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Improvements to Female Autonomy and Household Decision-Making Power from an Intervention Targeting Improved Food Security: A Gender-Based Analysis of the Rajasthan Nutrition Project

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Health 2021年第2期13卷 188-203页

作者： Lindsay M. Belvedere Siena F. Davis Bobbi L. Gray benjamin T. crookston Department of Public Health Brigham Young University Provo UT USA Grameen Foundation Washington USA

In India, women and children continue to experience food insecurity. The purpose of this study is to evaluate whether the Rajasthan Nutrition Project (RNP) led to changes in 1) dietary habits and nutrition, and 2) indicators of gender equality, female autonomy, and empowerment. This study surveyed women belonging to self-help groups who were pregnant or who had young children. Over the course of the intervention, significant improvements were seen in the following indicators: breastfeeding within one hour of birth, exclusively breastfeeding for the first six months, food insecurity of children and mothers, household decision-making, communication, mobility, and domestic violence. These findings suggest that the RNP is a promising intervention for improving nutrition and female autonomy in Rajasthan, India. Additional research is needed to determine if the RNP would be equally as effective in other regions of India, or in populations outside of India.

关键词： India Rajasthan Female Autonomy Food Security Maternal and Child Health

Using Teacher Goal Boards to Promote Healthy Eating and Physical Activity among Elementary Students

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Health 2015年第11期7卷 1448-1459页

作者： P. Cougar Hall Josh H. West benjamin T. crookston Yvonne Allsop Department of Health Science Brigham Young University Provo UT USA

Background: The purpose of this study was to explore the feasibility and understand the potential impact on elementary students’ perceptions of, and intentions related to, healthy eating and physical activity when their classroom teacher sets and shares goals related to these health behaviors. Methods: Participants in this study included 16 teachers and 229 students of grades 3 - 6 at a large elementary school in the Western United States. Participating students were surveyed before and after a six-week intervention conducted by classroom teachers that consisted of a weekly displaying of Teacher Goal Boards in a prominent classroom location and sharing of goals set for the week. Teacher reports of the previous week’s goals occurred each Monday prior to sharing and posting of new goals for the new week. Results: Respondents reported significantly higher post-test values for over half of pre-post comparisons. Respondents were more likely to intend to be physically active (post = 52.6% vs. pre = 39.0%, p = 0.003), to eat nutritious foods (52.0% vs. 36.4%, p = 0.001), and to maintain a healthy body weight (62.8% vs. 52.2%, p = 0.022). Similar results were found for summary measures. Intention to be physically active, to eat healthy, to maintain a healthy weight, as well as descriptive norms for physical activity and perception and value of personal health behaviors were all significantly higher at post-test. Discussion: This study and its findings are significant because teacher participants were able to significantly and positively impact on students’ behavioral intent, subjective norms, and perception and value of personal health behaviors amongst students without spending additional time on formal health promotion and education instruction. Conclusion: Schools should incentivize and encourage faculty and staff to engage in a variety of health behaviors to improve both personal health outcomes and role model health behaviors for students.

关键词： Health Education Health Behavior School Health Nutrition Physical Activity Elementary Students

Perceptions of Body Mass Index as a Valid Indicator of Weight Status among Adults in the United States

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Health 2019年第5期11卷 578-591页

作者： Brenden E. Garrett Joshua H. West benjamin T. crookston P. Cougar Hall Department of Public Health Brigham Young University Provo USA

Background: Being overweight or obese increases risk for heart disease, stroke, type 2 diabetes, joint disease, and certain cancers. The Body Mass Index (BMI) is commonly used to determine weight status. As rates of overweight and obesity have risen sharply in the United States over the past 30 years, perceptions of a “normal” or healthy weight are subject to change. The purpose of this study was to analyze perceptions of BMI as an indicator of weight status. Methods: An online survey was administered to 376 US adults. The survey collected demographic information including height, weight, and perceived weight status (underweight, healthy weight, overweight and obese). The survey software calculated and presented participants with their personal BMI values. Participants then answered questions about their perception of the BMI as a valid indicator of weight status. Results: More participants reported a healthy weight status (51.6%) than were classified as such according to their computed BMI (43.6%). The majority of the sample (85.1%) considered BMI to be a valid indicator of weight status, although perceptions of validity varied by weight status. Participants that perceived BMI to be invalid most commonly cited incongruence with one’s perception of their own body weight, no accounting for unique body shapes, and no accounting for additional muscle mass. Conclusion: BMI is generally perceived to be a valid indicator of weight status. These perceptions of validity can vary depending on the individuals’ actual weight status. In instances where perceptions are not favorable toward BMI, it is largely attributable to opinions of incongruence with BMI and body shape, type, or composition. Continued use of BMI as a preliminary tool for determining weight status appears to be accepted. Efforts to increase BMI-related awareness and education may be necessary for individuals that currently see it as invalid.

关键词： Body-Mass Index (BMI) Overweight Obesity Weight Status

Technology for health: A qualitative study on barriers to using the iPad for diet change

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Health 2013年第4期5卷 761-768页

作者： Cameron Lister Joshua H. West Rickelle Richards benjamin crookston Parley Cougar Hall Alisha H. Redelfs Department of Health Science Brigham Young University Provo USA Department of Nutrition Dietetics and Food Science Brigham Young University Provo USA Division of Health Promotion and Behavioral Sciences School of Public Health The University of Texas Health Science Center at Houston El Paso USA

Emergence of tablet computers has led to interest in their use to impact health-related behaviors of users. However, little is known regarding which devices are most effective for changing these behaviors, and whether or not these devices or accompanying applications (apps) are feasible or desired vehicles for behavior change. Four focus groups were conducted with students from a Western university who were given iPads to download diet-related apps. Participants were asked questions about preferences regarding iPad functionality, app functionality, and the likelihood of using apps and iPads for facilitating diet-related behavior change in the future. Two key themes emerged from focus group discussions on diet-related apps for iPads and their usefulness to facilitate behavior change. The first theme, lack of iPad practicality, contained three subthemes: inconvenient mid-way technology, internet access barriers, and smart-phone preference. The second theme that emerged was attitudes towards apps in general. Three subthemes were identified under the second theme: too intensive;positive functions not specific to iPads;and lack of reliable/trustworthy information. This paper is the first, to this author’s knowledge, to report the use of qualitative methods to study the practicality of using apps and iPads in changing dietrelated behaviors. Early generations of iPads may not be effective devices for facilitating behavior change among college students;and diet-related apps seem to have poor functionality that lead to cessation of use.

关键词： iPads Diet-Related Behavior Change Qualitative Methods Technology and Health Behavior Change

Factors Associated with Accessing ICDS Services among Women in Rural Rajasthan, India

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Health 2018年第10期10卷 1271-1282页

作者： Siena F. Davis Hannah E. Payne Cassidy A. Hine Bobbi L. Gray benjamin T. crookston Department of Public Health Brigham Young University Provo UT USA Freedom from Hunger Davis CA USA

Background: The Integrated Child Development Services (ICDS) Scheme, launched in 1975 by the Government of India, provides various health services to children and their mothers at ICDS centres. Objectives: The purpose of this study is to understand 1) the extent to which women living in Rajasthan, India utilize services provided by ICDS centres and 2) the factors that are associated with their use. Methods: Freedom from Hunger and Freedom from Hunger India Trust, in collaboration with two local partners in Rajasthan, India, conducted a baseline assessment with 403 pregnant women and women with young children belonging to self-help groups to compare use of ICDS centres with key demographic variables and measures of poverty, food security and nutrition, curative care related to diarrhea, coping strategies, and household decision-making. Results: The results revealed that households that accessed ICDS services were more likely to report receiving nutrition information from ICDS centres, to purchase ORS in the last year, and to give oral rehydration solution (ORS) to children who had diarrhea. Women who decide how much food to serve each family member or spend money without discussing it first with someone else were more likely to receive benefits from ICDS centres. Those who spoke with their spouse about household nutrition needs were less likely to report accessing ICDS services. Conclusion: Interventions aimed at increasing utilization of ICDS centres in this region may find it beneficial to increase female participation in health care decisions, likely through spousal communication and gender relations.

关键词： India Integrated Child Development Services (ICDS) Scheme Anganwadi Centres Maternal Health Child Health

Addressing Communications Campaign Development Challenges to Reduce Stunting in Indonesia

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Health 2018年第12期10卷 1764-1778页

作者： Cougar Hall Ahmad Syafiq benjamin crookston Cudjoe Bennett Muhamad R. Hasan Mary Linehan Joshua West Scott Torres Kirk Dearden Department of Public Health Brigham Young University Provo Utah USA Faculty of Public Health Universitas Indonesia Depok Indonesia IMA World Health Washington DC USA IMA World Health Jakarta Indonesia IMA World Health Dares Salaam Tanzania

One in four children under 5 years of age in the developing world are stunted (chronically malnourished). Reducing stunting can be a challenge, especially in populous countries where families are dispersed, as is the case in Indonesia. This paper describes how one government project (Indonesia’s National Nutrition Communication Campaign [NNCC]) delivered effective behavior change communications interventions that reached 40 million people. This paper focuses on four challenges that nutrition campaigns often face and provides useful lessons for similar campaigns, based on the experience of NNCC, which include the following: 1) Fully engaging stakeholders at all levels in campaign design and implementation ensured broad-based support for stunting reduction efforts;2) Pro-actively involving journalists in nutrition campaigns improved public opinion about stunting and positively influenced decision-making in policy formulation;3) Use of humorous public service announcements with limited technical information was effective in engaging priority populations;and 4) Social media (YouTube ads, web advertorials, Facebook pages, Twitter, Instagram) extended the campaign’s reach and reinforced messaging from other sources. Based on NNCC’s experience, specific recommendations are provided.

关键词： Global Health Promotion Stunting Indonesia Communications Campaign

Are Participants in a Behavior Change Communication Campaign More Likely to Seek Care for Childhood Diarrhea? A Study of Caregivers of Children under 2 in Tanzania

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Health 2022年第3期14卷 342-354页

作者： Britton Reher Shelly Cooper Generose Mulokozi Janaya Brown Heather Merrill Mary Linehan Kirk Dearden Scott Torres benjamin crookston Josh West Cougar Hall Department of Public Health Brigham Young University Provo USA IMA World Health Washington DC USA RTI International Washington DC USA

Stunting remains a particular challenge in Sub-Saharan Africa. Despite encouraging declines in Tanzania over the past 25 years, one-third of Tanzanian children under the age of five years are stunted. Diarrhea remains one of the greatest causes of childhood stunting worldwide. Mass media has been used to improve the uptake of behaviors associated with reductions in diarrhea. This study evaluates the effectiveness of a mass media campaign in the Lake Zone region of Tanzania from 2015-2020 and positive changes in caregiver health-seeking behaviors related to diarrhea in children. Approximately 5000 households participated in a cross-sectional survey after a communications campaign. Exposure variables included hearing and seeing radio and TV spots and participating in a variety of interpersonal communication approaches. Study results indicated primary caregivers (mothers) exposed to media messages only (OR 1.66, CI 1.05 - 2.62), and to media messages and interpersonal communication (OR 2.51, CI 1.48 - 4.26), were more likely to seek advice or treatment for diarrhea from a health facility. Primary caregivers exposed to both media messages and interpersonal communication were more likely to give oral rehydration salts (OR 2.56, CI 1.72 - 3.79), zinc tablets/syrup (OR 1.74, CI 1.18 - 2.57), and homemade fluids (OR 2.02, CI 1.15 - 3.55) when their children had diarrhea. Male heads of household (fathers) exposure to mass media was not associated with care-seeking for diarrhea treatment.

关键词： Tanzania Diarrhea Diarrheal Treatment Stunting Mass Media Communication Campaign

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Health 2018年第9期10卷 1250-1260页

作者： Joshua West Ahmad Syafiq benjamin crookston Cudjoe Bennett Muhamad R. Hasan Kirk Dearden Mary Linehan Cougar Hall Scott Torres Department of Public Health Brigham Young University Provo UT USA Faculty of Public Health Universitas Indonesia Depok Indonesia IMA World Health Washington DC USA IMA World Health Jakarta Indonesia IMA World Health Dar es Salaam Tanzania

Background: Stunting in young children continues to be a major concern in developing country settings, including middle income countries like Indonesia. Early intervention is critical to prevent increased morbidity and mortality, lower cognitive functioning, and diminished productivity in adulthood. Mothers may benefit from knowledge and information related to stunting causes and effects. Indonesia has readily adopted a variety of platforms, which are now being used to disseminate health information. The purpose of this study was to address two related research questions: 1) What are the primary sources of Indonesian mothers’ stunting-related knowledge? 2) What factors are associated with using these various platforms to access stunting-related information? Method: Mothers (n = 745) responded to questions about demographics and the source of stunting knowledge, which included hospitals, the Internet, midwives, posyandu (community health posts), and puskesmas (public health centers). Multivariate logistic regression was used to identify factors associated with mothers’ reported use of the three most common sources to acquire information about stunting, including posyandu, puskesmas and the Internet. Results: Eighty percent of mothers in this study sample used posyandu, 31.7% puskesmas, and 16.9% used the Internet as a source for stunting-related knowledge. For the three most common sources, factors associated with each included not accessing the other sources. Conclusions: Indonesian mothers are using a variety of platforms and services to acquire information about stunting. These sources are different one from another and each may be an important resource for disseminating health information, especially outside of urban centers. Results from this study may help to identify characteristics of Indonesian mothers who could benefit from acquiring stunting-related information in these formats. Each of these sources of information appears to be utilized by different group

关键词： Indonesia Internet Nutrition Knowledge Posyandu Puskesmas Stunting

Water, Sanitation, and Hygiene Factors Associated with Child Illness in Tanzania

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Health 2019年第6期11卷 827-840页

作者： Marco Verdeja Kendra Thomas Gina Dorsan Megan Hawks Kirk Dearden Nancy Stroupe Taylor Hoj Josh West benjamin crookston Mangi Ezekial Cougar Hall Department of Public Health Brigham Young University Provo USA IMA World Health Dar es Salaam Tanzania IMA World Health Washington DC USA School of Public Health and Social Sciences Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania

Water, sanitation, and hygiene (WASH) are critical to ensuring health and preventing disease in Tanzania where approximately one-third of childhood deaths are related to poor hygiene. This study explored associations between WASH practices and childhood illness. Data came from a cross-sectional survey of 5000 female caregivers living in the Lake Zone region of Tanzania. Measures included self-reported presence of fever, diarrhea, cough and various WASH factors. Multiple logistic regressions were used. Thirty-seven percent of children experienced fever, 26% diarrhea, and 11% cough in the previous two weeks. Unimproved toilets were positively associated with fever (OR 1.25, CI 1.03 - 1.53, p < 0.05) and animal enclosures were negatively associated with diarrhea (OR 0.76, CI 0.61 - 0.96, p < 0.05). Unsafe disposal of a child’s stool was associated with both fever (OR 0.77, CI 0.67 - 0.89, p < 0.05) and diarrhea (OR 1.18, CI 1.0 - 1.38, p < 0.05). Eating soil was associated with both fever (OR 2.02, CI 1.79 - 2.29, p < 0.05) and diarrhea (OR 2.23, CI 1.95 - 2.57, p < 0.05). Eating chicken feces was associated with both fever (OR 2.07, CI 1.66 - 2.58, p < 0.05) and diarrhea (OR 2.38, CI 1.9 - 2.98, p < 0.05). Water shortages were associated with fever (OR 1.21, CI 1.07 - 1.36, p < 0.05) and cough (OR 1.48, CI 1.22 - 1.81, p < 0.05). Policy makers and program designers should consider increasing access to water and sanitation to improve children’s health.

关键词： Tanzania Water Sanitation Hygiene Childhood Illness