Medicine and Health Sciences Commons^™

“For Lack Of Knowledge, Our People Will Perish”: Using Focus Group Methodology To Explore African-American Communities’ Perceptions Of Breast Cancer And The Environment, Kaleea Lewis, Shibani Kulkarni, Swann Arp Adams, Heather M. Brandt, Jamie R. Lead, John R. Ureda, Delores Fedrick, Chris Mathews, Daniela B. Friedman

Faculty Publications

Among women living in the United States, breast cancer is the second leading cause of cancer death. Disproportionate racial disparities in breast cancer exist, with African American (AA) women consistently having the highest rates of breast cancer related mortality despite lower incidence. This study attends to the Institute of Medicine's (IOM) call to action recommending the identification of effective strategies for communicating accurate and reliable breast cancer risk information to diverse audiences. Using focus group methodology, this study explores how AAs perceive and decipher information related to breast cancer and its relationship to their environment. Six focus groups were conducted. …

Walkable Urban Design Attributes And Japanese Older Adults' Body Mass Index: Mediation Effects Of Physical Activity And Sedentary Behavior, Mohammad Javad Koohsari, Andrew T. Kaczynski, Tomoki Nakaya, Ai Shibata, Kaori Ishii, Akitomo Yasunaga, Ellen W. Stowe, Tomoya Hanibuchi, Koichiro Oka

Faculty Publications

Purpose: The purposes of this study were to examine associations between objectively measured walkable urban design attributes with Japanese older adults’ body mass index (BMI) and to test whether objectively assessed physical activity and sedentary behavior mediated such associations.

Design: Cross-sectional.

Setting: Matsudo City, Chiba Prefecture, Japan.

Participants: Participants were 297 older residents (aged 65-84 years) randomly selected from the registry of residential addresses.

Measures: Walkable urban design attributes, including population density, availability of physical activity facilities, intersection density, and access to public transportation stations, were calculated using geographic information systems. Physical activity, sedentary behavior, and BMI were measured objectively. …

Hpv-Related Cancer Prevention And Control Programs At Community-Based Hiv/Aids Service Organizations: Implications For Future Engagement, Lisa T. Wigfall, Shalanda A. Bynum, Heather M. Brandt, Neethu Sebastian, Marcia G. Ory

Faculty Publications

People living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and, men who have sex with men (MSM) are disproportionately affected by genital warts and cancers caused by human papillomavirus (HPV). We assessed community-based HIV/AIDS service organizations' (ASOs) staff awareness, knowledge, attitudes, and beliefs about HPV and effective cancer prevention tools, namely HPV vaccination, Pap, and HPV tests. The potential engagement of ASO staff in future efforts to reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM was explored. In May-June 2016, staff were recruited from three ASOs located in the South United States Census …

A Mobile Smoking Cessation Intervention For Mexico (Vive Sin Tabaco... ¡Decídete!): Single-Arm Pilot Study, Ana Paula Cupertino, Francisco Cartujano-Barrera, Mariana Ramírez, Rosibel Rodríguez-Bolaños, James F. Thrasher, Gloria Pérez-Rubio, Ramcés Falfán-Valencia, Edward F. Ellerbeck, Luz Myriam Reynales-Shigematsu

Faculty Publications

Background: Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico.

Objective: This study aimed to assess the feasibility and acceptability of an innovative, personalized, and interactive smoking cessation mobile intervention developed for Mexican smokers.

Methods: We recruited 40 Mexican smokers to participate in Vive sin Tabaco... ¡Decídete!, a smoking cessation program that uses a tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text …

Concentrations Of Nicotine, Nitrosamines, And Humectants In Legal And Illegal Cigarettes In Mexico, Ariela Braverman-Bronstein, James F. Thrasher, Luz Myriam Reynales-Shigematsu, Mauricio Hernández-Ávila, Tonatiuh Barrientos Gutierrez

Faculty Publications

Background: Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers.

Methods: Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene …

Proposing A Transactional Model Of Ehealth Literacy: Concept Analysis, Samantha R. Paige, Michael Stellefson, Janice L. Krieger, Charkarra Anderson-Lewis, Jeewon Cheong, Christine Stopka

Faculty Publications

Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and …

A Requirement For Slc15a4 In Imiquimod-Induced Systemic Inflammation And Psoriasiform Inflammation In Mice, Alexis D. Griffith, Asifa K. Zaidi, Ashley Pietro, Matthew Hadiono, Jessica S. Yang, Rachel Davis, Daniel L. Popkin

Faculty Publications

There is competing evidence that plasmacytoid dendritic cells (pDC), the most potent source of IFN-I, may initiate psoriasis. We targeted pDC function using the slc15a4 loss-of-function mouse whose pDC are unresponsive to TLR agonists. slc15a4 treated with the topical TLR7-agonist imiquimod (IMQ) demonstrated decreased epidermal thickening 24 hours post-treatment which was more pronounced by day 5 as compared to wildtype mice. These findings were specific to the acute IMQ model and not the protracted IL23 model that drives inflammation downstream of TLR activation. Systemically, slc15a4 was required for IMQ-induced weight loss and cutaneous accumulation of CD4+ and Siglec H+, but …

Exploring The Impact Of Efficacy Messages On Cessation-Related Outcomes Using Ecological Momentary Assessment, Victoria Lambert, Stuart G. Ferguson, Jeff Niederdeppe, David Hammond, James W. Hardin, Jim Thrasher

Faculty Publications

Introduction:
Observational studies indicate that cigarette package inserts with efficacy messages about the benefits of quitting (i.e. response efficacy) and recommendations for successful cessation increase smokers’ self-efficacy to quit and promote sustained cessation. However, the effects of inserts with such efficacy messages have not been studied using experimental designs. This study used ecological momentary assessment (EMA) to assess smokers’ responses to efficacy inserts.

Material and Methods:
In a randomized case-crossover study among smokers from the United States (n=23), participants received a one-week supply of cigarettes with efficacy inserts and a one-week supply without any inserts, and were randomized to use …

Evaluation Of Self-Report Adherence Measures And Their Associations With Detectable Viral Load Among People Living With Hiv (Plhiv) In China, Wendi Da, Xiaoming Li Ph.D., Shan Qiao Ph.D., Yuejiao Zhou, Zhiyong Shen

Faculty Publications

Objectives Self-report antiretroviral therapy (ART) adherence has been consistently associated with clinical outcomes. This study aims to compare the accuracy of self-report ART adherence measures with varying recall timeframes or item contents to predict virological response.

Methods Data from a cross-sectional study among 2146 participants on ART in Guangxi, China were used. Detectable viral load was defined as viral load > 50 copies/ml. Adherence was measured using the number of days on which all doses were taken in the past month (i.e., the “one-month days taken” measure), the number of days on which any dose was missed in the past month …

Large-Scale Social And Behavior Change Communication Interventions Have Sustained Impacts On Infant And Young Child Feeding Knowledge And Practices: Results Of A 2-Year Follow-Up Study In Bangladesh, Sunny S. Kim, Phuong Hong Nguyen, Lan Mai Tran, Tina Sanghvi, Zeba Mahmud, Mohammad Raisul Haque, Kaosar Afsana, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Background: Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010-2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity. Objective: We assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + …

Attitudes Toward Evidence-Based Practice, Occupational Stress And Work-Related Social Support Among Health Care Providers In China: A Sem Analysis, Shan Qiao Ph.D., Xiaoming Li Ph.D., Yuejiao Zhou, Zhiyong Shen, Bonita Stanton

Faculty Publications

Individuals’ attitudes toward evidence-based practices (EBP) are critical in adopting, implementing and maintaining the EBP in clinical settings. Multiple empirical studies have examined how work context may shape perceptions and attitudes towards EBP. The current study aims to further explore how both work and family contexts, as assessed by three psychosocial indicators (i.e., occupational stress, work-related social support from coworkers, and work-related social support from family), may affect attitudes toward EBP among health care providers in HIV clinics in China. We analyzed cross-sectional survey data from 357 health care providers recruited from 40 HIV clinics across 16 cities/counties in Guangxi …

Engagement Of Husbands In A Maternal Nutrition Program Substantially Contributed To Greater Intake Of Micronutrient Supplements And Dietary Diversity During Pregnancy: Results Of A Cluster-Randomized Program Evaluation In Bangladesh, Phuong Hong Nguyen, Edward A. Frongillo Jr., Tina Sanghvi, Gargi Wable, Zeba Mahmud, Lan Mai Tran, Bachera Aktar, Kaosar Afsana, Silvia Alayon, Marie T. Ruel, Purnima Menon

Faculty Publications

Background:

Although husbands may provide support during pregnancy, limited evidence exists on how to promote husbands' engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh.

Objectives:

We evaluated 1) the impact of a nutrition-focused MNCH program, compared with the standard MNCH program, on husbands' behavioral determinants (i.e., awareness, knowledge, self-efficacy) and support to wives to adopt optimal nutrition practices and 2) how much of the previously documented impact on women's supplement intake and dietary diversity was explained by husbands' behavioral …

Smokers' Neurological Responses To Novel And Repeated Health Warning Labels (Hwls) From Cigarette Packages, Johann F. Fridriksson, Chris Rorden, Roger D. Newman-Norlund, Brett Froeliger, Jim Thrasher

Faculty Publications

Graphic health warning labels (HWLs) depicting bodily injury due to smoking are effective for producing changes in affect, cognition and smoking behavior in adult smokers. However, little is known about the effects of repeated presentation of graphic HWL’s on the aforementioned processes. The goal of this study was to examine neural and behavioral responses to graphic HWL’s and evaluate whether the repeated presentation of graphic HWL’s leads to repetition suppression (RS). Smokers (N = 16) performed an event-related HWL cue task while blood oxygen level dependent (BOLD) signal was collected during a functional magnetic resonance imaging (fMRI) experimental session. Consistent …

Disclosure Of Homosexual Behaviors To Healthcare Providers And Uptake Of Hiv Testing For Men Who Have Sex With Men: A Systematic Review., Shan Qiao Ph.D., Guangyu Zhou, Xiaoming Li

Faculty Publications

To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients’ sexual behaviors. Otherwise, HCPs may overlook MSM’s risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in …

Best Practices For Developing And Validating Scales For Health, Social, And Behavioral Research: A Primer, Godfred O. Boateng, Torsten B. Neilands, Edward A. Frongillo Jr., Hugo R. Melgar-Quiñonez, Sera L. Young

Faculty Publications

Scale development and validation are critical to much of the work in the health, social, and behavioral sciences. However, the constellation of techniques required for scale development and evaluation can be onerous, jargon-filled, unfamiliar, and resource-intensive. Further, it is often not a part of graduate training. Therefore, our goal was to concisely review the process of scale development in as straightforward a manner as possible, both to facilitate the development of new, valid, and reliable scales, and to help improve existing ones. To do this, we have created a primer for best practices for scale development in measuring complex phenomena. …

Cohort Profile: The Maternal And Infant Nutrition Interventions In Matlab (Minimat) Cohort In Bangladesh, Shams El Arifeen, Eva-Charlotte Ekström, Edward A. Frongillo Jr., Jena Hamadani, Ashraful I. Khan, Ruchira T. Naved, Anisur Rahman, Rubhana Raqib, Kathleen M. Rasmussen, Katarina Ekholm Selling, Yukiko Wagatsuma, Lars Åke Persson

Faculty Publications

No abstract provided.

Dietary Diversity Predicts The Adequacy Of Micronutrient Intake In Pregnant Adolescent Girls And Women In Bangladesh, But Use Of The 5-Group Cutoff Poorly Identifies Individuals With Inadequate Intake, Phuong Hong Nguyen, Lieven Huybregts, Tina G. Sanghvi, Lan Mai Tran, Edward A. Frongillo Jr., Purnima Menon, Marie T. Ruel

Faculty Publications

Background: The Minimum Dietary Diversity for Women (MDD-W) indicator based on a 10-food group women dietary diversity score (WDDS-10) has been validated to assess dietary quality in nonpregnant women. Little is known about its applicability in pregnant women, and specifically pregnant adolescent girls with higher nutrient requirements. Objectives: This study aimed to 1) compare the adequacy of micronutrient intakes between pregnant adolescent girls and women, 2) examine the performance of WDDS-10 in predicting the mean probability of adequacy (MPA) of 11 micronutrients, and 3) assess how well the MDD-W cutoff of 5 groups performed in pregnant adolescent girls and women. …

Which Type Of Tobacco Product Warning Imagery Is More Effective And Sustainable Over Time?, Dien Anshari, Hua-Hei Yong, Ron Borland, Kamala Swayampakala, Jim Thrasher

Faculty Publications

Objective This study examined smokers’ responses to pictorial health warnings (PHWs) with different types of imagery under natural exposure conditions.

Methods Adult smokers from online panels in Canada (n=2357), Australia (n=1671) and Mexico (n=2537) were surveyed every 4 months from 2012 to 2013. Participants were shown PHWs on packs in their respective countries and asked about: (1) noticing PHWs; (2) negative affects towards PHWs; (3) believability of PHWs; (4) PHW-stimulated discussions; and (5) quit motivation due to PHWs. Country-specific generalised estimating equation models regressed these outcomes on time (ie, survey wave), PHW imagery type (ie, symbolic representations of risk, suffering …

Importance Of Coverage And Quality For Impact Of Nutrition Interventions Delivered Through An Existing Health Programme In Bangladesh, Phuong Hong Nguyen, Edward A. Frongillo Jr., Tina Sanghvi, Sunny S. Kim, Silvia Alayon, Lan Mai Tran, Zeba Mahmud, Bachera Aktar, Purnima Menon

Faculty Publications

Understanding implementation of interventions is critical to illuminate if, how, and why the interventions achieve impact. Alive & Thrive integrated a nutrition intervention into an existing maternal, neonatal, and child health (MNCH) programme in Bangladesh, documenting improvements in women's micronutrient supplement intake and dietary diversity. Here, we examined how well the nutrition intervention was implemented and which elements of implementation explained intervention impact. Survey data were collected in 2015 and 2016 from frontline health workers (FLW) and households in areas randomized to nutrition‐focused MNCH (intensified interpersonal counselling, community mobilization, distribution of free micronutrient supplements, and weight‐gain monitoring) or standard MNCH …

Reducing High-Users’ Visits To The Emergency Department By A Primary Care Intervention For The Uninsured: A Retrospective Study, Meng-Han Tsai, Sudha Xirasagar, Scott Carroll, Charles S. Bryan, Pamela J. Gallagher, Kim Davis, Edward C. Jauch

Faculty Publications

Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus postmean annual visit rates and discharge emergency severity index (ESI; triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) …

Antenatal Care Satisfaction In A Developing Country: A Cross-Sectional Study From Nigeria, Dumbiri J. Onyeajam, Sudha Xirasagar, Mahmud M. Khan, James W. Hardin, Oluwole Odutolu

Faculty Publications

Background

Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization.

Methods

Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider’s interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied.

Results

Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, …

Antenatal Care Satisfaction In A Developing Country: A Study From Nigeria, Dumbiri J. Onyeajam, Sudha Xirasagar, Mahmud M. Khan, James W. Hardin, Oluwole Odutolu

Faculty Publications

Background: Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization.

Methods: Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider’s interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied.

Results: Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, …

Factors Associated With Quit Attempts And Smoking Cessation In Brazil: Findings From The International Tobacco Control Brazil Survey, Leticia Casado, Jim Thrasher, Cristina Perez, Luiz Claudio Thuler, Geoffrey T. Fong

Faculty Publications

Background:
In Brazil, the treatment of tobacco dependence is available at no cost. This study aimed to identify factors associated with attempting to quit and of successful smoking cessation in a population-based sample of Brazilian smokers.

Methods:
Data came from the first two waves of the International Tobacco Control (ITC) Brazil Survey, conducted in 2009 and 2012/2013 in three cities: Rio de Janeiro, São Paulo, and Porto Alegre. Prospective cohort data were collected from 488 adults (≥18 years) who smoked at Wave 1 who were resurveyed at Wave 2. Crude and adjusted relative risks (RR) for two outcomes (making a …

Integrating Nutrition Into Health Systems At Community Level:Impact Evaluation Of The Community‐Based Maternal Andneonatal Health And Nutrition Projects In Ethiopia, Kenya, And Senegal, Jacqueline K. Kung'u, Richard Pendame, Mame Bineta Ndiaye, Mulusew Gerbaba, Sophie Ochola, Adama Faye, Sulochana Basnet, Edward A. Frongillo Jr., Sara Wuehler, Luz Maria De‐Regil

Faculty Publications

Maternal undernutrition and mortality remain high in several African countries. Key nutrition andhealth interventions improve maternal and birth outcomes. Evidence is scarce on how tostrengthen health systems to ensure pregnant women and newborns are reached with theseinterventions. We conducted three quasi‐experimental nonrandomized Community BasedMaternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenyato demonstrate how proven nutrition interventions could be integrated into health programs toimprove knowledge and practices during pregnancy, birth, and postpartum. We evaluated impacton knowledge and practices related to maternal and neonatal care using logistic regression andrepeated‐measures models with districts as a fixed variable …

Sociocultural And Health System Factors Associated With Mortality Among Febrile Inpatients In Tanzania: A Prospective Social Biopsy Cohort Study, Michael E. Snavely, Michael J. Maze, Charles Muiruri, Lilian Ngowi, Flora Mboya, Julia Beamesderfer, Glory F. Makupa, Anthon G. Mwingwa, Bingileki F. Lwezaula, Blandina T. Mmbaga, Venance P. Maro, John A. Crump, Jan Ostermann, Matthew P. Rubach

Faculty Publications

Introduction Communicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Tanzania.

Methods We interviewed febrile inpatients to determine prevalence of barriers in seeking or receiving care and grouped these barriers using the Three Delays model (delays at home, in transport and at healthcare facilities). We assessed 6-week mortality and, after matching on age, gender and severity of illness, measured the association between delays and mortality using conditional logistic regression.

Results We enrolled 475 children, …

Facilitators And Barriers For Hiv-Testing In Zambia: A Systematic Review Of Multi-Level Factors, Shan Qiao Ph.D., Yao Zhang, Xiaoming Li Ph.D., J. Anitha Menon

Faculty Publications

It was estimated that 1.2 million people live with HIV/AIDS in Zambia by 2015. Zambia has developed and implemented diverse programs to reduce the prevalence in the country. HIVtesting is a critical step in HIV treatment and prevention, especially among all the key populations. However, there is no systematic review so far to demonstrate the trend of HIV-testing studies in Zambia since 1990s or synthesis the key factors that associated with HIVtesting practices in the country. Therefore, this study conducted a systematic review to search all English literature published prior to November 2016 in six electronic databases and retrieved 32 …

Testing Cessation Messages For Cigarette Package Inserts: Findings From A Best/Worst Discrete Choice Experiment, Jim Thrasher, Farahnaz Islam, Rachel E. Davis, Lucy Popova, Victoria Lambert, Yoo Jin Cho, Ramzi G. Salloum, Jordan Louviere, David Hammond

Faculty Publications

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed …

Can Integrated Interventions Create The Conditions That Support Caregiving For Better Child Growth?, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

No abstract provided.

Teens As Teachers In The Garden: Cultivating A Sustainable Model For Teaching Healthy Living, Virginia Bolshakova, John Gieng, C. Sheena Sidhu, Mary Vollinger, Lorena Gimeno, Jessica Guild

Faculty Publications

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 …