Although higher dietary intake of MUFA has been shown to improve glycaemic control and lipid profiles, whether MUFA consumption from different sources is linked to the development of type 2 diabetes (T2D) remains unclear. We aimed to prospectively assess the associations of plant-derived MUFA (P-MUFA) and animal-derived MUFA (A-MUFA) intakes with T2D risk in a nationwide oriental cohort. Overall, 15 022 Chinese adults, aged andhe;20 years, from the China Health and Nutrition Survey (CHNS 1997-2011) were prospectively followed up for a median of 14 years. Consumption of MUFA from plant and animal sources was assessed using 3-d 24-h recalls in each survey, and the cumulative average of intake was calculated. Multivariable-adjusted Cox models were constructed to estimate the hazard ratios (HR) of T2D according to quartiles of MUFA intake. P-MUFA were mainly consumed from cooked vegetable oils, fried bread sticks and rice, while A-MUFA were mainly consumed from pork, lard and eggs. Intake of P-MUFA was associated with a higher risk of T2D (HRQ4 v. Q1 1-50 (95 % CI 1-18, 1-90); Ptrend = 0-0013), whereas A-MUFA showed no significant association (HRQ4 v. Q1 0-84 (95 % CI 0-59, 1-20); Ptrend = 0-30). When further considering the cooking method of food sources, consumption of P-MUFA from fried foods was positively associated with T2D risk (HRQ4 v. Q1 1-60 (95 % CI 1-26, 2-02); Ptrend = 0-0006), whereas non-fried P-MUFA were not associated. Intake of MUFA from fried plant-based foods may elevate T2D risk among the Chinese population.

BACKGROUND: Previous studies show a positive association between household wealth and overweight in sub-Saharan African (SSA) countries; however, the manner in which this relationship differs in the presence of educational attainment has not been well-established. This study examined the multiplicative effect modification of educational attainment on the association between middle-income and rich household wealth and overweight status among adult females in 22 SSA countries. We hypothesized that household wealth was associated with a greater likelihood of being overweight among middle income and rich women with lower levels of educational attainment compared to those with higher levels of educational attainment. METHODS: Demographic and Health Survey (DHS) data from 2006 to 2016 for women aged 18-49 years in SSA countries were used for the study. Overweight was defined as a body mass index (BMI) ≥ 25 kg/m2. Household wealth index tertile was the exposure and educational attainment, the effect modifier. Potential confounders included age, ethnicity, place of residence, and parity. Descriptive analysis was conducted, and separate logistic regression models were fitted for each of the 22 SSA countries to compute measures of effect modification and 95% confidence intervals. Analysis of credibility (AnCred) methods were applied to assess the intrinsic credibility of the study findings and guide statistical inference. RESULTS: The prevalence of overweight ranged from 12.6% in Chad to 56.6% in Swaziland. Eighteen of the 22 SSA countries had measures of effect modification below one in at least one wealth tertile. This included eight of the 12 low-income countries and all 10 middle income countries. This implied that the odds of overweight were greater among middle-income and rich women with lower levels of educational attainment than those with higher educational attainment. On the basis of the AnCred analysis, it was found that the majority of the study findings across the region provided some support for the study hypothesis. CONCLUSIONS: Women in higher wealth strata and with lower levels of educational attainment appear to be more vulnerable to overweight compared to those in the same wealth strata but with higher levels of educational attainment in most low- and middle- income SSA countries.

Introduction: Over 80% of the world’s one billion tobacco smokers reside in low- and middle-income countries (LMICs); therefore, it is important to understand factors that promote intention to quit smoking in these countries. This study evaluated factors associated with three stages of intention to quit tobacco smoking among adults in LMICs. Methods: Data from 43,540 participants of the Global Adult Tobacco Survey in 14 LMICs were analyzed. Intentions to quit smoking were categorized into precontemplation (referent category), contemplation, and preparation stages based on the transtheoretical model. A multinomial logit model was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Approximately 82%, 14%, and 4% of the smokers were in precontemplation, contemplation, and preparation stages, respectively. Rural residents had increased odds of being in contemplation stage (OR = 1.41, 95% CI = 1.09–1.83) compared to urban residents. Compared to homes where smoking was allowed, smoke-free homes were associated with increased odds of contemplation (OR = 1.77, 95% CI = 1.41–2.23) and preparation (OR = 2.18, 95% CI = 1.78–2.66). Exposure to anti-smoking messages in more than one media channel was associated with increased odds of contemplation (OR = 1.60, 95% CI = 1.33–1.92) and preparation (OR = 1.73, 95% CI = 1.28–2.33) compared to no exposure to anti-smoking messages. Conclusion: The results suggest that anti-smoking media campaigns and smoke-free policies may promote intention to quit smoking in LMICs. While these suggest the need for implementation of comprehensive anti-smoking campaigns and smoke-free policies, longitudinal studies are required to confirm these findings and to evaluate how intention to quit translates into quit attempts in LMICs.

Purpose: Coordinated school health programs (CSHPs), a type of health promoting school (HPS) program adopted by Canada and the USA, were developed to provide a comprehensive approach to school health in the USA. Community partnerships are central to CSHP and HPS efforts, yet the quality of collaboration efforts is rarely assessed. The purpose of this paper is to use Himmelman’s strategies for working together to assess the types of partnerships that are being formed by CSHPs and to explore the methodological usefulness of this framework. The Himmelman methodology describes four degrees of partnering interaction: networking, coordinating, cooperating, and collaborating, with each degree of interaction signifying a different level of partnership between organizations. Design/methodology/approach: Data were collected as part of the 2008-2009 and 2009-2010 CSHP annual Requests for Proposal from all 131 public school systems in Tennessee. Thematic analysis methods were used to assess partnerships in school systems. Descriptive analyses were completed to calculate individual collaboration scores for each of the eight CSHP components (comprehensive health education, physical education/activity, nutrition services, health services, mental health services, student, family, and community involvement, healthy school environment, and health promotion of staff) during the two data collection periods. The level of collaboration was assessed based on Himmelman’s methodology, with higher scores indicating a greater degree of collaboration. Scores were averaged to obtain a mean score and individual component scores were then averaged to obtain statewide collaboration index scores (CISs) for each CSHP component. Findings: The majority of CSHPs partnering activities can be described as coordination, level two in partnering interaction. The physical activity component had the highest CISs and scored in between coordinating and cooperating (2.42), while healthy school environment had the lowest score, scoring between networking and coordinating (1.93), CISs increased from Year 1 to Year 2 for all of the CSHP components. Applying the theoretical framework of Himmelman’s methodology provided a novel way to quantify levels of collaboration among school partners. This approach offered an opportunity to use qualitative and quantitative methods to explore levels of collaboration, determine current levels of collaboration, and assess changes in levels of collaboration over the study period. Research limitations/implications: This study provides a framework for using the Himmelman methodology to quantify partnerships in a HPS program in the USA. However, the case study nature of the enquiry means that changes may have been influenced by a range of contextual factors, and quantitative analyses are solely descriptive and therefore do not provide an opportunity for statistical comparisons. Practical implications: Quantifying collaboration efforts is useful for HPS programs. Community activities that link back to the classroom are important to the success of any HPS program. Himmelman’s methodology may be useful when applied to HPSs to assess the quality of existing partnerships and guide program implementation efforts. Originality/value: This research is the first of its kind and uses a theoretical framework to quantify partnership levels in school health programs. In the future, using this methodology could provide an opportunity to develop more effective partnerships in school health programs, health education, and public health.

In the summer of 2015, the East Tennessee State University (ETSU) College of Public Health and regional health systems serving 29 counties in Northeast Tennessee and Southwest Virginia began the process of identifying a set of high-impact health programs for inclusion in a ten-year regional plan to break the cycle of inter-generational poor health outcomes in this region. It was decided that selection of effective health improvement programming must be driven by a comprehensive and deliberate effort to garner input from communities and stakeholders across the region. More than 170 professionals representing 96 health-related agencies volunteered to form steering committees around four topic areas: healthy children and families, population health, mental health and addictions, and research and academics. Each committee was tasked with; 1) providing information to the health systems on regional health priorities, 2) identifying effective approaches to addressing them, and 3) pinpointing opportunities for cross-sector collaboration. Community input was secured by holding meetings in ten area counties using the World Café model; a format chosen to encourage and facilitate discussion between participants around their local community's health concerns. In addition to priority setting for the 10-year plan, cross-sector commitment and community buy-in was established during this process that will serve as the basis for organizational planning of a proposed accountable care community (ACC). Challenges and opportunities uncovered during our efforts to improve regional health outcomes through a collaborative approach may benefit other communities working on similar projects.

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No description available.

Abstract available in the American Journal of Pharmaceutical Education.

It has been well documented that Adverse Childhood Experiences (ACEs) lead to unfavorable outcomes in later life, especially with regard to health and psychological outcomes. Recent research has demonstrated the impact of early childhood adversity on the onset of aggression and illegal behavior. However, often those with mental illness diagnoses with comorbid behavioral problems exhibit trajectories that include both arrest and hospitalization. While some are arrested for their criminal behavior, others are hospitalized. This begs the question: are those with mental illness and behavioral problems more likely to be arrested, or hospitalized, for their early behavioral problems? In the current study, it was hypothesized that arrest precedes hospitalization for the majority of these offenders, and that specific diagnoses of a mental illness are related to outcome. It was also hypothesized that early exposure to environmental adversity, as measured by the age of earliest ACE and total ACE score, would impact whether offenders were arrested or hospitalized first. The data for this study were gathered from comprised sample of 182 adult psychiatric inpatients in a secure forensic facility. Data were archival and retrospective in nature. All participants had been hospitalized following acts of violence or aggression, exhibiting a history of both behavioral problems as well as mental illness. A series of logistic and linear regressions were used to examine the relationship between reason for first admission to a psychiatric facility, diagnosis of a mental disorder, and early childhood adversity to clarify whether early problematic behaviors resulted in initial arrest or psychiatric hospitalization. Results indicate that subjects were much more likely to be hospitalized initially than arrested (33.5% arrested first, 66.5% hospitalized first). A diagnosis of impulse control disorder was significantly related to whether initial incident led to arrest or hospitalization (p=0.030), while the diagnosis Page 54 2016 Appalachian Student Research Forum of ADHD neared significance (p=0.056). No significant relationship was found between incidence of initial arrest or hospitalization and age that drug/alcohol abuse began. Other findings and implications for future research will be discussed.

BACKGROUND: The success of flipped classrooms is dependent upon students' preparation prior to class, the lack of which is the most common challenge associated with this teaching methodology. To mitigate this limitation, it is important to develop and assess methods of engaging learners during pre-class activities. OBJECTIVE: To determine if quiz delivery method (embedded throughout versus after pre-class videos) affects students' knowledge retention, grades, and video viewing behavior. METHODS: Participating students were randomized to take quizzes, either during pre-class videos via Panopto (EQV) or after pre-class videos in the traditional manner via Moodle (TMM). Outcomes assessed included students' knowledge retention, scores on pre- and post-class quizzes, and pre-class video viewing behavior (total views and minutes viewed per student) during a three-week period. Having experienced both quizzing modalities during the semester, the perceptions from students in the EQV group were surveyed. RESULTS: Baseline assessment results of both groups (n = 27 per group) were comparable with a median score of 33% (IQR: 17, 50) in both groups. Performance was also similar on knowledge retention [TMM: 67% (50, 83) vs. EQV: 83% (50, 83)], pre-class quiz scores [TMM: 90% (87, 97) vs. EQV: 93% (90, 95)], and post-class quiz scores [TMM: 93% (80, 100) vs. EQV: 87% (80, 100)], while students in the EQV group had more total views [10 (8, 12)] vs. [5 (2, 11)] and minutes viewed [71 (36, 108) vs. 35 (15, 81)]. Results from the perception survey administered to students in the EQV group (74.1% response rate) indicated a preference for embedded quizzes overall (58%) and for class preparation (75%) when compared with post-video quizzes. CONCLUSION: Students' knowledge retention and performance were similar in both EQV and TMM groups, though students in the EQV group were more engaged with videos and most of them preferred this quiz delivery. Using embedded quizzes for formative rather than summative assessment might be an appropriate mechanism to encourage students' viewing of pre-class videos and their preparation for flipped classes.