DAT was found to be reliable and valid. All scales and subscales were determined to have high levels of internal consistency (coefficient α = .739 to .927).
Discussion: States and professional organizations could apply the EHE-DAT on a wider scale. The EHE-DAT is customizable for states or grade levels where EHE requirements vary from Alabama.
Translation to Health Education Practice: The EHE-DAT has implications for EHE practice and accountability. By determining school district engagement in readiness behaviors and practices, it provides a starting point for bridging the gap between state standards and EHE delivery.

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Research Articles

Policies and Practices of High Performing Let’s Go Schools
– Kristin Giombi, Jean Wiecha, Jackie Vine, & Victoria W. Rogers
Background: PoLet’s Go! is a Maine-based, nationally recognized childhood obesity prevention program.
Purpose: The purpose of this study was to identify specific program and school characteristics, policies, and practices associated with schools achieving Let’s Go!’s priority strategies for increasing opportunities for healthy eating/active living in schools and suggest areas for program improvement.
Method:A serial cross-sectional design over 3 years was used to identify characteristics of higher-performing Let’s Go! schools and suggestions for program improvement. Logistic regressions used data from Let’s Go! school surveys and Common Core of Data.
Results: Outcome variables were the 5 priority strategies for each year (2013, 2014, and 2015). Strongest predictors were having a Let’s Go! team at the school (P < .01), having enforced district policy on the priority strategy (P < .05), and educating families in adopting a lifestyle supporting healthy eating/active living (P < .01).
Discussion: Enforced district wellness policies, school wellness teams, and family involvement are crucial components to the success of Let’s Go!.
Translation to Health Education Practice: Child health programs must adjust to the context in which they will be administered and will be more successful when supported by additional efforts including district wellness policies, collaborative wellness teams, and strong communication between parents and teachers.

School Based Intervention to Promote a Healthy Lifestyle and Obesity Prevention Among Fifth and Sixth Grade Children
Tal Aperman-ItzhakAnat Yom-TovZvi VeredRonit WaysbergIrit Livne & Sigal Eilat-Adar
Background: Children’s overweight and obesity have increased in Western societies, including Israel. Childhood is an important time for shaping healthy habits.
Purpose: The purpose of this study was to evaluate the effectiveness of a healthy lifestyle intervention on health knowledge, behavior, and anthropometric measurements.
Methods:: A total of 396 fifth- and sixth-grade children, from 2 religious and 2 secular schools, participated in a nonrandomized controlled trial during the 2011–2012 school year. Intervention group were given an extensive educational program focusing on eating habits and physical activity.
Results: EiOverweight and obesity decreased significantly within the intervention group (from 25% to 17.9%, P = .04), without a significant change in the control group (from 20.5% to 17.6%, P = .12). Religious children had double the risk of being overweight or obese (odds ratio [OR] = 2.10; 95% confidence interval [CI], 1.15–3.73; P = .02). Knowledge was improved in both study groups (P < .01), with no difference in health behavior scores at the beginning (P = .59) or end (P = .36) of the year.
Discussion: Health Education during fifth and sixth grades improved children’s weight and health knowledge but not healthy behavior.
Translation to Health Education Practice: School-based healthy lifestyle educational programs are important for primary prevention and weight management.

Factors Influencing Nutrition Label Reading Behavior in Individuals with Selected Chronic Disease
Tyler M. RoseElizabeth J. Unni & Gregory J. Jones
Background: Proper nutrition is essential in managing chronic diseases, and knowing how to use nutrition labels is vital in this respect.
Purpose: The purpose of this study was to determine factors impacting nutrition label use and identify the most used, most preferred, and most impactful sources of nutrition information.
Methods: ProA cross-sectional survey using a web link was distributed through a convenience sample of pharmacies. Data were collected on nutrition knowledge; label knowledge, use, and attitudes; demographics; and nutrition information sources. Predictors of label use were identified. Label use and knowledge were compared among those with and without chronic disease and caregivers of those with chronic disease.
Results: Of 284 respondents, 68% were women, 56% had a bachelor’s degree or higher, and 47% reported at least one chronic disease. Label use was significantly predicted only by nutrition knowledge, which in turn was predicted by label knowledge, disease duration, and education.
Discussion: Those with chronic disease read labels more but showed less label knowledge. Web pages, physicians, and health education professionals were the most preferred sources of nutrition information.
Translation to Health Education Practice: Individuals with chronic diseases and their caregivers need interventions to improve nutrition knowledge, probably through web pages and physician offices and by improving patient access to dietitians and Certified Health Education Specialists.

Examining Health Behaviors, Health Literacy and Self Efficacy in College Students with Chronic Conditions
D. Jeremy BarsellRobin S. EverhartSamantha A. Miadich & Michael A. Trujillo
Background: Every year, young adults with chronic conditions matriculate into college, which is a unique transitional period in that students may be managing a chronic condition on their own for the first time. Therefore, it is important to examine which factors may contribute to positive health behaviors and risky behaviors in college students with chronic conditions.
Purpose: The current study examined associations between health literacy, self-efficacy, and health behaviors in a sample of college students with chronic conditions.
Methods: Data were collected from 147 undergraduate students at a Mid-Atlantic U.S. university. Students completed an online consent and questionnaires assessing chronic conditions, health literacy, self-efficacy, and health behaviors (general behavior, wellness maintenance, substance use).
Results: Asthma was the most prevalent self-reported chronic condition (26.1%). Higher levels of health literacy and self-efficacy were significantly associated with general health behaviors and wellness maintenance and fewer substance use behaviors.
Discussion: These findings highlight health literacy and self-efficacy as potential foci for maintaining healthy behaviors in college students with chronic conditions.
Translation to Health Education Practice: PCollege health centers are important facilitators of promoting college student health. Incorporating health literacy and self-efficacy into Health Education interventions could be effective in improving student health.

Nutrition Knowledge and Diet: Exploring the Influence of Social and Informational Factor in an Indian Adult Population
Christopher J. McKinleyYam B. LimbuRajesh K. GautamAjay K. AhirwarPragya Dubey & C. Jayachandran
Background: There has been little research conducted within developing nations examining the link between knowledge and diet-related perceptions and behaviors. In addition, prior investigations have rarely examined interrelationships between knowledge and other nutrition-related factors.
Purpose: This study explored the relationship between nutrition knowledge, social/informational factors, and diet-related outcomes among Indian adults with multiple chronic conditions.
Methods: A snowball sampling technique was employed to recruit individuals. Hierarchical regression analysis was employed to examine mediating and moderating relationships.
Results: Results from a cross-sectional survey indicated that knowledge only predicted use among those reporting greater pressure/concern from close others. Furthermore, social support and social trust were found to moderate the relationship between knowledge and diet-related perceptions and behaviors.
Discussion: Results suggest that social factors may play a critical role in moderating the impact of nutrition knowledge on diet-related perceptions and behaviors.
Translation to Health Education Practice: FuPublic Health Education interventions targeting developing nations should aim to maximize consumers’ nutrition knowledge while identifying valued close others who can help encourage positive health action. Furthermore, Health Educators as well as government and local communities must engage in outreach efforts to reinforce or, if necessary, change public perceptions regarding the food industry.

A Community-Based Intervention to Reduce CVD Risk Factors in Rural Community-Dwelling African Americans
Jermaine B. MitchellAngelia M. PaschalPatricia A. Parmelee & Pilar Z. Murphy
Background: Cardiovascular disease (CVD) is the leading cause of death in Americans. Rural African American (AA) adults are disproportionately affected by CVD—a disease whose risk can be mitigated by a healthy diet and regular physical activity.
Purpose: The purpose of this study was to evaluate the effectiveness of the Living in Victory Everyday (LIVE) Program, a 3-month community-based nutrition and physical activity intervention.
Methods:Forty rural AA adults (age range: 35–80; 2 men, 38 women) at risk for CVD from the Black Belt region of Alabama enrolled in the program. Thirty-four of the 40 participants completed both pre and post health and functional appraisals and surveys, which included questions about fruit and vegetable consumption, physical activity, quality of life, and demographic items.
Results: Postintervention results indicated significant balance improvements in the right and left legs. Additionally, participants’ daily fruit and vegetable consumption, healthy food selection, quality of life, and weekly physical activity improved.
Translation to Health Education Practice: Findings from this study can provide rural practitioners with a framework for group-based lifestyle behavior interventions aimed at reducing CVD risk factors among AA adults.