Public Health Messages Research Articles

Independent, Stratified, and Joint Associations of Sedentary Time and Physical Activity With Cardiovascular Disease: A Systematic Review.

Recent statistics highlight cardiovascular diseases (CVD) as a major global cause of death. This review examines the methodological approaches and the main results of independent, stratified, and joint association of sedentary time (ST) and physical activity (PA) on CVD outcomes. We searched PubMed, Embase, Web of Science, and Scopus for prospective cohorts that examined the independent, stratified, or joint associations of ST and PA with CVD outcomes. Independent associations were defined as analyses mutually adjusted for PA and ST. Stratified associations were considered when there was a reference group in each stratum of PA or ST, and joint associations were defined by a single reference group for all other combined categories of ST and PA levels. Of 45 articles, 69% explored independent association of ST or PA on CVD outcomes, while 31% using a stratified/joint approach. Most studies used self-reports for ST and PA and focused on CVD mortality. Mutually adjusted analyses identified ST positively and PA inversely associated to CVD outcomes. Stratified studies showed higher ST's pronounced impact on CVD for lower PA levels. High PA mitigated but did not eliminate ST's negative impact. Joint analyses revealed highest CVD risk in those with both high ST and low PA, and elevated risk in various intermediate combinations. Employing independent, stratified, and joint association approaches can yield distinct and complementary public health messages aimed at promoting cardiovascular health. Recommendations should aim to not only to encourage boosting PA levels, but also, concurrently decrease ST.

Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015-2022.

We investigated differences in risk factors and preventive behaviors by age and sex among persons with reported Lyme disease in Ontario, Canada, during 2015-2022. Incidence rates peaked among children 5-9 and adults 50-79 years of age. Median age was higher for female than male case-patients (54 vs. 51 years). Male case-patients reported more activity in wooded and tall grass areas than did female case-patients; fewer male case-patients reported sharing living space with outdoor-exposed companion animals. As age increased, more case-patients reported activity in blacklegged tick habitats, exposure to ticks, and wearing adequate clothing, but fewer reported sharing living space with outdoor-exposed companion animals. Adoption of preventive behaviors was relatively low and did not differ by sex. Male case-patients, children 5-9 years of age and their parents or caregivers, and adults >59 years of age represent populations that would benefit from tailored public health messaging on Lyme disease prevention.

Gaps in Awareness of the United States Minimum Legal Age of E-Cigarette and Cigarette Sales: Implications for Public Health Messaging

PurposeIn 2019, the United States raised the minimum legal age (MLA) of sales for all tobacco products from 18 to 21. Public awareness of the federal MLA of tobacco sales overall and by demographics is understudied. MethodsA national, cross-sectional 2023 survey in which 6,098 participants aged 13–40 years responded to the question, “at which age is it legal to purchase [e-cigarettes; cigarettes; alcohol] in the United States?” Participants also reported age, sex, race/ethnicity, and prior use of each substance. ResultsSixty-one percent, 64.6%, and 88.7% correctly identified the MLA of sales for e-cigarettes, cigarettes, and alcohol, respectively. Differences in awareness of the MLA were found by age, sex, race/ethnicity, and prior use status. DiscussionGaps in awareness of the MLA of tobacco sales, particularly among adolescents and adults, suggest messaging regarding the federal Tobacco 21 law is needed.

Categorizing E-cigarette-related tweets using BERT topic modeling

BackgroundSocial media platforms are critical channels for promoting e-cigarettes, particularly among youth, making analysis of their vast and diverse content essential for public health interventions. Prevalence rates of e-cigarette use are high and evidence suggests that social media are popular forums that promote e-cigarette use through direct and indirect marketing techniques. The volume and diverse nature of e-cigarette-related information on social media is challenging and may obfuscate public health prevention messaging. Traditional hand-coding methods are labor-intensive and limit scalability. In contrast, unsupervised machine learning approaches, such as topic modeling, allow for efficient analysis of large datasets, uncovering patterns and trends that manual methods cannot achieve at scale. The present study focused on ascertaining the extent to which themes and topics in tweets related to e-cigarettes can be successfully rendered into useful homogenous units using machine learning. A better understanding of current depictions and discussions around e-cigarette products and use on social media can inform public health counter messaging and policy interventions. MethodsWe used topic modeling (BERTopic) to iteratively derive vape-related tweet clusters and calculate the importance of particular words to these groupings. We conducted a qualitative content analysis to study clustered tweets. We also sought to determine the geographic locations of e-cigarette conversations using automated geoparsing methods, which translate toponyms in textual data into geographic identifiers, to attempt to infer the location of tweets. ResultsWe were able to successfully identify >100,000 tweets in broad thematic categories in English and Spanish. Our correlation and inter-topic map analysis of the machine-derived topics, which examines the relationships between topics, indicated that most of the topics were unique (correlation value < 0.5) and did not overlap with each other. We identified six topics: Flavors and Disposable Vapes, Cannabis, Vape Shops and Refillable Vapes, Vape Culture, Anti-vaping and Quitting, and Spanish Tweets and Vaping Nicotine. Further analysis of these topics using qualitative methods identified themes within each topic. For example, Category 6 (Spanish Tweets and Vaping Nicotine) included four topics focused on the health risks of vaping, personal motivations for vaping, and the regulation of vaping products. Using geoparsing, which automatically detects location information, we found that the United States had the highest number of tweets related to vaping. Discussion/conclusionResults underscore the possibility of leveraging BERTopic modeling to reduce large quantities of data to comprehensively describe and categorize myriad e-cigarette related messages to which social media users are exposed. This data reduction approach can be applied to various social media platforms to describe and categorize e-cigarette posts and thereby triangulate and validate findings. Thematic content analysis of the topics identified through this technique requires supervision and human inputs. Our approach provides a comprehensive understanding of the evolving e-cigarette discourse, informing public health counter-messaging and policy interventions. Moreover, findings support the need for regulation, such as reducing appealing flavors and suggest that social media can be used effectively to support public health messaging (i.e., quitting messages).

Flavonoid-Rich Foods, Dementia Risk, and Interactions With Genetic Risk, Hypertension, and Depression.

A composite score of flavonoid-rich foods (flavodiet) may provide a clear public health message regarding the range of foods with the potential to lower dementia risk. To examine associations of flavodiet score and intakes of flavonoid subclasses with dementia risk according to genetic risk and presence of depression and hypertension. This prospective, population-based cohort study included dietary data from adults aged 40 to 70 years in the UK Biobank, recruited between 2006 and 2010, with a mean (SD) follow-up of 9.2 (1.5) years. The data analyses were conducted from September 1 to 30, 2023. Flavodiet score adherence and intake of flavonoid subclasses derived from 24-hour computerized dietary assessments. The main outcome was incident all-cause dementia and interactions with genetic risk, hypertension, and depressive symptoms using multivariable Cox proportional hazards regression models. The sample included 121 986 participants (mean [SD] age, 56.1 [7.8] years; 55.6% female; 882 with incident dementia). Comparing the highest with lowest quintile of flavodiet score, consuming 6 additional servings per day of flavonoid-rich foods was associated with a lower risk of dementia among all participants (adjusted hazard ratio [AHR], 0.72; 95% CI, 0.57-0.89), those at high genetic risk (AHR, 0.57; 95% CI, 0.42-0.78), and those with depressive symptoms (AHR, 0.52; 95% CI, 0.33-0.81) after multivariable adjustment. The greatest risk reduction was observed in participants consuming at least 2 of the following per day: 5 servings of tea, 1 serving of red wine, and 0.5 servings of berries, compared with those who did not achieve any of these intakes (AHR, 0.62; 95% CI, 0.46-0.84). Higher intakes of flavonoid subclasses, including anthocyanins, flavan-3-ols, flavonols, and flavones, of which tea, red wine, and berries are the main contributors, supported these findings, showing inverse associations with dementia risk. In this cohort study, high adherence to a flavonoid-rich diet score was associated with a lower risk of dementia, with reductions more pronounced in individuals with a high genetic risk, hypertension, and depressive symptoms. These findings suggest that simple dietary changes of increasing intakes of commonly consumed flavonoid-rich foods and drinks may lower dementia risk.

Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis.

Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government's response to the pandemic to keep the public updated and equip them in protecting themselves. Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies.

Group sex and behavior change associated with the 2022 Mpox outbreak among men who have sex with men in Southern California.

The Monkeypox (Mpox) outbreak disproportionately affected sexually active gay, bisexual, and other men who have sex with men. To understand community-level changes in sexual behavior, we surveyed individuals in a semi-urban area in Southern California. Participants were recruited between October 2022 to April 2023, using palm cards, and geolocation-focused online advertisements on social media and dating apps. Eligible participants were male, ≥18 years, reported sex with men, residents of San Bernardino or Riverside counties, California, Human Immunodeficiency Virus (HIV)-negative, currently not taking pre-exposure prophylaxis (PrEP). Descriptive analyses were performed. Chi-square, Fisher's exact, and Student's T-tests examined the association between group sex behaviors and demographics. We enrolled 91 gay, bisexual, and other men who have sex with men with a median age of 35 years (range 18-70 years). Nearly half reported having participated in group sex in the past year. Overall, 48.9% of group sex participants reported changing their sexual behaviors to prevent Mpox transmission, with limiting the number of sex partners being the most reported prevention strategy (47.6%). To prevent Mpox infection, participants that engage in group sex reported limiting the number of sex partners (34.4%), using condoms for anal sex (16.7%), avoiding crowded social venues (14.3%), and asking partners about Mpox symptoms before sex (9.5%). Survey participants reported modest sexual behavior changes in response to the Mpox outbreak. Group sex may increase the risk for Mpox, HIV, and other sexually transmitted infections; therefore, public health messages should include specific discussion of safer group sex practices in sexual health promotion.

Capturing invisible health threats through augmented reality-based public health messaging: focusing on perceived realism, issue involvement, and message attitudes

ABSTRACT Augmented reality (AR) has been extensively applied to health science education. However, a question still remains as to the optimal way to design AR interfaces to enhance users’ understanding of information that is presented in text format. Utilising the context of indoor air pollution, the current study examines the effects of messages about particulate matter (PM) delivered using different modes of AR visualisation (i.e. overlaying AR visuals onto users’ faces [AR-overlay self] vs. overlaying AR visuals onto users’ surroundings [AR-overlay environment] vs. no use of AR [AR control]). A between-subjects online experiment (N = 306) demonstrated that the AR-overlay environment has a pronounced effect on perceived realism toward 3D-rendered PM, which induced powerful effects on increasing both issue involvement and positive attitudes toward the textual information being presented. Compared to the AR control, the AR-overlay environment demonstrated a serial and positive mediation effect on perceived realism, which subsequently influenced issue involvement and message attitudes. However, overlaying 3D-rendered PM onto one’s face turned out to be a less effective means of eliciting perceived realism. Implications are discussed in the context of how to design effective AR interfaces that can best help users understand health science information.

Does maternal education moderate the relationship between adolescent cannabis use and mental health in early adulthood?

Socioeconomic disadvantage has been associated with cannabis use and poor mental health. It is therefore hypothesised that lower maternal education, a proxy for socioeconomic disadvantage, may increase the risk of cannabis-related mental health and substance use consequences. A total of 5099 participants from the Avon Longitudinal Study of Parents and Children reported cannabis use via questionnaires at 16 or 18. Logistic regression was used to examine the relationship between any and regular (weekly or more) adolescent cannabis use with depression, anxiety, psychotic experiences, and problematic cannabis use at age 24. Maternal education was included as an effect modifier. Missing data were addressed through multiple imputation using chained equations. In total, 36.5% of participants reported adolescent cannabis use and, of these, 14% reported regular use. Adolescent cannabis use was associated with an increased likelihood of anxiety and problematic cannabis use; however, there was little evidence of moderation by maternal education. Regular cannabis use was associated with an increased likelihood of problematic cannabis use, with little evidence of moderation by maternal education. There was weak evidence that the association between regular cannabis use and depression (interaction p-value = 0.024) and anxiety (interaction p-value = 0.056) was stronger in people with high maternal education. Adolescent cannabis use is associated with increased risk of anxiety and cannabis use disorder, but there was insufficient evidence that childhood socioeconomic position (proxied by maternal education) modifies this relationship. Improved public health messages for all adolescents about these risks may be warranted.

Heating or eating? The framing of food and fuel poverty in UK news media

Amidst the cost-of-living crisis the UK news has been increasingly reporting of individuals “choosing between heating and eating,” suggesting overlapping food and fuel poverty (FFP). The media plays a powerful role in establishing narratives, shaping political debates, and even influencing what societies regard as an “issue” or a “public health issue.” Relying on framing theory, this media analysis seeks to better understand how FFP have been constructed relationally in the UK news and how surrounding public health messaging has been employed. Using the NexisLexis database, we searched for UK news articles about intersecting FFP published between January 2010 and April 2022. After double screening, relevant data were extracted from 185 articles and data fragments were coded and analysed. FFP-focused news largely gained momentum in late 2021 into 2022. Two frame categories – descriptive and prescriptive – of FFP were identified. Descriptive frames explained the experience of FFP as a: trade-off between goods (71% of articles), mutual cutback of goods (28%), or just poverty (income/monetary poverty) (1%). Prescriptive frames assigned blame or responsibility to: government (59% of articles), food/fuel industry (13%), community or charity organisations (12%), or individuals (3%). Relatively few (29%) articles linked FFP with health consequences, and none framed it as a health issue. The prominence of the trade-off frame in the UK news suggests that FFP is a crucial topic for the UK public that requires joint attention. Despite the prominence of the government responsibility framing, the frame lacks accompanying prescriptions of consistent, specific, targeted solutions. A public health frame in the UK news may address this gap by outlining potential evidence-based solutions and increasing capacity by appointing responsible actors to help prevent and address this issue.

A Comprehensive Analysis of Skin Cancer Concerns and Protective Practices in Manitoba, Canada, Highlights Lack of Skin Cancer Awareness and Predominance of High-Risk Sun Exposure Behaviors.

The rapidly increasing skin cancer rates in Canada are alarming, with current data estimating that 1/3 of Canadians will be affected in their lifetime. Thus, deeper understanding of high-risk sun exposure behaviors is needed to help counter this trend. Only limited action has been taken by federal/provincial governments to reduce skin cancer incidence. A cross-sectional survey study was conducted in Manitoba, with frequency counts, means, and percentages used to encapsulate responses. Age- and gender-adjusted odds ratios were calculated using logistic regression analyses. Our study identified worrying inadequacies in sun protective behaviors and attitudes, with the threat of such high-risk behaviors amplified by a lack of skin cancer awareness. Alarming elements were noted in participants' sun exposure history (>65% reported a history of sunburns, >50% previously used a tanning bed, and >75% recently tanned for pleasure), beliefs and attitudes (>50% believe that they look better/healthier with a tan, and >40% believe that having a base tan is protective against further sun damage), and sun protection efforts (sun protective clothing was used <60% of the time, sunscreen was used by <50%, and there was a lack of knowledge about sunscreen characteristics in ~30% of respondents), in addition to significant differences being established between demographic subgroups (based on gender, age, skin phototype, income, and education attained). This study provides worrisome insight onto the grim landscape of sun protective behaviors and attitudes in Manitoba, which will inevitably translate into higher skin cancer rates and should serve as a call to action to promote targeted public health messaging in this jurisdiction and beyond.

Patient demographic characteristics and risk factors associated with sun protection behaviours in specialist melanoma clinics.

We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high-risk and specific population subgroups. A cross-sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023. The primary outcome was Sun Protection Habits (SPH) index (a summary score measured as habitual past month use of sunscreen, hats, sunglasses, a shirt with sleeves that covers the shoulders, limiting midday sun exposure and seeking shade, using a Likert scale). The primary analysis considered the SPH index and its component items scored as continuous. Data from 883 people were analysed. Factors associated with less frequent sun protection behaviours overall included male gender, no personal history of melanoma, lower perceived risk, lower calculated 10-year risk of developing melanoma, and no private health insurance. People aged >61 years reported lower use of sunscreen but higher use of hats and sleeved-shirts compared with people in the younger age group. There was no difference in overall sun protection behaviours according to family history of melanoma, country of birth or by lifetime melanoma risk among people without a personal history of melanoma. These findings highlight the potential for targeting high-risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours.

82 - Knowledge of obesity-related cancer risk factors via public health messaging and impact on dietary behaviour

82 - Knowledge of obesity-related cancer risk factors via public health messaging and impact on dietary behaviour

153 ”We’re unburdened” - Audio diaries as a novel and inclusive approach to movement behaviours in mental health

Abstract Physical activity, sedentary time and sleep are traditionally measured with quantitative approaches, limiting the possibility to capture information on type and context of these behaviours. Here, we adopted a flexible approach with audio diaries to explore movement behaviours in people living with severe mental illness (SMI). Audio diaries are an affordable approach, potentially able to overcome health inequalities and literacy levels. However, the use of this method in exploring movement behaviours in mental health is limited. Qualitative data were generated using audio diaries for 7 days with 9 participants experiencing SMI. Semi-structured interviews on the method were performed at the end of data generation. These were conducted online or in-person and analysed using reflexive thematic analysis. This study was grounded ontologically in relativism and epistemologically in constructionism, with an experiential orientation to data interpretation to capture participants’ perspectives of movement behaviours. The protocol for the use of audio diaries has been co-produced with a lived experience advisory panel. Four themes were developed: finding themselves in a “vicious circle” with physical, mental issues impacting movement behaviours and vice versa; daily internal dialogue – repetitive thoughts that attempt to override daily functioning, movement and sleep; “Do not let fatigue win” by pushing through the day – motivation vs commitment; positive AND negative awareness of the importance of movement behaviours. The fluidity in speech enabling an immediate response and the control over how participants recorded their account, led to high acceptability and completion rates. The use of audio diaries was experienced as cathartic in that it helped to reflect upon the challenges in movement behaviours when the emotional load had a severe impact on daily life. Participants showed awareness of the need to be physically active. However, when people faced increased mental or physical burden, this contributed to feelings of frustration, with completion of activities driven by guilt rather than enjoyment. Attention should be given to public health messaging for movement behaviours in mental health with involvement of people with lived experience of SMI. The value of verbalisation with audio diaries could offer an in-depth understanding of processes underpinning health-related behaviours.

Survey study on the Korean quarantine-at-home system for Covid-19: suggestions for improvements.

We examined whether quarantined individuals complied with rules to prevent transmission at home and whether the government provided appropriate support to individuals in quarantine. Between November 2020 and August 2021, we surveyed 198 individuals who had been or were quarantined at home without infection. The online survey results show that respondents experienced difficulties living in close quarters with their cohabitants and had low compliance with in-house hygiene rules. The government needed to provide adequate employment protection, living expense, or care support. Such failures of the system were mainly due to a lack of legal grounds for the government to operate. To improve compliance, the government can amend laws to permit active communication of public health messages with those quarantined at home and provide the necessary support.

The effect of economic downturn, financial hardship, unemployment, and relevant government responses on suicide.

Economic circumstances and related factors, including unemployment and poverty, can have substantial effects on suicide rates. This relationship applies in all countries, irrespective of their World Bank income status or level of development. Therefore, means of mitigating such influences are essential components of strategies to reduce suicides. In this Series paper, we consider examples of such initiatives, including national policies to try to reduce the effect of economic downturns, efforts to maintain employment and avoid damaging austerity measures, maintenance of reasonable minimum wage levels, and specific policies to assist those most affected by poverty. We also highlight upstream measures such as investment in transport infrastructure, industries, and retraining programmes. Positive public health messaging that encourages coping, together with discouragement of media stories with messages that could contribute to hopelessness in those experiencing economic difficulties, can also be important components of strategies to try to reduce the effect of economic downturn on suicide.

Recent and forecasted increases in coccidioidomycosis incidence in California linked to hydroclimatic swings.

Coccidioidomycosis, or Valley fever, is an infectious disease caused by inhalation of Coccidioides spp., fungi found primarily in soils of the southwestern United States. Prior work showed that coccidioidomycosis cases in California sharply increase by nearly 2-fold following wet winters that occur one- and two-years following drought. Statewide drought between 2020-2022 followed by heavy precipitation during the 2022-2023 winter raised concerns over potential increases in coccidioidomycosis cases in the fall of 2023, prompting California Department of Public Health (CDPH) to issue public health alerts. As anticipated, California saw a near record number of cases in 2023, with 9,054 provisional cases reported. During the 2023-2024 California wet season, precipitation was 115% the long-term average, furthering concerns about continued high coccidioidomycosis risk. We developed an ensemble model to forecast coccidioidomycosis cases in California in 2024-2025. Using this model, we predicted a total of 11,846 cases (90% PI: 10,056-14,094) in California between April 1, 2023, and March 31, 2024, encompassing the preliminary state report of 10,593. Our model forecasted 12,244 cases statewide between April 1, 2024, and March 31, 2025 - a 62% increase over the cases reported during the same period two years prior, and on par with the high incidence seen in 2023. The Southern San Joaquin Valley (5,398 cases, 90% PI: 4,556-6,442), Southern Coast (3,322, 90% PI: 2,694-3,961), and Central Coast (1,207 cases, 90% PI: 867-1,585) regions are expected to see the largest number of infections. Our model forecasts that disease incidence will exhibit pronounced seasonality, particularly in endemic regions, with cases rising in June and peaking in November at 1,411 (90% PI: 815-2,172) cases statewide - 98% higher than the peak two years prior (714) and nearly as high as the peak in 2023 (1,462). Near-term forecasts have the potential to inform public health messaging to enhance provider and patient awareness, encourage risk reduction practices, and improve recognition and management of coccidioidomycosis.

Fostering Trust in Public Health Messaging: Tailoring Communication for Rural Parents.

As pandemic-related mistrust of public health recommendations in rural communities may compound gaps in pediatric immunizations, our team explored parents' perceptions of trustworthiness in messaging. Qualitative study using 4 virtual focus groups. Rural Wisconsin. Participants (n = 25) were parents or guardians of children recruited through our contacts with community-based organizations serving rural communities. Researchers used task-oriented elicitation techniques to initiate discussion on the trustworthiness of messengers and messages providing health recommendations. Participants were asked to (1) review existing public health messaging on a range of topics and from a range of sponsors; and (2) rank a list of potential messengers in terms of trustworthiness (eg, local health department, Centers for Disease Control). Discussions were recorded, and audio files transcribed, to facilitate a team-based, thematic analysis. Competency in medical knowledge and parenting experience contributed to estimations of trustworthiness. Participants also responded well to messages and messengers that were able to project recognition of their children's uniqueness and their experience as parents. Participants distrusted messengers who were seen as biased or "one-sided" in their perspectives. For successful health promotion for rural-living parents, messengers must be recognized as "competent" to provide pediatric health advice and to avoid blanket recommendations that may undermine parents' experience and feelings of being "understood" and affect perceptions of trustworthiness.

The role of civil society organizations (CSOs) as community-based knowledge brokers: A qualitative study with CSOs during the first year of the COVID-19 pandemic in Canada

Background: This study explored how civil society organizations in British Columbia, Canada, obtained, shared, and communicated multilingual COVID-19 information with people whose first language is not English. Aim: The aim was to examine civil society organizations’ role as community-based knowledge brokers during the first year of the COVID-19 pandemic. Methods: Commencing in December 2022, virtual semi-structured interviews were conducted with employees from civil society organizations in British Columbia (N=15). Results: Civil society organizations played a crucial role in sharing multilingual information with people whose first language is not English. They amplified public health messages, addressed confusion concerning public health orders, and engaged with community members to better understand and address local needs. Discussion: Civil society organizations contributed to health communication efforts and succeeded in reaching populations overlooked by mainstream communication channels. Conclusions: The COVID-19 pandemic provides an opportunity to reflect on the role of civil society organizations as community-based knowledge brokers that acted as intermediaries to support information-sharing from government public health communications to priority populations. Based on this study’s findings, we propose several recommendations to enhance equity-based preparedness, responses, and re­covery for health emergencies.

Racial and Ethnic Differences in Sodium Sources and Sodium Reduction Behaviors among US Adults: NHANES 2017-2020 pre pandemic.

Background Nearly all US adults exceed sodium recommendations, which increases cardiovascular risk. Understanding racial and ethnic differences in sodium sources and behaviors could lead to nuanced public health messaging, dietary interventions, and clinical guidance to more equitably achieve population-level sodium reduction. Methods Using National Health and Nutrition Examination Survey 2017-2020 pre-pandemic data, racial and ethnic differences in sodium sources and sodium-related behaviors (e.g., salt use at the table and in food preparation, doctor advice to reduce sodium, attempts to reduce sodium, and label reading) were assessed using weighted chi-square. Given the nutrient database?s assumption that rice is salted may be inappropriate for some ethnic groups, we conducted a secondary analysis altering this assumption. Results Pizza, soup, and chicken were top sources of sodium across racial and ethnic groups. For Asian Americans, 4 top sources were unique (e.g., soy-based condiments). Black adults reported the highest rates of reducing sodium (67% vs. 44% among White adults) and receiving physician sodium reduction advice (35% vs.18% among Asian Americans). Asian Americans were the most likely to frequently use salt during food preparation (66% vs. Other Race adults 32%) but reported not using salt at the table (43% vs. 23% among Other Race adults). Assuming rice is unsalted reduces Asian American sodium intake estimates by ~325 mg/day. Conclusions While product reformulation targets and front-of-pack nutrition labeling may help reduce sodium intake across groups, to equitably address sodium intake, culturally appropriate advice on sources of sodium and salt usage may be needed, particularly for Asian Americans.