Health Outcomes and Behavior Program

Background: Emerging evidence suggests sleep duration may be associated with health outcomes among cancer survivors. There have been few studies analyzing sleep among gynecologic cancer survivors (GCS). We defined GCS as respondents who reported being told they had a form of gynecologic cancer (cervical, endometrial, and ovarian cancer) in their life. This study aimed to explore the associations between health outcomes, health behaviors, and socioeconomic status (SES) on sleep duration in GCS. Methods: We used the 2016-2020 Behavioral Risk Factor Surveillance System (BRFSS) datasets to evaluate the impacts of health outcomes, health behaviors, and SES on sleep duration among GCS. We categorized sleep duration into Short Sleep Duration (<7 hours) (SSD), Long Sleep Duration (>8 hours) (LSD), and Optimal Sleep Duration (7-8 hours) (OSD). Bivariate analyses including chi-square tests, were used to examine associations between health outcomes, behaviors, SES, and sleep duration. A multivariable ordinal logistic regression model was produced to assess the adjusted odds ratios (aOR) for sleep duration, considering health outcomes, behaviors, and SES, while controlling for confounders. Results: Our sample (N=10222) was primarily composed of cervical (n=8856) followed by endometrial (n=1198) and ovarian (n=168) cancer survivors. Most of the sample was 65+ years old (65.93%), followed by the age categories 40-64 years old (32.17%) and 18-39 years old (1.90%). Regarding race, most of the sample was non-Hispanic White (95.68%), followed by non-Hispanic Black (2.54%) and Hispanic (1.78%). We found significant associations between health outcomes, health behaviors, and SES in relation to sleep duration among GCS. GCS who reported depression had higher odds of both LSD (aOR=1.93, 95% CI: 1.45-2.58) and SSD (aOR=1.57, 95% CI: 1.29-1.92). GCS engaging in exercise were more likely to report LSD (aOR=1.53, 95% CI: 1.15-2.04). Current smokers had an increased likelihood of SSD (aOR=1.47, 95% CI: 1.11-1.95). Unemployment was associated with an increased likelihood of LSD (aOR=2.67, 95% CI: 1.87-3.82). Additionally, GCS with incomes <$25,000 had significantly higher odds of SSD compared to GCS earning >$75,000 (aOR=1.82, 95% CI: 1.38-2.39). For health outcomes, GCS with fair/poor health were significantly more likely to report SSD compared to GCS with excellent health (aOR=1.63, 95% CI: 1.20-2.20). GCS experiencing 14 or more poor health days in a month also had higher odds of SSD (aOR=1.31, 95% CI: 1.11-1.55). Finally, GCS residing in rural areas had an association with SSD (aOR=1.22, 95% CI: 1.03-1.44) in comparison to GCS residing in urban areas. Discussion: Our findings illustrate a complex interplay of health outcomes, health behaviors, and SES contributing to sleep duration among GCS. This underscores the crucial need to address sleep duration to improve health outcomes, reduce disparities, and increase quality of life for all GCS. Opportunities for future research include sleep hygiene interventions that may mitigate these effects and improve sleep among GCS. Citation Format: LaShae D. Rolle, Maurice J. Chery, Alyssa Mercadel, Matthew P. Schlumbrecht, Sophia H.L. George, Tracy E. Crane. Impact of health behaviors, health outcomes, and socioeconomic status on sleep duration among gynecologic cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B054.

Objective:The South Asian Health Needs Assessment was conducted to collect health status information on the rapidly growing Asian Indian (AI) community in the Houston area. Many were highly educated and reported high income levels, factors usually associated with better health outcomes. This study examined the relationship between socioeconomic advantage and the health behaviors and health outcomes of AIs.Methods:We analyzed cross-sectional survey data from a convenience sample of 1416 AIs. Income was categorized as low, medium, and high. Descriptive statistics were generated by income categories and weighted multinomial regression analyses were conducted to examine the association of income with health behaviors and outcomes, adjusting for age, sex, health insurance, and years in the United States.Results:Income was positively associated with better self-rated health, higher body mass index, moderate physical activity, having shingles vaccine, and cervical cancer screening. Income was inversely associated with perceived stress and heart disease. However, income was not significantly associated with alternative therapies, cigarette smoking, alcohol consumption, self-reported overweight/obesity, fruit and vegetable consumption, diabetes, high blood pressure, high cholesterol and screening for breast, prostate, and colon cancer.Conclusions:Socioeconomic advantage was not consistently associated with positive health outcomes or desired health behaviors among AIs. We speculate that other factors, including cultural beliefs and acculturation may also impact health behaviors and health outcomes in this group. Further studies examining the influence of these variables on health behaviors and health outcomes are warranted.

Introduction According to the existing studies, there are relatively few studies about the effectiveness of the health literacy promotion program on health behaviours and health outcomes among pre-aging individuals with overweight and obesity. According to the aforementioned problems and reviewed data, this study aimed to address the need for accessible health knowledge. Particularly, older adults with obesity should aim to lose weight and prevent chronic diseases caused by obesity, thereby preparing them to handle age-related health conditions. Methods This study employed a pretest-posttest Randomized Controlled Trial (RCT) conducted between February and June 2024 among pre-aging individuals with overweight and obesity in Thailand. The total sample size was 136 (the control arm had 68 samples, the experimental arm had 68 samples). Results The study assessed the health behaviors and outcomes of an older adult group with overweight and obesity, following their participation in a health literacy development program. Post-intervention, the experimental arm exhibited significantly higher health literacy scores ( p < 0.001) and health behavior scores related to overweight and obesity ( p < 0.001) compared to the control arm. Furthermore, the overall health outcomes of the experimental arm were also significantly better than those of the control arm (p-values ranging from 0.001 to 0.004). Discussion This study shows that a health literacy promotion program can significantly improve health behaviors and outcomes in pre-aging individuals with overweight and obesity. Compared to the control arm, participants in the experimental arm received better clinical scores and effectively improved their own health conditions, indicating that the program is conducive to promoting a healthy lifestyle and preparing for aging. Conclusions These findings provide evidence to support the health literacy concepts as guidelines for developing a health-promoting program for the pre-aging group with overweight and obesity.

The environment an adult resides within is associated with their health behaviours, and their mental and physical health outcomes: a nationwide geospatial study

Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data-connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients' own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program's efficacy for future clinical implementation.

IntroductionSocial networks can affect health beliefs, behaviours and outcomes through various mechanisms, including social support, social influence and information diffusion. Social network analysis (SNA), an approach which emerged from the...

Schools can play an important role in health promotion mainly by improving students' health literacy, behaviors and academic achievements. School-based health promotion can be particularly valuable in developing countries facing the challenges of low health literacy and high burden of disease. We conducted a scoping review of the published literature focusing on school-based interventions for health promotion and their impact in developing countries. We included 30 studies meeting specific criteria: (i) studies mainly targeted school going children or adolescents; (ii) admissible designs were randomized controlled trials, controlled before-after studies or interrupted time series; (iii) studies included at least one measure of impact and (iv) were primary studies or systematic reviews. We found that school-based interventions can be classified in two main categories: those targeting individual determinants of health such as knowledge, skills and health behaviors and those targeting environmental determinants such as the social and physical environment at the school, family and community level. Findings suggest that a comprehensive approach addressing both individual and environmental determinants can induce long-term behavior change and significantly improve health and educational outcomes. We highlight the need for further study of the long-term impact of school-based interventions on health outcomes in developing countries.

The current study investigates the economic impact of education on health behaviour and health outcomes, specifically targeting the Raymond Mhlaba and Buffalo City municipalities in the Eastern Cape region, South Africa. The study employs and modifies the National Income Dynamic Study (NIDS) data by combining all five waves to create a panel data. The study investigates an analytical objective which explored the relationship between education, health behaviours and health outcomes. This objective is addressed using a multivariate regression analysis (multinomial logistic regression) which offers the advantage of the ability to handle categorical outcomes with more than two categories. The current study uses marginal effects (dy/dx) to analyse how education affects health outcomes in each category of health outcomes. The results for the probability of predictor variables belonging to category 3 "good" [coded 3 on the dummy variable (DV)] are positive and significant [dy/dx = 0.328; p = 0.029], showing that the marginal effects of having an undergraduate degree and belonging to category 3 are higher (33pp) than in any other category. The empirical findings suggest that education can be an important determinant of behavioral transformation and later changes in health-related outcomes. Thus, it is the policy implications and recommendations of this study that improving health outcomes requires more than health sector solutions. As such, given that education shapes health behaviours and health outcomes across the course of life, policies must move beyond silos and intergrade health education in South Africa's education system in order to rule out health illiteracy as a root cause of health inequality and poor health outcomes.

BackgroundPast studies have identified that inconvenient access to health clinics is one of the important barriers to health service utilization and health outcomes. However, establishing the link between the lack of access to health clinics and the high maternal and child morbidity and mortality in Nigeria has been a challenge due to the lack of data. This paper overcomes this problem by using the country’s health clinic census data.MethodsUsing the Nigerian health clinic census, we evaluate the intercorrelation between the quantity and the quality of health clinics available across the country. We also examine the correlation between the access to health clinics and health behaviors/outcomes for residents by merging the health clinic census data with data from the demographic and health survey (DHS). The health clinic census data makes it possible to capture the overall geographical allocation of health services across the country as well as their comprehensive relationship with health outcomes.ResultsWe find a strong positive correlation between the quality of a health clinic and the quantity and quality of neighboring clinics. The high quality clinics are concentrated in areas where the density of clinics is high, and where more of the clinics around them are also of high quality. We also find that an increase in access to health clinics of high quality that are in close proximity is significantly and positively correlated with an improvement in health behaviors as well as health outcomes. Women who are more disadvantaged benefit more from the access to high quality clinics than others.ConclusionsHealth clinics of good quality are unevenly distributed geographically in Nigeria. The quality of health clinics should be of a level that can support the promotion of recommended health behaviors and achieve improved health outcomes throughout the country. Further studies are necessary to evaluate the optimal distribution of clinics of good quality, given that residents in less populated areas gain a higher marginal benefit from improved access to health service, despite the higher costs of supplying the service in those areas.

Already commonplace in many health systems, genetic tests will become more readily available in the future. Assessments of these new technologies must consider a number of unique factors regarding the types of health outcomes that might arise. This paper examines the issues relating to the assessment of the health and psychosocial outcomes of genetic tests. We argue that diagnostic genetic tests are similar to diagnostic non-genetic tests, in that their primary utility results from the effectiveness of subsequent treatments. Thus, these tests can be assessed using standard procedures for measuring changes in health outcomes. Predictive and pre-dispositional tests may also result in improved health outcomes, but achieving these benefits may require that individuals significantly alter their health behaviours. Assessments of these tests must consider the extent to which individuals will alter their health behaviours and life decisions.

Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children.

The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England

BackgroundApathy (loss of motivation or goal‐directed behaviour) and depression each confer risk for dementia, cardiovascular disease and mortality in older adults. The mechanisms by which these neuropsychiatric symptoms are linked with health outcomes are not yet understood. Health behaviours may be one pathway, yet their potential links with apathy have received scant attention, whereas depression has been consistently associated with unhealthier behaviours including physical inactivity. Depression and apathy may be confounded, thus it is critical to determine their potential differential associations with health behaviours. This study thus aims to investigate whether apathy and depressive symptoms in older adults were associated with a broad battery of health behaviours.MethodCommunity‐dwelling participants from the Sydney Memory and Ageing Study (n = 1,030) aged 70‐90 without dementia completed assessments including the Geriatric Depression Scale, from which apathy (GDS‐3A) and depression (GDS‐12D) subscores were obtained. To investigate cross‐sectional associations with self‐reported physical activity, diet, current and lifetime alcohol consumption and smoking, linear or logistic regressions predicted the outcomes from apathy and depression, controlling for age, sex, education, global cognition and chronic conditions.ResultGreater apathy (but not depressive symptoms) was significantly associated with current physical inactivity (fewer hours/week weighted by intensity, p < .001) and frequent alcohol consumption (>2x weekly, p <.05). Depressive symptoms alone predicted poorer current adherence to Australian Dietary Guidelines (ADG‐2013, p <.05) and smoking (p <.001). Higher levels of both apathy and depressive symptoms were significantly associated with a past period of “heavier” alcohol consumption (p <.05); neither were related with lifetime history of smoking nor lifetime abstinence from alcohol.ConclusionApathy and depression were differentially associated with health behaviours. Presence of these symptoms in older adults may act as a barrier to engagement in healthier lifestyle activities, which are known to have numerous benefits for health and cognitive outcomes. These novel findings should be further examined longitudinally and with objective measures and alternative apathy assessment. Apathy should be considered along with depression as key determinants of health behaviours when designing health promotion interventions targeting older adults, and in models of dementia risk reduction.

Contents: D. Blazer, Aging, Health Behaviors, and Health Outcomes: Goals of the Conference. J.S. House, R.C. Kessler, A. Regula Herzog, R.P. Mero, A.M. Kinney, M.J. Breslow, Social Stratification, Age, and Health. R.P. Abeles, Social Stratification and Aging: Contemporaneous and Cumulative Effects. S.A. James, N.L. Keenan, S. Browning, Socioeconomic Status, Health Behaviors, and Health Status Among Blacks. D.R. Williams, Social Structure and the Health Behaviors of Blacks. G.L. Maddox, Discussion of Socioeconomic Status, Health Behaviors, and Health Status Among Blacks. G.A. Kaplan, Health and Aging in the Alameda County Study. I.C. Siegler, Aging and the Public Health: Reflections on Kaplan's Report of Health and Aging in the Alameda County Study. D. Blazer, The Laudables and Limits of Large Epidemiologic Studies of Mortality. W.A. Satariano, N.E. Ragheb, Living Arrangements and Problems With Daily Tasks for Older Women With Breast Cancer. S. Cohen, The Content and Context of Effective Spousal Support. A.M. Ostfeld, Reducing Disability in Research. L.K. George, Social Factors and the Onset and Outcome of Depression. S.A. Murrell, Cohort Experiences, Support Versatility, Depressive Traits, and Theory. C. Schooler, Statistical and Causal Interaction in the Diagnosis and Outcome of Depression. J.S. House, Aging, Health Behaviors, and Health Outcomes: Some Concluding Comments.

BackgroundFew studies have examined the impact of the built environment (BE) on health behaviours and health outcomes in middle income countries. This study examines associations between self-assessed characteristics of the home and neighbourhood environment and health-related behaviours and health outcomes in an elderly population in BrazilDesign and methodsIn a community sample of 6963 community dwellers 60 years old and older living in the state of Rio Grande do Sul, Brazil, associations between self-reported BE conditions and health behaviours and health outcomes were assessed using a structured questionnaire. Multivariate analysis was conducted to investigate these associations while accounting for other relevant characteristics.ResultsWe found significant positive associations between adverse BE conditions and pulmonary, urinary conditions, gastrointestinal, problems, headache and depression. There were mixed associations between adverse BE conditions and musculoskeletal and sensory conditions, inverse associations with metabolic disorders. and no associations with dermatologic problems and cancer. After accounting for health related behaviours, results suggest a modest association between adverse BE conditions and hypertension, with no significant associations with other indicators of cardiovascular conditions (heart problems, stroke, varicose veins).ConclusionsThe findings in this study suggest links between adverse conditions in the BE and health related behaviours in the hypothesized direction. Associations with the health conditions examined here are mixed. We find the strongest evidence for effects of adverse BE conditions for pulmonary and infectious conditions. Significant associations between the adverse BE indicators and health outcomes persist after accounting for health related behaviours, suggesting that BE conditions are linked to health pathways above and beyond the health related behaviours assessed in this study.Significance for public healthThe health outcomes for which we found most consistent evidence of associations with the built environment index (BEI) included respiratory conditions (bronchitis, pneumonia), urinary and renal conditions, gastrointestinal problems, headache, visual impairment and stroke. These health outcomes in the elderly may reflect exposures in the household environment associated with inadequate housing, such as mold, dust and damp. They may also be influenced by poor sanitary conditions, reflected in the absence of indoor plumbing and inadequate waste disposal facilities. Poor vision, headache and depression may all be associated with chronic exposure to poverty and stress, for which the measures of the household and neighborhood environmental conditions used in the BEI may be indicators. Assuring that the elderly in Brazil have access to adequate housing located in neighborhoods with access to basic sanitary conditions, water and lighting, will be increasingly important as the average age of Brazilians continues to increase, and increasing proportions of the population experience the adverse health effects associated with these conditions.