ABSTRACT Background Universities are well suited for tobacco-free advocacy efforts; university tobacco policy can change social norms around tobacco use, reduce secondhand smoke exposure, and help prevent occasional tobacco users from transitioning to daily use. Purpose This study took place in 2019 at a Midwestern public regional comprehensive university as part of a campaign to update campus tobacco policy. Researchers sought to increase the visibility of tobacco waste on campus under the current policy. Methods Researchers invited undergraduate students to create collages using nonhazardous tobacco waste collected on campus and participate in focus group discussions about their experiences. After verbatim transcription, researchers conducted template analysis to identify key themes. Results Undergraduate students (N = 16) shared concerns about human health and the natural environment on campus. Though students were passionate about reducing tobacco use on campus, they were uncertain that policy changes would be effective. Discussion In addition to engaging students in advocacy, policy change, and research, collages were displayed on campus and via social media. Students were able to create art to express their feelings about tobacco use and contribute to successful efforts to update university policy. Translation to Health Education Practice Collage can be an effective way to elicit discussion and create powerful visuals to use in advocacy. Engaging young adults in policy advocacy as students and increasing their civic engagement may help them develop skills and self-efficacy for advocacy activities in the future.

ABSTRACT Today’s health education professionals are faced with a host of complex issues which are exacerbated by a polarized political climate. The public health challenges of our time invite us to develop creative strategies, interventions, and programs, and to enter into healthy and productive dialogue with legislators, colleagues, and those we serve. One tactic for engaging in these processes is utilizing the power of “and” in health education practice and policy. To that end, the purpose of this paper is to present a rationale for “and” and its use as a method for effective health education practice and policy and to provide specific examples for applying this method.

ABSTRACT Background Approximately 12% of U.S. adults have mobility limitations, a group that may be at increased risk for poor bone health. Despite the importance of bone mineral density (BMD) as an indicator of skeletal health, recent syntheses of how BMD has been examined in this population are lacking. Purpose To examine the literature regarding BMD among people with specific mobility limitations including spinal cord injuries (SCIs). Methods MEDLINE, PubMed, and CINAHL were searched for studies published between 2014 and 2025. Twenty-five studies met the inclusion criteria. Results Studies consistently reported lower BMD in people with mobility limitations compared to those without mobility limitations. People with higher severity and duration of disability had lower BMD. Physical activity exerted a positive influence on BMD. Limitations of studies examined included small sample sizes and underrepresentation of female participants. Discussion Evidence indicates consistently reduced BMD and elevated osteoporosis burden among adults with mobility limitations, with low BMD risk enhanced by severity and duration of disability and modifiable behaviors. Translation to Health Education Practice Findings support targeted screening, tailored physical activity promotion, nutrition and risk factor counseling, and advocacy for research and programs that adequately represent women and incorporate sex-specific assessment of bone health needs.

ABSTRACT Background Nutrition practices are increasingly moving online with the rise of digital health tools. However, the limitations of fully digital approaches demand hybrid solutions. Purpose The purpose of this study was to examine the effectiveness of phygital (physical and digital) nutrition approach, which blends physical and digital strategies, in improving dietary adherence among adults with obesity or overweight. Methods A total of 432 responses were analyzed, with a body mass index of more than 25. A quantitative and cross-sectional research design was used. This design was used to measure variables in a systemic way, where statistical generalization is probable. Results The findings of this study show that behavior change is more likely to last when digital tools are combined with in-person support that helps individuals with obesity in promoting nutrition-related positive behavior change. Discussion The study indicates that combining in-person support with digital tools improves dietary adherence through strengthening self‑efficacy, whereas excessive dependence on digital delivery alone may decrease motivation. Translation to Health Education Practice This study guides Health Educators toward hybrid approaches in prevention of obesity. It also guides Health Educators to monitor digital overload, so that technology stays at the background as a support and human connection remains central.

ABSTRACT Background Time spent in physical activity (PA), sedentary behavior (SB), and sleep has distinct effects on health and may change across adolescence. Purpose To identify movement behavior (MB) profiles among adolescents and examine changes in profiles membership over one school year. Methods Students, part of the Movimente Program, self-reported time spent on sports and non-sports PA, recreational screen time (e.g. smartphone), and sleep. Latent transition analysis identified behavioral profiles and assessed membership transition. Results The sample included 609 adolescents (52.9% girls; age ± sd: 13.0 ± 1.01). Five profiles emerged: (1) “Inactive and unplugged” (n = 144; 23.6%), (2) “Sport practitioners” (n = 48; 7.9%), (3) “Smartphone users” (n = 230; 37.8%), (4) “Gamers” (n = 160; 19.0%), (5) “Non-sport Movers” (n = 71; 11.7%). Most adolescents (n = 458; 75.2%) remained in the same profile over time. A higher number of adolescents transitioned to profile (3) “Smartphone users” (n = 46) and profile (4) “Gamers” (n = 36). Conclusions Profiles reflected a blend of healthy and unhealthy behaviors, underscoring the complexity of MB patterns. Translation to Health Education Practice This study assists Health Educators in designing tailored interventions based on adolescents’ behavior trajectories, allowing them to target the behaviors most in need of change and ensuring school-based interventions are relevant, engaging, and effective.

ABSTRACT Background Individual differences in hope are associated with mental and physical health, academic achievement, and career success. However, little is known regarding how hope develops and changes over time. Theory and empirical evidence support the notion that central figures [parents, teachers, peers] are imperative for fostering hope in children/adolescents, although mechanism(s) for hope installment from central figures to youth is unknown. Purpose We hypothesized that behavioral engagement in school would mediate the relationship between various sources of school-related social support and changes in hope for adolescents. Methods This study utilized two-wave longitudinal data from a sample of 555 middle school students. Results Behavioral engagement fully mediated the association between perceived social support from teachers and hope, while behavioral engagement partially mediated the association between perceived social support for learning from family and changes in hope. Despite increasing involvement with middle school peers, peer support at school was not associated with students’ hope differences. Discussion Results imply that teacher and family support for learning promote hope in adolescents, partially, by facilitating school engagement. Translation to Health Education Practice Study results have implications for school and behavioral health professionals in promoting behavioral engagement, school-related social support and hope for adolescents.

ABSTRACT Background Energy drinks (EDs) are a broad category of beverages that typically include high levels of caffeine along with taurine, simple sugars, inositol, B vitamins, flavorings, preservatives, and acidity regulators. Purpose This study aimed to assess how the Theory of Planned Behavior explains energy drink consumption among college students in the Kurdistan Region of Iraq, examining the effects of attitude, subjective norms, and perceived behavioral control on consumption intentions and behavior, and the influence of past consumption on recent use. Methods This cross-sectional study was conducted among 726 participants at Raparin University between September 2025 and December 2025. Results The mean age of the students was 21.03 years (95% CI: 20.87, 21.18). Compared to non-consumers, student consumers reported significantly more positive attitudes, stronger subjective norms, and higher intention to consume energy drinks. Discussion The discussion emphasizes constructs of the Theory of Planned Behavior and energy drink consumption, situating the findings within a broader theoretical framework. Translation to Health Education Practice This study supports the role of health educators in monitoring behavioral trends, planning future programs, and assessing the success of subsequent health education initiatives within college settings by offering baseline data on energy drink consumption and its psychosocial correlates.

ABSTRACT Background Cognitive anxiety and its associated physical symptoms are common among university students during exams. However, limited research has explored this issue within African higher education, particularly in Morocco. Purpose This study examined the relationship between cognitive anxiety and physical symptoms among Moroccan university students. Methods A cross-sectional correlational design was employed with 213 students from different academic levels. Data were collected using the Spielberger Test Anxiety Inventory (TAI). Reliability was evaluated through Cronbach’s alpha and McDonald’s omega. Analyses included Pearson’s correlation and simple linear regression using SPSS and JASP. Results The TAI showed good internal consistency (α = 0.870; ω = 0.866 for cognitive anxiety and α = 0.866; ω = 0.867 for physical symptoms). A strong positive correlation was observed between cognitive anxiety and physical symptoms (r = 0.673, p < .001). Regression results indicated that cognitive anxiety significantly predicted physical symptoms (β = 0.512, R2 = 0.453, F = 175.066, p < .001). Discussion Findings highlight the substantial physical impact of cognitive anxiety during exams. Translation to Health Education Practice Health education programs should include mental health support and stress-reduction strategies to enhance students’ well-being.

ABSTRACT Sudden Infant Death Syndrome (SIDS), often referred to as “crib death,” remains a leading cause of postneonatal mortality in the United States. This commentary synthesizes current guidance from the American Academy of Pediatrics (AAP) and public health resources to illustrate how an AI-powered avatar, paired with animation, can serve as an innovative patient-and-family education tool to promote infant safe sleep practices, counter misinformation, and support harm reduction. By grounding content in the Triple Risk Model and aligning with AAP 2022 recommendations, avatars can deliver interactive, culturally responsive education that addresses diverse literacy levels and emotional needs. Features such as conversational guidance, interactive prompts, and visual demonstrations can help caregivers understand and adopt safe sleep behaviors. This commentary discusses considerations for health literacy, cultural and linguistic accessibility, clinical integration, and barriers and facilitators to adoption, as well as strategies to ensure acceptability and feasibility. Proposed outcomes include increased caregiver knowledge and awareness, shifts in perceived benefits and risks, improved compliance with safe sleep guidelines, enhanced engagement, and robust safety measures. This approach leverages best practices in combating health misinformation while tailoring content to meet families where they are.

ABSTRACT Background The increasing prevalence of sedentary behavior in college and university settings highlights the need to explore alternative solutions, such as active desk. However, little is known about the impact of using active desks on other lifestyle habits, such as nutrition. Purpose To examine how cycling desks at light and moderate intensity affect energy intake and food preferences during academic tasks among university students. Methods Using a randomized crossover design, 18 university students completed tasks under three conditions: seated, light-intensity cycling, and moderate-intensity cycling. Energy intake was measured using an ad libitum buffet. Visual attention to food categories was assessed with eye tracking. Results The cycling moderate-intensity was associated with greater consumption of low-fat sweet foods, particularly sugar-sweetened beverages. Participants also showed increased fixation time on these items, although not statistically significant. Overall, there were no significant differences in total energy or macronutrient intake between conditions. Discussion This study contributes to the literature by demonstrating that while cycling desks do not significantly alter overall energy intake, moderate-intensity activity increases the consumption of low-fat sweet foods. Translation to Health Education Practice Findings suggest the need to integrate nutritional guidance when implementing active desk interventions on campus to support student health.