Digital Literacy Training for Low-Income Older Adults Through Undergraduate Community-Engaged Learning: Single-Group Pretest-Posttest Study.

BACKGROUND: Digital technology is a social determinant of health that affects older people's ability to engage in health maintenance and disease prevention activities; connect with family and friends; and, more generally, age in place. Unfortunately, disparities in technology adoption and use exist among older adults compared with other age groups and are even greater among low-income older adults. OBJECTIVE: In this study, we described the development and implementation of a digital literacy training program designed with the dual goals of training low-income older adults in the community and teaching students about aging using a community-engaged learning (CEL) approach. METHODS: The training program was embedded within a 10-week CEL course that paired undergraduates (N=27) with low-income older adults (n=18) for 8 weeks of digital literacy training. Older adults and students met weekly at the local senior center for the training. Students also met in the classroom weekly to learn about aging and how to use design thinking to train their older adult trainees. Both older adults and students completed pre- and posttraining surveys. RESULTS: Older adults demonstrated increased digital literacy skills and confidence in the use of digital technology. Loneliness did not change from pre to postassessment measurements; however, older adults showed improvements in their attitudes toward their own aging and expressed enthusiasm for the training program. Although students' fear of older adults did not change, their comfort in working with older adults increased. Importantly, older adults and students expressed positive feelings about the trainee-trainer relationship that they formed during the training program. CONCLUSIONS: A CEL approach that brings together students and low-income older adults in the community has a strong potential to reduce the digital divide experienced by underserved older adults. Additional work is needed to explore the efficacy and scalability of this approach in terms of older adults' digital literacy as well as other potential benefits to both older and younger adults.

Home-prepared meals among college students at-risk for food insecurity: A mixed-methods study.

The ability to prepare meals at home is an important life skill with potential to improve dietary quality and reduce costs and thus may be particularly important for college students with food insecurity. However, heavy time demands, limited financial resources, and therefore other barriers such as lack of motivation to follow a healthy diet may constrain meal preparation skills. To gain greater insight into this issue, we conducted a mixed-methods study. The quantitative component assessed relationships among food security, motivation, and meal preparation skills. The qualitative component used focus groups to more closely consider college students' perceptions, values, and barriers surrounding preparing meals at home, including current practices, desired future practices, and the ways in which the campus could support their efforts. The survey (n = 226) assessed food security, meal preparation skills, and motivation (i.e., perceived ability and willingness) to consume a healthy diet. Ten focus groups (n = 60) discussed food choice, meal preparation practices, and ways in which the campus could help students develop meal preparation skills. Students with food insecurity had lower meal preparation skills and lower perceived ability to consume a healthy diet. However, a) willingness to consume a healthy diet and b) the impact of both willingness and perceived ability did not differ by food security status. Focus group data indicated that in-person and online cooking classes, information cards in the food pantry, and incentives (e.g., kitchen equipment and vouchers from local grocery stores) were popular ideas for improving home-meal preparation. A greater understanding of meal preparation skills and their interconnectedness to food choice and the campus environment may inform effective ways to support the ability and willingness of college students with food insecurity to prepare meals at home.

Associations between campus climate perceptions and food insecurity among undergraduates at a public university.

Objective:Food-insecure college students have expressed frustration toward their academic institution for failing to meet students' needs. However, it is unclear whether campus climate perceptions are related to food insecurity status. We examined the association between campus climate surrounding health and food insecurity status among college students.Participants:Participants were undergraduate students (n = 1378) enrolled at a public university.Methods:We used secondary data from the American College Health Association-National College Health Assessment II (ACHA-NCHA-II) with campus-specific measures of campus climate and food insecurity status.Results:Findings showed that students with less favorable views of campus climate were between 1.85 and 1.74 times more likely to be food insecure, even after adjusting for demographics and financial hardship.Conclusions:Future research is needed to better understand how students' campus climate perceptions can inform programs that effectively address food insecurity on college campuses.

When Media Health Stories Conflict: Test of the Contradictory Health Information Processing (CHIP) Model.

Guided by Uncertainty Management Theory, UMT, we tested a model that explicates how uncertainty arising from contradictory health information is managed through information seeking. In an online experiment, 763 U.S. adults were randomly assigned to one of three message conditions: contradictory, non-contradictory, or control. Participants in the contradictory and non-contradictory conditions answered questions about their perceptions of contradiction, issue and decision uncertainty, negative appraisals and emotions, and information-seeking intentions. They also completed measures of several moderator variables, including information overload, intolerance for uncertainty, and health self-efficacy. Baseline levels of issue and decision uncertainty were measured in the control condition. Model tenets were confirmed: perceptions of contradiction led to issue uncertainty which, in turn, prompted cognitive appraisals directly, and indirectly through increased decision uncertainty. The effects of issue and decision uncertainty on information-seeking intentions were mediated by negative appraisals and threat emotions. Individuals with high health self-efficacy and positive outcome expectations of information search were more likely to manage uncertainty through information seeking. These results support the use of the CHIP model when perceptions of contradiction and decision uncertainty need to be accounted for, while also validating UMT for its original purposes. Model refinements and implications are discussed.

The Importance of Understanding COVID-19: The Role of Knowledge in Promoting Adherence to Protective Behaviors.

Background: Past research suggests that knowledge supports- but strong illness expectations thwart- adoption of protective behaviors (e.g., handwashing). Strong illness expectations may place COVID-19 essential workers at risk. It is unclear, however, whether knowledge can moderate the negative effects of pessimistic illness expectations on protective behaviors. We test COVID-19 knowledge as a moderator of the effects of (1) pessimistic illness expectations and (2) essential worker status on adherence to protective behaviors. Methods: Participants (n = 350) completed measures of knowledge, illness expectations, and protective behaviors. We used chi-square tests to examine associations between variables and logistic regressions to test the moderation models predicting adherence (low, high) while controlling for demographics. Results: Knowledge, illness expectations, and adherence were significantly associated with each other (p < 0.05). Essential workers had stronger illness expectations and lower knowledge than did non-essential workers (p < 0.001). Logistic regressions showed a non-significant Worker Status × Knowledge interaction (p = 0.59) but a significant Knowledge × Illness Expectations interaction (p < 0.05) indicating that those with strong illness expectations and low knowledge were disproportionately at risk of failing to adhere to recommended behaviors. Conclusions: Knowledge promotes protective behaviors by buffering the negative effects of pessimistic illness expectations. Essential workers are more likely to have low levels of knowledge with strong illness expectations, suggesting that educational policies may be warranted.

Volunteering, Self-Perceptions of Aging, and Mental Health in Later Life.

BACKGROUND AND OBJECTIVES: Scholars argue that volunteering enhances social, physical, and cognitive activities that are increasingly valued as people age, which in turn improves older adults' well-being via a host of psychosocial and neurobiological mechanisms. This study explicitly tested older adults' self-perceptions of aging as a mechanism underlying the mental health benefits of volunteering. RESEARCH DESIGN AND METHODS: Using 2-wave data from the Health and Retirement Study (2008/2010 for Wave 1 and 2012/2014 for Wave 2), we analyzed reports from a pooled sample of older adults aged 65 or older (N = 9,017). Participants reported on demographic characteristics, volunteer work (did not volunteer, 1-99 h/year, 100+ h/year), self-perceptions of aging, and depressive symptoms. We estimated an autoregressive cross-lagged panel model. RESULTS: Volunteering for 100 h or more per year was associated with older adults' more positive and less negative self-perceptions of aging in the subsequent wave (i.e., 4 years later), which in turn predicted fewer depressive symptoms. DISCUSSION AND IMPLICATIONS: This study suggests the promising role of volunteering in shaping older adults' self-perceptions of aging on a sustained basis and refines our understanding of the benefits volunteering brings. Findings shed light on future interventions aimed at improving older adults' adjustment to age-related changes and lessening ageism in society.

Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey.

BACKGROUND: Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. METHODS: Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. RESULTS: Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. CONCLUSIONS: Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.

Nutrition Label Use and Its Association With Dietary Quality Among Latinos: The Roles of Poverty and Acculturation.

OBJECTIVE: To investigate how acculturation and poverty are independently and jointly associated with the use of the Nutrition Facts panel (nutrition label) and to examine the extent to which nutrition label use moderates the association of poverty and acculturation on dietary quality among Latinos. DESIGN: Cross-sectional analysis of the 2007/2008 and 2009/2010 waves of the National Health and Nutrition Examination Survey. PARTICIPANTS: A total of 3,696 adults (aged >19 years) self-identified as Latino/Hispanic with food label use data from the most recent Consumer Behavior Phone Follow-Up Modules. MAIN OUTCOME MEASURE(S): Nutrition label use and dietary quality. ANALYSIS: Logistic regression. RESULTS: Acculturation moderated the association of income on the likelihood of using nutrition labels, such that lower-income English-speaking Latinos were half as likely as higher-income English-speakers to use nutrition labels (P = .01, odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.24-0.81); however, Spanish speakers were equally likely to use nutrition labels across income levels (P = .99; OR = 1.00; 95% CI, 0.77-1.31). Nutrition label use moderated the association of acculturation on diet. Among English-speaking Latinos, those who read nutrition labels had less than half the risk for poor diet (P =.001; OR = 0.43; 95% CI, 0.26-0.69); however, label use was not significantly associated with the diet quality of Spanish speakers (P = .07; OR = 0.82; 95% CI, 0.67-1.02). Nutrition label use decreased the risk for poor dietary quality regardless of poverty status. CONCLUSIONS AND IMPLICATIONS: Overall, results demonstrated a positive association between the use of the Nutrition Facts panel for Latinos and dietary quality. An important nutrition education strategy among bicultural Latinos at risk for a poor diet as a result of acculturation may include label reading comprehension. This approach may also address the low rates of label use. The study provides evidence of segmented assimilation in which low-income, bicultural Latinos follow an underclass pattern of acculturation demonstrated by a lower likelihood of reading nutrition labels and higher-income, bicultural Latinos follow the more successful selective pattern.

Understanding Why Older Adults With Type 2 Diabetes Join Diabetes Online Communities: Semantic Network Analyses.

BACKGROUND: As individuals age, chronic health difficulties may disrupt physical and social well-being. Individuals can turn to online communities to interact with similar peers, which may help buffer negative effects resulting from health difficulties. OBJECTIVE: This study investigated the reasons that older adults join a diabetes online community to better understand the specific resources that are being sought. METHODS: We used semantic network analyses to categorize the reasons participants provided for joining a community during the sign-up process. RESULTS: The most frequent reasons for joining were to seek information about their health condition, to help with self-management of health difficulties, for feelings of informational and social support, and for having a community with whom to share. Women were more likely to go online for sharing and companionship as well as for information and social support reasons, whereas men were more likely to go online for general information and self-management reasons. CONCLUSIONS: This study shows the reasons older adults seek to join a diabetes online community: for increased information and support regarding chronic health difficulties. Practitioners may want to consider ways to promote access to online communities among their older patients as a source of health information and a resource to provide a sense of community.

Developing Nutrition Label Reading Skills: A Web-Based Practice Approach.

BACKGROUND: Nutrition labels offer the information needed to follow Dietary Guidelines for Americans, yet many individuals use labels infrequently or ineffectively due to limited comprehension and the effort required to use them. OBJECTIVE: The objective of our study was to develop and test a Web-based label-reading training tool to improve individuals' ability to use labels to select more healthful foods. We were particularly interested in determining whether practice can lead to increased accuracy using labels as well as decreased effort, together reflecting greater efficiency. We compared a basic and an enhanced, prior-knowledge version of the tool that contained an additional component, a brief nutrition tutorial. METHODS: Participants were 140 college students with an average age of 20.7 (SD 2.1) years and education 14.6 (SD 1.2) years, who completed 3 sets of practice that were designed to teach them, through repetition and feedback, how to use nutrition labels to select more healthful products. Prior to training, participants in the prior-knowledge group viewed a multimedia nutrition presentation, which those in the basic group did not receive. Mixed-effects models tested for improvement in accuracy and speed with practice, and whether improvements varied by group. RESULTS: The training led to significant increases in average accuracy across the 3 practice sets (averaging 79% [19/24 questions], 92% [22/24], 96% [23/24] respectively, P<.001), as well as decreases in time to complete with mean (SD) values of 8.7 (2.8), 4.6 (1.8), and 4.1 (1.7) seconds, respectively. In block 3, the odds of a correct answer for the prior-knowledge group were 79% higher (odds ratio, OR=1.79, 95% CI 1.1-2.9) than those for the basic group (P=.02). There was no significant difference between the groups in block 2 (P=.89). CONCLUSIONS: Practice led to improvements in nutrition label reading skills that are indicative of early stages of automatic processing. To the extent that automatic processes are at the core of healthy habit change, this may be an efficient way to improve dietary decision-making.

An Evaluation of an eHealth Tool Designed to Improve College Students' Label-Reading Skills and Feelings of Empowerment to Choose Healthful Foods.

OBJECTIVE: College students are at risk for poor dietary choices. New skills can empower individuals to adopt healthful behaviors, yet eHealth tools designed to develop food-choice skills, such as label-reading skills, are uncommon. We investigated the effects of web-based label-reading training on college students' perceptions of healthful food-choice empowerment. METHODS: Students completed label-reading training in which they practiced selecting the more healthful food using nutrition labels. We examined improvements in label-reading accuracy (correct healthfulness decisions) and perceptions of empowerment, using a 6-item scale. Repeated measures ANOVAs and paired-samples t-tests were used to examine changes in accuracy and empowerment across the training session. RESULTS: In addition to increases in label-reading accuracy with training, we found increases in healthful food-choice empowerment scores. Specifically, the proportion of correct (i.e., more healthful) food choices increased across the three blocks of practice (p = 0.04) and food-choice empowerment scores were about 7.5% higher on average after training (p < 0.001). CONCLUSION AND IMPLICATIONS: Label-reading training was associated with increased feelings of empowerment associated with making healthful food choices. Skill focused eHealth tools may offer an important avenue for motivating behavior change through skill development.

Age differences in the use of serving size information on food labels: numeracy or attention?

OBJECTIVE: The ability to use serving size information on food labels is important for managing age-related chronic conditions such as diabetes, obesity and cancer. Past research suggests that older adults are at risk for failing to accurately use this portion of the food label due to numeracy skills. However, the extent to which older adults pay attention to serving size information on packages is unclear. We compared the effects of numeracy and attention on age differences in accurate use of serving size information while individuals evaluated product healthfulness. DESIGN: Accuracy and attention were assessed across two tasks in which participants compared nutrition labels of two products to determine which was more healthful if they were to consume the entire package. Participants' eye movements were monitored as a measure of attention while they compared two products presented side-by-side on a computer screen. Numeracy as well as food label habits and nutrition knowledge were assessed using questionnaires. SETTING: Sacramento area, California, USA, 2013-2014. SUBJECTS: Stratified sample of 358 adults, aged 20-78 years. RESULTS: Accuracy declined with age among those older adults who paid less attention to serving size information. Although numeracy, nutrition knowledge and self-reported food label use supported accuracy, these factors did not influence age differences in accuracy. CONCLUSIONS: The data suggest that older adults are less accurate than younger adults in their use of serving size information. Age differences appear to be more related to lack of attention to serving size information than to numeracy skills.

The effects of nutrition knowledge on food label use. A review of the literature.

Nutrition information on food labels is an important source of nutrition information but is typically underutilized by consumers. This review examined whether consumer nutrition knowledge is important for communication of nutrition information through labels on packaged foods. A cognitive processing model posits that consumers with prior knowledge are more likely to use label information effectively, that is, focus on salient information, understand information, and make healthful decisions based on this information. Consistent with this model, the review found that nutrition knowledge provides support for food label use. However, nutrition knowledge measures varied widely in terms of the dimensions they included and the extensiveness of the assessment. Relatively few studies investigated knowledge effects on the use of ingredient lists and claims, compared to nutrition facts labels. We also found an overreliance on convenience samples relying on younger adults, limiting our understanding of how knowledge supports food label use in later life. Future research should 1) investigate which dimensions, or forms, of nutrition knowledge are most critical to food label use and dietary decision making and 2) determine whether increases in nutrition knowledge can promote great use of nutrition information on food labels.

The eHealth Enhanced Chronic Care Model: a theory derivation approach.

BACKGROUND: Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. OBJECTIVE: The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. METHODS: Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. RESULTS: We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. CONCLUSIONS: The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.

Misunderstanding of Front-Of-Package Nutrition Information on US Food Products.

Front-of-package nutrition symbols (FOPs) are presumably readily noticeable and require minimal prior nutrition knowledge to use. Although there is evidence to support this notion, few studies have focused on Facts Up Front type symbols which are used in the US. Participants with varying levels of prior knowledge were asked to view two products and decide which was more healthful. FOPs on packages were manipulated so that one product was more healthful, allowing us to assess accuracy. Attention to nutrition information was assessed via eye tracking to determine what if any FOP information was used to make their decisions. Results showed that accuracy was below chance on half of the comparisons despite consulting FOPs. Negative correlations between attention to calories, fat, and sodium and accuracy indicated that consumers over-relied on these nutrients. Although relatively little attention was allocated to fiber and sugar, associations between attention and accuracy were positive. Attention to vitamin D showed no association to accuracy, indicating confusion surrounding what constitutes a meaningful change across products. Greater nutrition knowledge was associated with greater accuracy, even when less attention was paid. Individuals, particularly those with less knowledge, are misled by calorie, sodium, and fat information on FOPs.

Relationships among food label use, motivation, and dietary quality.

Nutrition information on packaged foods supplies information that aids consumers in meeting the recommendations put forth in the US Dietary Guidelines for Americans such as reducing intake of solid fats and added sugars. It is important to understand how food label use is related to dietary intake. However, prior work is based only on self-reported use of food labels, making it unclear if subjective assessments are biased toward motivational influences. We assessed food label use using both self-reported and objective measures, the stage of change, and dietary quality in a sample of 392 stratified by income. Self-reported food label use was assessed using a questionnaire. Objective use was assessed using a mock shopping task in which participants viewed food labels and decided which foods to purchase. Eye movements were monitored to assess attention to nutrition information on the food labels. Individuals paid attention to nutrition information when selecting foods to buy. Self-reported and objective measures of label use showed some overlap with each other (r=0.29, p<0.001), and both predicted dietary quality (p<0.001 for both). The stage of change diminished the predictive power of subjective (p<0.09), but not objective (p<0.01), food label use. These data show both self-reported and objective measures of food label use are positively associated with dietary quality. However, self-reported measures appear to capture a greater motivational component of food label use than do more objective measures.

Knowledge differentially supports memory for nutrition information in later life.

We examined the extent to which prior knowledge about nutrition moderates age differences in remembering newly learned nutrition information. Younger and older adults with varying levels of knowledge read an article on fats and cholesterol and then completed a memory task. Participants responded to statements that were-or were not-presented in the text, which enabled us to examine memory accuracy overall as well as hits and memory errors. Results showed age differences were present in the low-knowledge group but not in the high-knowledge group. Findings illustrate the importance of knowledge for older adults' memory for health information.

Making healthy food choices using nutrition facts panels. The roles of knowledge, motivation, dietary modifications goals, and age.

Nutrition facts panels (NFPs) contain a rich assortment of nutrition information and are available on most food packages. The importance of this information is potentially even greater among older adults due to their increased risk for diet-related diseases, as well as those with goals for dietary modifications that may impact food choice. Despite past work suggesting that knowledge and motivation impact attitudes surrounding and self-reported use of NFPs, we know little about how (i.e., strategies used) and how well (i.e., level of accuracy) younger and older individuals process NFP information when evaluating healthful qualities of foods. We manipulated the content of NFPs and, using eye tracking methodology, examined strategies associated with deciding which of two NFPs, presented side-by-side, was healthier. We examined associations among strategy use and accuracy as well as age, dietary modification status, knowledge, and motivation. Results showed that, across age groups, those with dietary modification goals made relatively more comparisons between NFPs with increasing knowledge and motivation; but that strategy effectiveness (relationship to accuracy) depended on age and motivation. Results also showed that knowledge and motivation may protect against declines in accuracy in later life and that, across age and dietary modification status, knowledge mediates the relationship between motivation and decision accuracy.