Health Program Interventions Research Articles

An intervention to determine the effectiveness of the Sanubari optimal health program (OHP) in improving mental well-being among junior doctors in Malaysia: a quasi-experimental study

BackgroundMental health problems among junior doctors in Malaysia pose a significant concern, as they not only adversely affect their overall well-being but also impact the quality of health services they provide. Therefore, it is important to implement interventions aimed at preserving their mental health. This study aimed to evaluate the effectiveness of the Sanubari Optimal Health Program (OHP) intervention in enhancing the mental well-being of junior doctors in Malaysia.MethodsThe study utilised a quasi-experimental design involving 204 junior doctors who participated in the intervention. The Sanubari OHP Intervention Package was employed alongside self-administered questionnaires for mental health and well-being assessment. To evaluate the effects over time, repeated measures ANOVA was employed to analyse within-group and between-group changes in various endpoints, as measured at different assessment time points.ResultsThe study revealed that self-efficacy and adaptive coping behaviours scores increased over time among the intervention group and decreased among the control group. Yet, depression and anxiety scores decreased significantly over time among the intervention group but not in the control group. No significant differences were observed in well-being and maladaptive coping strategies among the groups.ConclusionsThis study showed promising results regarding the effectiveness of Sanubari OHP in improving mental well-being among junior doctors.

Community-Based Intervention and Its Effect on Decreasing the Prevalence of Urinary Schistosomiasis in an Al-Alaqa Male Primary school in Al-Alaqa Village White Nile State, Sudan

Aim of studyThis study assessed the effectiveness of community-based interventions, health awareness, and treatment in controlling schistosomiasis among schoolchildren to improve policies and strategies. MethodsThis pre- and post-intervention study was conducted in an Al-Alaqa male primary school, and systematic simple random sampling was used to investigate 237 participants, which resulted in 132 (55.7%) infected students. The infected and noninfected students (580 students) were treated by delivering the praziquantel doses immediately after the results; after 4 weeks, the infected students received the second dose. After 6 months, the rates were investigated again, and all procedures were performed after the height and weight of the students were recorded according to the protocol. Health education was provided for all participants using posters and leaflets. The data were collected via a questionnaire and urine test. The data were analyzed using SPSS (Statistical Package for the Social Sciences), and ANOVA and t-tests were used to determine the significant differences between the variables. ResultsA urine investigation was conducted on 237 students; 132 (55.7%) had positive results which showed marked improvement and the prevalence in the school decreased to 3.8% after the intervention. The researcher found strong evidence of a relationship between the prevalence of schistosomiasis before the intervention and availability of water in the home (chi-square = 18.331, df = 1, p value = 000). ANOVA showed strong statistical significance (0.002 and F = 6.564) between the mean score of student age and reasons behind going to the pond. ConclusionThis study concluded that mass chemotherapy and treatment were highly effective when associated with a health program intervention. Mass chemotherapy alone may reduce the prevalence of disease for a short time. RecommendationCommunity-based interventions should be applied in schools with an emphasis on health education programs through the training of schoolteachers on investigations for schistosomiasis, treatment with praziquantel, and the provision of materials (microscopes, reagents, and drugs).

The adaptation of a youth mental health intervention to a peer-delivery model utilizing CBPR methods and the ADAPT-ITT framework in Sierra Leone.

Low- and middle-income countries (LMICs) carry a significant proportion of the global burden of untreated mental health disorders. Peer-delivered programs offer LMICs with limited mental health professionals an opportunity to increase mental health service access. This study describes the process of adapting a lay-worker-delivered evidence-based youth mental health intervention to a peer-delivery model in Sierra Leone using participatory methods. We convened Youth Community Advisory Boards (YCABs) as partners to develop a peer-delivery model for an evidence-based intervention. In collaboration with YCABs, the Assessment, Decision, Administration, Production, Topical experts, Integration, Training, Testing (ADAPT-ITT) framework was applied to guide the adaptation. The ADAPT-ITT framework is an eight-step process to adapt evidence-based interventions. The ADAPT-ITT framework facilitated the adaptation of the Youth Readiness Intervention (YRI), an evidence-based mental health program intervention that has been delivered by adult lay-workers to the youth peer-delivery platform in Sierra Leone. The YCABs identified program modifications, including the incorporation of storytelling, refinement of metaphors, and alterations to make delivery more accessible to low-literacy youth with particular attention to gender. YCABs also provided recommendations on how to support youth facilitators in providing psychosocial support, emphasizing self-care and boundary setting to ensure high-quality intervention delivery and do-no-harm principles. Study findings suggest that the ADAPT-ITT framework can be feasibly applied to guide the intervention adaptation process in LMICs. The use of participatory methods generated modifications that reflected youth experiences, needs, and concerns as facilitators and participants. Next steps include refinement and pilot testing of the adapted intervention.

Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial.

The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support. The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program. The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m2 (mean 30.71, SD 2.13 kg/m2). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes. The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7%) in the intervention group versus 1.29 kg (1.5%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups. The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy. German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249. RR2-10.3390/ijerph19031393.

Practical Strategies for Improving Sustainability and Scale-up of Noncommunicable Disease-related Public Health Interventions: Lessons from the Better Health Program in Southeast Asia.

The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance. The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions. We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions. Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively. This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.

Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers.

BackgroundThere is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill.ObjectiveThis study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia.MethodsA qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis.ResultsA total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program.ConclusionsWe recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers.

ANALISIS KECUKUPAN MATERI KURSUS CALON PENGANTIN

The high rate of maternal and infant mortality and the difficulty of AKI and AKB to decrease indicate that maternal health program interventions cannot only be carried out in the downstream part, namely for pregnant women, but also should be drawn upstream in the group of adolescents and young adults to ensure individuals can grow and develop healthy. Today, reproductive health problems in adolescents have not been fully addressed. This can be seen from the still high age of marriage, which amounted to 46.7% ( (Kemenkes, 2010)[i]) and still high births in adolescence (ASFR), which amounted to 48 per 1000 women (IDHS, 2012). Teenagers' knowledge of reproductive health is also still low and the incidence of pregnancy at adolescence is still high at 16.7%. Even though the implementation of thin bride and groom has been carried out by the Ministry of Religion in collaboration with the Health Office.This research is a qualitative descriptive study that will look at how the curriculum is applied in implementing the bride and groom courses, especially the curriculum on reproductive health and pregnancy preparation. The technique of collecting data by indept interview to the Ministry of Religion, DKK and Puskesmas will then be triangulated to prospective brides who have received a bride and groom course. Data will be analyzed using content analysis.The results of the study show that the material that must be delivered is not in accordance with the existing time allocation, there are variations in the implementation of catin class counseling

A psychosocial intervention for individuals with advanced chronic kidney disease: A feasibility randomized controlled trial.

The current study evaluated the feasibility and preliminary efficacy of a psychosocial intervention, the Kidney Optimal Health Program, in reducing symptoms of depression and anxiety in individuals with advanced chronic kidney disease. Patients with stage 4 or 5 chronic kidney disease were randomized to either a nine-session psychosocial intervention programme or usual care. Feasibility was assessed through recruitment and retention rates and programme acceptability. Participants completed assessments of depression, anxiety and psychosocial health at baseline and at 3-, 6- and 12-month follow-up. A repeated-measures analysis of variance was used to compare groups on outcomes over time. One hundred and twenty-eight patients were screened for eligibility; 84 consented to participant and were randomized to receive the intervention (N = 42) or usual care (N = 42). 27 (32.1%) participants withdrew prior to baseline assessment. Of those who completed the baseline assessment (N = 57), trial retention was high (75.4% at 3-month, 80.7% at 6-month and 70.2% at 12-month follow-up). Participants reported high levels of programme acceptability. The patients who completed the intervention (N = 17) demonstrated significantly decreased depression at 12-month follow-up compared to the usual care group (N = 13). The results support the feasibility of the Kidney Optimal Health Program intervention in recruitment, retention and programme acceptability with an improved screening protocol. Preliminary support is provided for improvement in depressive symptoms in patients with advanced chronic kidney disease. Further investigation through a fully powered randomized controlled trial is warranted.

Factors Associated with Under-Five Mortality: A Comparison between Empowered Action Group (EAG) and Non-EAG States of India

Background: In India under-five mortality (U5MR) has declined by 71% from 126 to 37 deaths per 1000 live births between 1990 and 2018. The Empowered Action Group (EAG) states accounts for 74% of the under-five deaths as compared to 26% among Non-EAG states. Method: National Family Health Survey round fourth (NFHS-4), 2015-16 was used for this study. A life table method and Cox Proportional Hazard (PH) model was used to examine the various factors associated with U5MR in EAG and Non-EAG states of India. Result: Overall, it was observed that U5MR is much higher in EAG compared to Non-EAG states. Absolute difference varies according to background characteristics. The highest difference was among mothers who had never breastfed (316 vs 150 U5MR per 1000 live births in EAG & Non-EAG states respectively). Factors—total children ever born to mother, household members, children never breastfed and size of the baby were found to be statistically significantly associated with under-five mortality after controlling for other factors in both EAG and Non-EAG states. Hazard of U5MR was two and half-times higher among birth order 4+ (AHR = 2.5, 95% CI = 1.8 - 3.3) compared to birth order ≤2 after controlling for other factors in EAG states. The risk of under-five mortality was found three times higher among mother having up to primary or no education (AHR = 2.9, 95% CI = 1.4 - 5.9) compared to mother having higher education in non-EAG states. Conclusion: The study revealed that both groups of states need health program interventions focused on high risk mothers, TT immunization and promoting basic health services and breastfeeding practices for the reduction U5MR.

Beliefs, Attitudes, and Practices of Latinas Related to Gestational Weight Gain: A Qualitative Meta-Synthesis.

Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic. Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas. Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008). The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.

Factors Influencing Unintended Pregnancies amongst Adolescent Girls and Young Women in Cambodia.

Background: Unintended pregnancies in Cambodian youth are a major reproductive health concern with detrimental personal and socioeconomic consequences. A social ecological model was used to identify sociodemographic factors potentially associated with unintended pregnancies, and an analysis of data from the 2014 Cambodian Demographic and Health Survey was used to determine associations. Methods: Weighted data were analysed using multiple logistic regression analyses for 3406 Cambodian sexually active single, in union or married females aged 15–29 years. Results: The prevalence of unintended pregnancy was 12.3%. Unintended pregnancy was significantly associated with younger age groups (15–24 years), multiparity, history of abortion, and current use of modern contraceptive methods. All women had an increased likelihood of unintended pregnancy when the husband alone or someone else in the household made decisions about their access to healthcare. Conclusion: The burden of unintended pregnancies is associated with young age, multiparity, history of abortions, unemployment, and low autonomy for accessing healthcare. Multi-pronged, holistic reproductive and sexual health program interventions are needed to increase literacy and accessibility to modern contraception and to raise awareness about women’s health and status in Cambodia.

Health and Lifestyle Modification for Reducing Severity of Cardio-metabolic Risk in Individuals With Metabolic Syndrome: Findings From the MODERN Rrial

Background: Metabolic syndrome (MetS) predisposes individuals to increased risk of developing type 2 diabetes and/or cardiovascular disease (CVD). Nurse facilitated interventions are effective for the management of chronic disease. Aim: To determine if nurse-led clinics implementing a health and lifestyle modification program (intervention) are more beneficial than standard care (control) to reduce the concurrence of cardio-metabolic risk factors over 24 months follow up. Methods: A multi-centre, RCT in regional Victoria was conducted for people aged 40–70 years with MetS and no evidence of CVD or other chronic disease. Presence of ≥3 risk factors including central obesity, low HDL or high triglycerides or high blood pressure (BP) and dysglycaemia were randomised to intervention or control groups. Change in risk factors were compared and MetS status evaluated using a novel severity score. Results: Follow up data were available for 241 of 276 (87%) randomised participants. Average age was 57 ± 8 years and 62% were women. BP decreased significantly more among intervention than control participants (by 7/3 mmHg, p < .001). While improvements were seen in body weight, lipids and blood glucose, no significant group differences occurred. MetS prevalence was sharply reduced in 56% (intervention) and 48% (controls; p = .246) and MetS severity scores decreased significantly more in the intervention group than control group (−1.07 vs. −0.50, p < .01). Conclusion: Independent community nurse clinics can be effective in reducing the aggregate severity of cardio-metabolic risk factors. Determinants of change, cost effective analyses and progression to type 2 diabetes and CVD onset will be reviewed.

The Community as Patient: Assessing Needs for Public Health Program Planning and Intervention

Will know how to: complete a community health assessment utilizing the MAPP framework, conduct public health interventions based on an assessment of community needs and strategic health improvement planning.

Teens as Teachers in the Garden: Cultivating a Sustainable Model for Teaching Healthy Living

School gardens are an ideal space to deliver a healthy living curriculum, such as nutrition and physical activity education, to elementary school youth. However, public schools often lack the resources and support to establish sustainable garden-based programming. We created the Healthy Living Ambassador program, a collaborative after-school garden program in low-income communities that brought together resources from schools, community programs, and University of California Cooperative Extension. This school garden program featured culturally competent teens as teachers to serve as near-peer educators and mentors to elementary school youth. The program development model incorporated lessons from sustainable community-based health program interventions and essential elements of teens-as-teachers programs. We share the program logic model and discuss the successes and challenges of this program model that we encountered while developing a long-term, maintainable community garden program to teach healthy living.

Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries.

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a “buffering” of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24–59 mo (N = 2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24–35 mo) compared to oldest age group (48–59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings.

A Profile of Biomass Stove Use in Sri Lanka

A large body of evidence has confirmed that the indoor air pollution (IAP) from biomass fuel use is a major cause of premature deaths, and acute and chronic diseases. Over 78% of Sri Lankans use biomass fuel for cooking, the major source of IAP in developing countries. We conducted a review of the available literature and data sources to profile biomass fuel use in Sri Lanka. We also produced two maps (population density and biomass use; and cooking fuel sources by district) to illustrate the problem in a geographical context. The biomass use in Sri Lanka is limited to wood while coal, charcoal, and cow dung are not used. Government data sources indicate poor residents in rural areas are more likely to use biomass fuel. Respiratory diseases, which may have been caused by cooking emissions, are one of the leading causes of hospitalizations and death. The World Health Organization estimated that the number of deaths attributable to IAP in Sri Lanka in 2004 was 4300. Small scale studies have been conducted in-country in an attempt to associate biomass fuel use with cataracts, low birth weight, respiratory diseases and lung cancer. However, the IAP issue has not been broadly researched and is not prominent in Sri Lankan public health policies and programs to date. Our profile of Sri Lanka calls for further analytical studies and new innovative initiatives to inform public health policy, advocacy and program interventions to address the IAP problem of Sri Lanka.

Measuring Effectiveness of Health Program Intervention in the Field

Improving and sustaining successful public health interventions relies increasingly on the ability to identify the key components of an intervention that are effective, to identify for whom the intervention is effective, and to identify under what conditions the intervention is effective. Bayesian probability an “advanced” experimental design framework of methodology is used in the study to develop a systematic tool that can assist health care managers and field workers in measuring effectiveness of health program intervention and systematically assess the components of programs to be applied to design program improvements and to advocate for resources. The study focuses on essential management elements of the health system that must be in place to ensure the effectiveness of IMNCI intervention. Early experiences with IMNCI implemented led to greater awareness of the need to improve drug delivery, support for effective planning and management at all levels and address issues related to the organization of work at health facilities. The efficacy of IMNCI program from the experience of experts and specialists working in the state is 0.67 and probability of effective- ness of all management components in the study is 58%. Overall the standard assessment tool used predicts success of around 39% for the IMNCI intervention implemented in current situation in Rajasthan. Training management component carried the highest weight-age of 21% with 73% probability of being effective in the state. Human resource management has weight-age of 13% with 53% probability of being effective in current scenario. Monitoring and evaluation carried a weight-age of 11% with only 33% probability of being effective. Operational planning carried a weight-age of 9% with 100% probability of being effectively managed. Supply management carried a weight-age of 8% with zero probability of being effective in the current field scenario. In the study, each question that received low score identifies it as a likely obstacle to the success of the health program. The health program should improve all sub-components with low scores to increase the likelihood of meeting its objectives. Public health interventions tend to be complex, programmatic and context dependent. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of the intervention, and relative success or failure of the intervention itself. We advocate management attributes incorporation into criteria for appraising evidence on public health interventions. This can strengthen the value of evidence and their potential contributions to the process of public health management and social development.

Measuring Effectiveness of Health Program Intervention in the Field

Measuring Effectiveness of Health Program Intervention in the Field

Improving short-term sun safety practices among adolescent survivors of childhood cancer: a randomized controlled efficacy trial

Skin cancer is one of the most common secondary neoplasms among childhood cancer survivors. However, little evidence exists for effective interventions to promote sun safety behaviors within this population. This small-scale randomized controlled trial examined the efficacy of the Survivor Health and Resilience Education (SHARE) Program intervention, a multiple health behavior change intervention designed to increase sun safety practices among adolescent survivors of childhood cancer. Adolescent survivors of childhood cancer (11-21 years) were randomly allocated to a group-based behavioral intervention (n = 38) or wait-list control (n = 37). Self-reported sun safety behaviors were assessed using a valid, 8-item scale at baseline and 1-month post-intervention. Controlling for baseline sun safety, gender, and seasonal influences, intervention participants reported significantly more sun safety practices (e.g., using sunscreen, reapplying sunscreen regularly) at 1-month post-intervention than control participants (B = 2.64, 95% CI = 1.02, 4.27, p = 0.002). The results suggest that SHARE was efficacious in producing improvements in short-term self-reported sun safety practices among adolescent survivors of childhood cancer. Future research is needed to build upon this work by incorporating objective measures of sun safety behaviors and examining intervention durability. Behavioral interventions addressing lifestyle factors, including sun safety behaviors, among adolescent survivors of childhood cancer should be integrated into long-term care to reduce the risk for secondary malignancies and diseases.

Efficacy of the Survivor Health and Resilience Education (SHARE) program to improve bone health behaviors among adolescent survivors of childhood cancer.

The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention--a manualized, behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer. Participants were 75 teens aged 11-21 years, one or more years post-treatment, and currently cancer-free. Teens were randomized to a group-based intervention focusing on bone health or a wait-list control. Bone health behaviors were assessed at baseline and 1-month post-intervention. Controlling for baseline outcome measures and theoretical predictors, milk consumption frequency (p=0.03), past month calcium supplementation (p<0.001), days in the past month with calcium supplementation (p<0.001), and dietary calcium intake (p=0.04) were significantly greater at 1-month follow-up among intervention participants compared with control participants. The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer. Research examining long-term intervention effectiveness is warranted.