July / August 2020



AJHE: American Journal of Health Education

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  July/August 2020 (Volume 51, Issue 4)

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Table of Contents

Free Access Article
/Applying the Concepts of “Community Spread” and “Flatten the Curve” to Chronic Conditions and Their Prevention
 – Thomas W. O’Rourke

As this is being written, the Coronavirus (COVID-19) pandemic is spreading around the planet. To date, 210 countries have been affected. Billions of people are in lockdown as health services struggle to cope. Across America, cases and fatalities have been reported in all states. Particularly hard hit have been major cities such as New York, New Orleans, Seattle, Chicago and Detroit with more certainly to come. Words such as isolation and self-quarantine are ubiquitous. Previously unknown or rarely referenced terms such as social isolation, social distancing, shelter in place, personal protection equipment (PPE) and ventilators also are now part of everyday lexicon and jargon. Millions of Americans, like myself, are hunkered down and doing their best to minimize their own risk and risk to others; an option unavailable to millions more in essential services, ranging from health care workers and first responders to transportation, food processing and grocery store employees.

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Research Articles

CATs to Kiddie CATS: Transforming an Elementary Physical Activity Curriculum for Preschoolers
Lori E. Meyer, Betsy Hoza, Caroline P. Martin, Erin K. Shoulberg, Connie L. Tompkins, Marissa Dennis, and Allison Krasner
Background: As more schools begin to include preschool classrooms, teachers and administrators may need physical activity (PA) curricula that are inclusive, specially designed for young children, and linked to PA curricula used with elementary students.
Purpose: The purpose of this study was to pilot an elementary PA curriculum (i.e., Children and Teachers [CATs] on the Move) with preschoolers to identify curricular adaptations to design a PA curriculum for preschoolers that is feasible for, and acceptable to, inclusive early childhood teachers.
Methods: Focus groups were held with early childhood teachers and PA program leaders after the curriculum was used with preschoolers with and without disabilities across 13 weeks.
Results: Teachers and program leaders identified changes to the program’s structure, rules, activities, and the creation of enhancements to promote children’s participation in the curriculum (e.g., visual supports).
Discussion: Several fundamental changes were necessary for the CATs program to be feasible in early childhood classrooms. Teacher and program leader feedback led to a new curriculum (i.e., Kiddie CATs on the Move).
Translation to Health Education Practice: It is crucial to choose an appropriate and inclusive PA curriculum specifically created for young children.

College Students’ Intention to Select Healthy Snacks: An Application of the Theory of Planned Behavior
Laurel G. Lambert, Yunhee Chang, and Georgianna Mann
Background: As snacking has become an increasingly important part of adult diet over the past decades, better understanding of the intent to choose healthy snacks is crucial for promotion of healthy eating.
Purpose: This study aimed to explain college students’ intentions to choose healthy snacks using the Theory of Planned Behavior (TPB). 
Methods: An online survey of students was conducted in a large public university in the South-eastern U.S. In addition to basic demographics, behavioral intention to choose healthy snacks as well as direct and indirect measures of attitudes, subjective norm, and perceived behavioral control were assessed. Stepwise multiple linear regressions were estimated to determine relationships between constructs.
Results: University students’ attitude and perceived behavioral control regarding healthy snacking were key predictors of behavioral intention. Controlling for TPB variables, African American students had significantly lower intention to choose healthy snacks.
Discussion: TPB is an effective framework in identifying variables predictive of nutrition behaviors and food choices. The study showed that factors outside of TPB also play a role.
Translation to Health Education Practice: To improve snacking behaviors, education efforts should include components to increase student motivation and provide resources and ideas to help prepare or purchase healthy snacks.

Fitness Wearables and Exercise Dependence in College Women: Considerations for University Health Education Specialists
Sarah R. Blackstone and Lynn K. Herrmann
Background: Research has elucidated some harmful aspects of fitness wearable devices including their role in exacerbating disordered eating and exercise behaviors in young adults.
Purpose: The purpose of this study was to examine 1) if use of wearables was associated with exercise dependence and 2) prevalence of compensatory behaviors (CB) in response to not meeting goals set within the wearable.
Methods: University students completed an anonymous online survey with the Exercise Dependence Scale-21. Participants also provided information about wearable use and CB (e.g. restricting food) in response to not meeting fitness goals. Multiple linear regression assessed the association between wearable use, CB, and exercise dependence.
Results: Majority of participants using wearables reported CB if they did not meet goals set by wearables. Using wearables and engagement in CB were associated with higher exercise dependence scores.
Discussion: This study suggests that wearables may exacerbate harmful compulsions, like exercise dependence, and should be recommended with caution by health education specialists.
Translation to Health Education Practice: Consequences of wearable use are important to consider in the development of health education materials and interventions promoting wearable use. Certified Health Education Specialists should consider how to address negative aspects of fitness technology in physical activity promotion.

Perceived Severity of Interrelated Cardiometabolic Risk Factors among U.S. College Students
Ashley L. Merianos, Wura Jacobs, Oluyomi Oloruntoba, Olivia E. Gittens, and Matthew Lee Smith
Background: Cardiometabolic risk factors are related to the early onset of chronic health conditions.
Purpose: To identify factors associated with perceptions about the severity of three interrelated cardiometabolic risks (i.e., high blood pressure, obesity, and cardiovascular disease) among U.S. college students.
Methods: Data were analyzed from 1,361 college students using an internet-delivered survey. Linear regression models were fitted. Primary independent variables of interest were sex and cigarette smoking status.
Results: Relative to nonsmokers, smokers perceived high blood pressure (B = −0.09, P = .001), obesity (B = −0.12, P < .001), and cardiovascular disease (B = −0.12, P < .001) to be significantly less severe. Across models, females perceived all three cardiometabolic risk factors to be more severe (P < .005). Relative to non-Hispanic whites, Hispanic and Asian/Pacific Islander students perceived all three cardiometabolic risk factors to be less severe (P < .002). Compared to normal weight students, overweight (B = 0.41, P = .039) and obese (B = −0.72, P < .001) students reported higher severity perceptions about obesity only.
Discussion: There are discordances between perceived severity of interrelated cardiometabolic risks among college students by personal factors.
Translation to Health Education Practice: Smoking prevention and cessation interventions are needed to educate college students about cardiometabolic risks associated with cigarette smoking, especially among male and minority students.

Health Education and Changing Stress Mindsets: The Moderating Role of Personality
Jennifer Wegmann, Jason Marshall, Chou-Yu Tsai, and Shelley Dionne
Background: While prior research has demonstrated the ability of individuals to change their stress mindsets, the mechanisms through which these changes occur have not been studied. We offer health education as one such mechanism. Additionally, we posit that personality may moderate the change of stress mindset over time for students who are enrolled in health education courses.
Purpose: This study explores the role of personality in the change of stress mindset when there is a specific focus on improving individual health and well-being via health education courses.
Methods: Data was collected at two times in the semester, from 423 college students who are participating in college health education courses.
Results: Neuroticism, openness, and conscientiousness have cross-level moderating effects on the change of stress mindset over time when students were engaged in health education courses. However, extraversion and agreeableness do not.
Discussion: This study highlights the importance of health education, for specific personality types, in changing students’ mindsets as it relates to stress.
Translation to Health Education Practice: By offering more evidence of the reach, scope, and benefits health education may provide, this study provides additional rationale for the inclusion and implementation of health education in academics.

Co-Occurring Health Risk Behaviors and Their Association with Self-Rated Health among Female College Students
Jessica Samuolis and Laila McGeorge
Background: Existing research focuses on the co-occurrence of lifestyle-related health risk behaviors among college students. Although students’ self-reported health risk behaviors have been examined, students’ self-rated health and its association with these co-occurring health risk behaviors have been overlooked. 
Purpose: The goals of the current study were to identify levels of co-occurrence of health risk behaviors among female college students and to test the prediction that students with multiple co-occurring health risk behaviors would report poorer self-rated health.
Methods: Data from an online survey that assessed the five selected health risk behaviors and self-rated health of undergraduate students at a liberal arts university in the northeast of the USA were analyzed.
Results: High prevalence rates were found on all five risk behaviors and the majority of participants reported engaging in two or more co-occurring health behaviors. The inverse association between perceived health and level of co-occurrence of health risk behaviors was consistent with what was predicted.
Discussion: Students’ perceived health should be considered in the examination of health risk behaviors among college students.
Translation to Health Education Practice: These findings can inform efforts to provide Health Education and prevention programming on college campuses that incorporates multiple health behaviors.