The path to good health: Shifting the dialogue and promoting social ecological thinking.

The purpose of our research was to assess whether an intervention could produce changes in critical consciousness (CC) relative to participants' understanding of social influences on health and individual health behaviors. The intervention was a 4-min animation, entitled The Path to Good Health , that described how factors in our social environment influence individuals in a variety of ways and thereby our health. We used the same sampling and intervention strategies with two discrete cohorts of participants (Initial study: June 2018, n = 249; Retest study: October 2019, n = 315), who were recruited and incentivized through Amazon's Mechanical Turk platform. We measured direction and extent of change from pre-to post-intervention in four key constructs of CC (Passive Adaptation, Emotional Engagement, Cognitive Awakening, and Intentions to Act) using the 4-Factor Critical Consciousness Scale (4-FCCS), and we investigated differential effects of the intervention related to demographics of participants, including political typology. We also assessed concurrent and predictive validity of the (4-FCCS). Changes of CC subscale scores from pretest to posttest moved in the expected direction in both the Initial and Retest studies; Cohen's d effect sizes were medium to very large in both studies. Overall, findings suggest the video intervention was effective at improving CC among participants drawn from the general population. We demonstrated that it is possible to influence people's cognitive-emotional interpretations in as little as 4 min, regardless of one's political ideology, and that the (4-FCCS) is sufficiently sensitive to measure changes in CC. This study provides preliminary evidence that a brief intervention can broaden cognitive-emotional interpretations from an over-emphasis on personal responsibility for individual health to an appreciation of the impact of social ecological factors on population health.

Development and validation of the 4-Factor Critical Consciousness Scale.

Assessment of critical consciousness among individuals can provide a proxy measure of the readiness of communities, and individual decision-makers within, for social changes that address root causes of ill health. Critical consciousness, as conceived by Paolo Freire, emerges as a consequence of praxis. This iterative, recursive process of reflection and co-created knowledge enables community members to identify salient issues and the actions they want to take to address those issues. Public health and other social science researchers who engage in social- and population-level intervention work need a validated instrument that measures critical consciousness. Our purpose was to develop an instrument that can measure 4 key constructs of critical consciousness (passive adaptation, emotional engagement, cognitive awakening, and intentions to act) in an individual, relative to any salient community issue. We conducted two studies (Initial: June 2018; Retest: October 2019) to develop and validate this instrument. The same sampling strategy was used for both studies, but each study was conducted with a discrete cohort of participants. We used Amazon's Mechanical Turk to recruit and incentivize study participants. Data from the Initial study were used in an iterative process to evaluate construct validity and test our theoretical assumptions. Exploratory factor analyses were used to determine the best model fit that gave the greatest subscale reliability and validity. In the Retest study, confirmatory factor analysis was conducted and construct validity was verified. Our results indicated adequate construct validity as evidenced by good model fit. Additionally, the good fit of the data to the 4-factor structure confirmed our theoretical understanding of critical consciousness.

Revisiting the Roots and Aims of Photovoice.

Since its introduction, photovoice has been implemented in numerous fields with a wide array of outcomes of interest, but has the method been implemented in a way that is consistent with its initial aims in mind? From Caroline Wang and Mary Ann Burris's initial 1994 project, photovoice has demonstrated power to harness visual imagery and stories within a participatory empowerment process and established a new tool for the profession for understanding community members' lived experience and needs, raising the critical consciousness of communities, and advocating for actions leading to social change. Based in Freirean philosophy, feminist theory, and documentary photography, photovoice engages community members to identify, represent, and change their community by means of photography, dialogue, and action. Public health can benefit when researchers and practitioners more carefully conceptualize the intended aims of each photovoice effort. The purpose of this article is to consider the varied applications of photovoice and propose a classification system that encapsulates its wide-ranging aims. Close examination of foundational literature and previous applications of photovoice suggest the following categories for framing the application of the method; specifically, photovoice for (a) photovention, (b) community assessment, (c) community capacity building, and (d) advocacy for change. Full implementations of photovoice have the capacity to illuminate complex real-world issues leading to advocacy for policy, systems, and environmental change. It is our hope that the proposed framing clarifies the language used to discuss photovoice and its outcomes, distinguishes its various uses and stated aims, and maximizes its impact in future applications.

The Photovoice Decision Tree: Legal Considerations and Ethical Implications for Photographs and Captions.

This article presents a photovoice decision tree that serves as a guide for making lawful and ethical decisions during the portions of the photovoice process that involve photograph selection, caption development, and public display of photographs and captions. Lawful and ethical considerations encompass privacy of person, privacy of place, illegal acts and obscenity, defamation, representation of truth versus actual malice, and opinion versus assertion of fact, but do not address pursuing and obtaining institutional review board approval for photovoice projects and/or other important steps of photovoice projects that are beyond the scope of this article. The decision tree presumes that a comprehensive photo release process was completed with all photovoice participants and collected from any individual captured within a photograph. The decision tree has important implications for research and practice, including movement of photovoice practitioners beyond the required institutional review board approval for research projects to consider lawful and ethical issues associated with photograph selection, caption development, and public display of photographs and captions. This decision tree can serve as a meaningful tool for all photovoice practitioners and participants to guide their lawful and ethical decisions.

Rethinking Addiction.

Addiction is a complex and challenging condition with many contributing factors. Although addictive behaviors appear to be individual choices, behavior alterations cannot be addressed successfully without considering characteristics of the physical and social environments in which individuals live, work, and play. Exposure to chronic psychosocial stressors and the physiological response of individuals to their external environment activates the brain's neuroendocrine hypothalamic-pituitary-adrenal axis, with profound conditioning effects on behavior. This brief synopsis describes the social determinants of health; examines the interconnectedness of the psychosocial environment, behavior, and subsequent health outcomes; discusses the environment's critical influence on brain plasticity, adaptation and functioning; and explores additional factors that complicate adolescent addiction. Because the environment is both a determinant of behavior and an opportunity for intervention, in the context of addictions, it is important to incorporate these factors in the analysis of risk and design of early interventions for prevention and amelioration of addiction.

Human microbiota, blood group antigens, and disease.

Far from being just "bugs in our guts," the microbiota interacts with the body in previously unimagined ways. Research into the genome and the microbiome has revealed that the human body and the microbiota have a long-established but only recently recognized symbiotic relationship; homeostatic balance between them regulates body function. That balance is fragile, easily disturbed, and plays a fundamental role in human health-our very survival depends on the healthy functioning of these microorganisms. Increasing rates of cardiovascular, autoimmune, and inflammatory diseases, as well as epidemics in obesity and diabetes in recent decades are believed to be explained, in part, by unintended effects on the microbiota from vaccinations, poor diets, environmental chemicals, indiscriminate antibiotic use, and "germophobia." Discovery and exploration of the brain-gut-microbiota axis have provided new insights into functional diseases of the gut, autoimmune and stress-related disorders, and the role of probiotics in treating certain affective disorders; it may even explain some aspects of autism. Research into dietary effects on the human gut microbiota led to its classification into three proposed enterotypes, but also revealed the surprising role of blood group antigens in shaping those populations. Blood group antigens have previously been associated with disease risks; their subsequent association with the microbiota may reveal mechanisms that lead to development of nutritional interventions and improved treatment modalities. Further exploration of associations between specific enteric microbes and specific metabolites will foster new dietary interventions, treatment modalities, and genetic therapies, and inevitably, their application in personalized healthcare strategies. This article is categorized under: Laboratory Methods and Technologies > Metabolomics Translational, Genomic, and Systems Medicine > Translational Medicine Physiology > Mammalian Physiology in Health and Disease.

Hypertension in Low-Income Adolescents.

Disadvantaged adolescents are at higher risk for undiagnosed and untreated obesity and hypertension. Using nurse-measured weight, height, and blood pressure (BP) as well as self-reported age and activity/lifestyle behaviors, we assessed the prevalence of obesity and hypertension in 573 adolescent patients aged 13.0 to 17.9 years (females: n = 267, 46.6%; males: n = 306, 53.4%) from a clinic serving low-income, ethnically diverse pediatric patients. Body mass index distribution was as follows: 11, underweight (1.9%); 330, healthy weight (57.6%); 105, overweight (18.3%); and 127, obese (22.2%). The age-adjusted height percentile was normally distributed, but distribution by BP category was 326 normotensive (56.9%), 147 prehypertensive (25.7%), 60 with stage 1 hypertension (10.5%), and 40 with stage 2 hypertension (7.0%). Activity and lifestyle behaviors did not adequately explain obesity and hypertension rates. Efforts to prevent/reduce childhood overweight, obesity, and hypertension in underserved populations need to include dietary education, weight control interventions, and physical activity programs specifically tailored to overweight/obese youth and parents.

Blood type biochemistry and human disease.

Associations between blood type and disease have been studied since the early 1900s when researchers determined that antibodies and antigens are inherited. In the 1950s, the chemical identification of the carbohydrate structure of surface antigens led to the understanding of biosynthetic pathways. The blood type is defined by oligosaccharide structures, which are specific to the antigens, thus, blood group antigens are secondary gene products, while the primary gene products are various glycosyltransferase enzymes that attach the sugar molecules to the oligosaccharide chain. Blood group antigens are found on red blood cells, platelets, leukocytes, plasma proteins, certain tissues, and various cell surface enzymes, and also exist in soluble form in body secretions such as breast milk, seminal fluid, saliva, sweat, gastric secretions, urine, and amniotic fluid. Recent advances in technology, biochemistry, and genetics have clarified the functional classifications of human blood group antigens, the structure of the A, B, H, and Lewis determinants and the enzymes that produce them, and the association of blood group antigens with disease risks. Further research to identify differences in the biochemical composition of blood group antigens, and the relationship to risks for disease, can be important for the identification of targets for the development of nutritional intervention strategies, or the identification of druggable targets. WIREs Syst Biol Med 2016, 8:517-535. doi: 10.1002/wsbm.1355 For further resources related to this article, please visit the WIREs website.

Risk Factors in Adolescent Hypertension.

Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.