January / February 2019



AJHE: American Journal of Health Education

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  January/February 2019 (Volume 50, Issue 1)

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Table of Contents

Free Access Article
/Vaping in the News: The Influence of News Exposure on Perceived E-Cigarette Use Norms
 – Hue Trong Duong & Jiaying Liu

Background: Research has documented the impact of descriptive norms on tobacco use, but few studies have investigated how media exposure shapes e-cigarette use norms.
Purpose: The purpose of this study was to examine how exposure to e-cigarette-related news articles shapes individuals’ descriptive norm perceptions about real-world e-cigarette use.
Method: The study implemented an experiment with a 2 normative direction (high vs low prevalence) × 2 exposure dosage (single vs double dose) between-subjects factorial design (N = 298). Analysis of variance and thematic analysis were conducted.
Results: Normative direction and exposure dosage of prevalence information contained in the news articles interacted to influence perceived descriptive norms. Increasing the dosage of prevalence information enhanced descriptive norm perceptions in low-prevalence conditions only. Participants relied on institutional signals and behavioral cues to infer descriptive norms when prevalence information was absent in the news.
Discussion: The study investigates the underlying mechanism of how news articles may influence normative perceptions.
Translation to Health Education Practice: Given that news media may inadvertently form social norms that are conducive to e-cigarette use behavior, Health Educators should pay attention to descriptive norms emanated from the news media environment. They should also consider norm debiasing strategies and the integration of dosage of low-prevalence information into social norm messages.

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Research Articles

Disparities in Diabetes Education Programs Use by Disability Status Among People with Diabetes: Findings From the Behavioral Risk Factor Surveillance System
– Junrong Shi & Yong Li
Background: Patients with diabetes and disabilities often have more difficulties in managing their diabetes. Little is known about how disabilities affect their use of diabetes education program.
Purpose: The purpose of this study was to examine the association between disabilities and diabetes education program use for patients with diabetes and to identify factors associated with diabetes education program use.
Method:Data were from the 2015 Behavioral Risk Factor Surveillance System and included patients with diabetes aged ≥ 18 years (N = 22 375). Logistic regression was used to investigate the effects of disabilities, sociodemographics, and diabetes-related factors.
Results: People with disabilities were 14% less likely to use diabetes education programs than people without (P < .05). Impairment types, health insurance, and number of complications were associated with diabetes education program use for people with disabilities.
Discussion: The findings suggest that individuals with disabilities have more barriers to using diabetes education programs and there might be a disparity due to disability types.
Translation to Health Education Practice: Health/diabetes educators need to reach out to people with both diabetes and disabilities and make the program accessible, particularly for those who have a vision impairment, cognitive impairment, or multiple impairments; have fewer complications; and have no health insurance.

Determinants of Physical Activity in a Constructive Work Environment: A Study of Brown Water Mariners
– Dawn Bloyd Null, Afroza Hasin, Julie Partridge & Kathleen Welshimer
Background: MindfuTo date, research investigating workers’ engagement in physical activity while working and living in constrictive environments is limited.
Purpose:: AThe purpose of this study was to identify the determinants and prevalence of physical activity among mariners and to understand factors associated with exercise while working on the towboat.
Methods:: The study utilized constructs from the PRECEDE-PROCEED planning model to explore perceived benefits, barriers, and motivation for physical activity (PA) among mariners using a cross-sectional survey and anthropometric measurements.
Results: Only 29% of participants met moderate PA guidelines, and 34% met vigorous PA guidelines. Deckhands were most likely to meet moderate (49%) and vigorous (51%) guidelines and were significantly more likely to meet guidelines compared to all other occupations on the boat. Nearly all participants (92.9%) were considered overweight or obese. Nonexercisers were significantly more likely to suggest shift work and weather as barriers to PA.
Discussion: Findings suggest that mariners are at increased risk of chronic disease and the constrictive environment of the towboat is obesogenic by promoting physical inactivity.
Translation to Health Education Practice: PA changes must be considered because results reinforce the significance impact of outside forces, including split shift work and the built environment, on health behaviors.

Wearable Activity Tracker Use in Young Adults Through the Lens of Social Cognitive Theory
– Mary Gowin, Amanda Wilkerson, Sarah Maness, Daniel J. Larson, H. Michael Crowson, Michael Smith & Marshall K. Cheney
Background: Young adults are adopting wearables ahead of research.
Purpose: The purpose of this study was to explore the use of trackers through Social Cognitive Theory (SCT).
Methods:SCT-guided individual interviews were conducted with young adults (n = 57). Typical case sampling was used to recruit college students (n = 35) and straight-to-work (STW) young adults (n = 22) for in-person/online interviews. Interviews were recorded, transcribed, and analyzed using NVivo.
Results: There were few differences between the two groups. Most reported little knowledge of the benefits/risks associated with their health behavior (eg, physical activity) but high expectations of how devices would assist them in developing/maintaining behavior. Self-regulatory aspects were seen as benefits. Many reported not setting goals other than those set by their device. Most reported increased self-efficacy and viewed their device as positive, nonjudgmental social support.
Discussion: Young adult device use can be health directed or health related. Utilizing devices and SCT-based education may increase young adults’ knowledge, self-efficacy, and self-regulation while managing expectations.
Translation to Health Education Practice: Health Educators should focus on increasing health knowledge, managing expectations, and setting goals. Building on the increased self-efficacy and social support that young adults reported as part of their wearable activity tracker use could provide a solid foundation for Health Education efforts.

Conducting a Formative Evaluation of an Intervention Promoting Mammography Screening in an American Indian Community: The Native Women’s Health Project
– Eleni L. Tolma, Julie A. Stoner, Cara Thomas, Kimberly Engelman, Ji Li, Aleksandar Dichkov & Norma Neely
Background: Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women.
Purpose: To describe the formative evaluation of a multicomponent intervention to promote mammography screening in an AI community in rural Oklahoma.
Methods: A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach.
Results: Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings.
Translation to Health Education Practice: Community-based evaluation of breast health promotion programs among AI communities is challenging, because one has to balance methodological rigor with practical constraints. An evaluation plan, mixed methods, and a collaborative approach are useful tools in conducting the evaluation.