Characteristics, enablers, and barriers to the community health and wellbeing assessment component of the health promotion practice cycle: a scoping review protocol.

OBJECTIVE: The proposed review will describe the characteristics, enablers, and barriers to the community health and well-being assessment (CHWA) component of the health promotion practice cycle. INTRODUCTION: CHWA guides health promotion action in communities and populations. A "critical" approach to CHWA can be adopted, which addresses the social, political, cultural, economic, commercial, and environmental determinants of health and well-being to enhance health equity for priority communities and populations. Although tools exist to guide such a critical approach, little is known about the extent to which these tools are being used or the barriers and enablers to applying best practice CHWA. Such evidence is needed to inform future health promotion CHWA and research. INCLUSION CRITERIA: This review will consider literature that describes CHWA conducted in health promotion practice, focusing on an organizational, social, or geographical community or population. Literature that focuses on clinical practice or a specific health condition will be excluded. METHODS: Scopus, PubMed, Web of Science, and CINAHL (EBSCOhost) will be searched to identify peer-reviewed articles. Google Scholar and Google, as well as Public Health, Health & Medical, and Nursing and Allied Health (ProQuest) databases will be searched for gray literature. Articles will be screened and data extracted by 2 or more independent reviewers. The data extraction tool will be developed by the reviewers based on the JBI template and a critical health promotion approach to CHWA. Data will be analyzed and presented as frequency tables and narrative summaries of the characteristics, enablers, and barriers to CHWA. DETAILS OF THE PROTOCOL ARE AVAILABLE ON OPEN SCIENCE FRAMEWORK: osf.io/jq8th/.

"I am not the same as before": a mixed-methods study on depression in people with spinal injury in Qatar.

Incidence of spinal injury is high in the Middle East and North African region (MENA) due to the high incidence of road traffic crashes. A spinal injury may trigger mental health issues. Compared to the general population, people with spinal injury are at higher risk for developing major depression, anxiety, post-traumatic stress disorders, substance abuse, and suicide. Objectives: The objectives of the study were to determine depression prevalence; identify relationships between depression and cause and site of spinal injury, sociodemographic factors, and social support; and explore the lived experiences of depression in people with spinal injury in Qatar. Methods: A sequential cross-sectional mixed methods study was conducted. In the quantitative component, the universal sample consisted of 106 consenting individuals presenting with spinal injury at Hamad General Hospital, Doha, Qatar between January and December 2020. The Patient Health Questionnaire-9 was used to assess levels of depression and the Medical Outcomes Study Social Support Survey was used to assess perceived social support. The cause and site of injury were obtained from patient records. In the qualitative component, semi-structured in-depth interviews were conducted with 12 purposively selected participants from the quantitative component. Results: Spinal injury had a negative impact on participants physical, mental, social, and spiritual wellbeing. In total, 69% of participants had some level of depression: 28% mild, 25.5% minimal, and 15% moderate to severe. Depression was not associated with socio-demographic factors, or the cause or site of spinal injury. Higher levels of emotional/informational support and positive social interaction were associated with milder depression. Social support and religious faith were critical in assisting participants to cope with their new situation. Conclusions: Depression is prevalent among people with spinal injury attending health services. Early detection, referral, and treatment of depression are recommended. Strategies to enhance emotional/informational support and positive social interaction should be developed and tested with people with spinal injury.

Characterization of critical health promotion: a scoping review protocol.

OBJECTIVE: This scoping review will explore how critical health promotion is characterized in the health promotion literature. INTRODUCTION: Critical health promotion has emerged as a social justice approach to health promotion to address the persistent global issue of health inequity. Whilst critical health promotion is not conceptually new and the term has been used in the literature, albeit sparingly, this approach has not been adopted as standard health promotion practice, compromising the advancement of health equity. Given that language shapes the understanding and practice of health promotion, it is imperative to explore how critical health promotion is characterized in the literature to increase uptake of the approach. INCLUSION CRITERIA: This review will consider sources that explore critical health promotion and are explicitly positioned as health promotion sources. METHODS: Scopus, CINAHL (EBSCOhost), PubMed, Global Health (CABI), and the Public Health Database (ProQuest) will be searched to identify relevant full-text papers, including original research, reviews, editorials, and opinion papers. Searches of Google Scholar, Google, and ProQuest Dissertations & Theses Global (ProQuest) will be undertaken to identify gray literature. No language or date restrictions will be applied. Two reviewers will screen sources and extract data using a tool that will be pilot tested, modified, and revised, as necessary. Analysis will involve basic frequency counts and descriptive qualitative content analysis through basic coding. The results will be presented in tables, charts, and word clouds, accompanied by a narrative summary.

QATCHEPP: A quality assessment tool for critical health promotion practice.

Background: The origins of health promotion are based in critical practice; however, health promotion practice is still dominated by selective biomedical and behavioral approaches, which are insufficient to reduce health inequities resulting from the inequitable distribution of structural and systemic privilege and power. The Red Lotus Critical Health Promotion Model (RLCHPM), developed to enhance critical practice, includes values and principles that practitioners can use to critically reflect on health promotion practice. Existing quality assessment tools focus primarily on technical aspects of practice rather than the underpinning values and principles. The aim of this project was to develop a quality assessment tool to support critical reflection using the values and principles of critical health promotion. The purpose of the tool is to support the reorientation of health promotion practice toward a more critical approach. Research design: We used Critical Systems Heuristics as the theoretical framework to develop the quality assessment tool. First, we refined the values and principles in the RLCHPM, then created critical reflective questions, refined the response categories, and added a scoring system. Results: The Quality Assessment Tool for Critical Health Promotion Practice (QATCHEPP) includes 10 values and associated principles. Each value is a critical health promotion concept, and its associated principle provides a description of how the value is enacted in professional practice. QATCHEPP includes a set of three reflective questions for each value and associated principle. For each question, users score the practice as strongly, somewhat, or minimally/not at all reflective of critical health promotion practice. A percentage summary score is generated with 85% or above indicative of strongly critical practice, 50% ≤ 84% is somewhat critical practice, and < 50% minimally or does not reflect critical practice. Conclusion: QATCHEPP provides theory-based heuristic support for practitioners to use critical reflection to assess the extent to which practice aligns with critical health promotion. QATCHEPP can be used as part of the Red Lotus Critical Promotion Model or as an independent quality assessment tool to support the orientation of health promotion toward critical practice. This is essential to ensure that health promotion practice contributes to enhancing health equity.

"I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar.

Introduction: Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region. Methods: We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University. Results: Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood. Conclusion: WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.

Impact of the use of the Red Lotus Critical Health Promotion Model as a pedagogical framework on health promotion graduates' professional practice: A mixed methods study.

ISSUE ADDRESSED: The Red Lotus Critical Health Promotion Model (RLCHPM) is designed to support critical health promotion practice. This study investigated the impact of the use of the RLCHPM as a pedagogical framework for competency-based university curricula on the practice of graduates from health promotion programs from an Australian regional university. METHODS: A mixed methods study was undertaken, including an online survey of all 195 graduates from 2008 to 2016, followed by semi-structured interviews with a subset of respondents. RESULTS: There were 95 survey respondents and 10 interviewees. More than half of the survey respondents reported that the model impacted health promotion programs they are involved in, however, less than a quarter felt it impacted workplace policies. The impact was significantly higher for those with higher levels of knowledge about, confidence in using, and perception of utility of the RLCHPM, and stronger alignment of their practice with critical health promotion values and principles. Graduates' embodiment of the model's values and principles in practice enhanced the impact of the model. Factors that limited the impact included participants' implicit use of components of the model without explicit reference to the model, and the incongruence between participants' professional practice ideals and those of their workplace context. CONCLUSIONS: The use of the RLCHPM as a pedagogical framework for university health promotion programs positively impacted graduates' practice within the Australian context. SO WHAT?: The RLCHPM could be used as a pedagogical framework in universities to develop competency-based critical health promotion curricula to enable graduates to progress critical health promotion practice.

Equity in Vaccine Trials for Higher Weight People? A Rapid Review of Weight-Related Inclusion and Exclusion Criteria for COVID-19 Clinical Trials.

Higher weight status, defined as body mass index (BMI) ≥ 30 kg/m2, is frequently described as a risk factor for severity and susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (known as COVID-19). Therefore, study groups in COVID-19 vaccine trials should be representative of the weight spectrum across the global population. Appropriate subgroup analysis should be conducted to ensure equitable vaccine outcomes for higher weight people. In this study, inclusion and exclusion criteria of registered clinical trial protocols were reviewed to determine the proportion of trials including higher weight people, and the proportion of trials conducting subgroup analyses of efficacy by BMI. Eligibility criteria of 249 trial protocols (phase I, II, III and IV) were analysed; 51 protocols (20.5%) specified inclusion of BMI > 30, 73 (29.3%) specified exclusion of BMI > 30, and 125 (50.2%) did not specify whether BMI was an inclusion or exclusion criterion, or if BMI was included in any 'health' screenings or physical examinations during recruitment. Of the 58 protocols for trials in phase III and IV, only 2 (3.4%) indicated an intention to report subgroup analysis of vaccine efficacy by weight status. Higher weight people appear to be significantly under-represented in the majority of vaccine trials. This may result in reduced efficacy and acceptance of COVID-19 vaccines for higher weight people and exacerbation of health inequities within this population group. Explicit inclusion of higher weight people in COVID-19 vaccine trials is required to reduce health inequities.

Equity in vaccine trials for higher weight people? Protocol for a rapid review of inclusion and exclusion criteria for higher weight people in clinical trials for COVID-19.

INTRODUCTION: Vaccination is a public health strategy that aims to reduce the burden of viral illness, especially important for populations known or likely to be at increased risk for inequitable outcomes due to the disease itself or disparities in care accessed and received. The role of weight status in COVID-19 susceptibility and disease burden remains unclear. Despite this, higher weight is frequently described as a definitive risk factor for both susceptibility and disease severity. Therefore, COVID-19 vaccine trials should recruit a study group representative of the full weight spectrum, and undertake appropriate subgroup analysis by weight status to evaluate response and titrate dose regimes where indicated to ensure equitable outcomes for higher weight people. METHODS AND ANALYSIS: We aim to review inclusion and exclusion criteria of clinical trial protocols registered with ClinicalTrials.gov, ISRCTN Register, the WHO official vaccine trial register, and 'The COVID-19 Vaccine Tracker'. To determine the number of trials including higher weight (body mass index >30 kg/m2) individuals and the number of trials conducting efficacy subgroup analyses by weight status. Screening, data extraction and quality appraisal of trial protocols will be completed independently by a minimum of two reviewers. Clinical trials will be assessed for risk of bias using the Risk of Bias-2 tool. We will conduct a descriptive analysis of extracted data. The following subsets are proposed: participation of higher weight people in COVID-19 vaccine trials by trial phase, country and vaccine platform. ETHICS AND DISSEMINATION: Ethical approval was not required for this review. The results of this rapid review will be presented at appropriate conferences and published in a suitable peer reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020226573.

Evaluating the impact of a brief Health at Every Size®-informed health promotion activity on body positivity and internalized weight-based oppression.

Weight-based oppression, including negative attitudes about body weight, and harassment, stigma, and discrimination based on body weight, is a widespread phenomenon that leads to considerable distress and poor health and wellbeing outcomes. Conversely, body positivity is a multi-faceted concept that encompasses body acceptance, body appreciation, and body love, and adaptive approaches protective of health and wellbeing. The aim of this study was to evaluate the impact of a brief health promotion activity informed by Health at Every Size® and critical health promotion principles on body positivity and internalized weight-based oppression in female students at Qatar University. A quasi-experimental mixed methods pre-post evaluation design was used, with quantitative assessment of body positivity and internalized weight-based oppression before the activity, immediately afterwards, and 10 weeks later, and qualitative assessment at the 10-week follow up. Measures used were the Body Appreciation Scale 2, Modified Weight Bias Internalization Scale, Fat Attitudes Assessment Toolkit Size Acceptance and Self Reflection on Body Acceptance subscales, and an open-ended questionnaire. Body acceptance and appreciation increased significantly after the activity. Qualitative results suggest that these improvements were sustained at follow up. Brief Health at Every Size® informed health promotion activities show potential to improve health and wellbeing.

Holy anorexia: Eating disorders symptomatology and religiosity among Muslim women in the United Arab Emirates.

There is a substantial body of literature reporting a negative association between religiosity and psychiatric symptoms. In the context of eating disorders, however, this relationship appears to be reversed. The few studies exploring the relationship between religiosity and eating disorders have mostly focused on the Judeo-Christian religious traditions in Western nations. The present study examines this relationship among Muslim college women from the United Arab Emirates (UAE). All participants (N = 1069) independently completed the religious commitment inventory (RCI-10) and the eating attitudes test (EAT-26). As hypothesised, there was a positive association between religiosity and eating disorders symptoms. Furthermore, those scoring above the EAT-26 cut-off reported significantly greater levels of religiosity. These findings suggest that heightened religiosity among young Emirati women may represent a vulnerability factor for eating disorders. Preventative initiatives in the UAE should consider focusing on religiosity.

Acculturation, out-group positivity and eating disorders symptoms among Emirati women.

Western acculturation has been implicated in the development of eating disorders among populations living outside Europe and North America. This study explored the relationship between Western acculturation, in-group/out-group evaluations and eating disorders symptoms among female citizens of the United Arab Emirates (UAE). Emirati college women (N = 209) completed an affective priming task, designed to implicitly assess in-group (Emirati) and out-group (American) evaluations. Participants also completed the Westernization Survey, a widely used self-report measure of acculturation, and the Eating Attitudes Test (EAT-26). Across the whole sample, out-group positivity was correlated with higher levels of eating disorder symptoms. Participants classified as at risk for eating disorders showed a clear out-group preference (out-group positivity greater than in-group positivity). Western acculturation was also positively correlated with eating disorder symptoms. Overall, these findings lend further support to the acculturation hypothesis of eating disorders in the context of Emirati college women.

The invisibilization of health promotion in Australian public health initiatives.

The field of health promotion has arguably shifted over the past thirty years from being socially proactive to biomedically defensive. In many countries this has been accompanied by a gradual decline, or in some cases the almost complete removal of health promotion designated positions within Government health departments. The language or discourse used to describe the practice and discipline of health promotion is reflective of such changes. In this study, critical discourse analysis was used to determine the representation of health promotion as a practice and a discipline within 10 Australian Government weight-related public health initiatives. The analysis revealed the invisibilization of critical health promotion in favour of an agenda described as 'preventive health'. This was achieved primarily through the textual practices of overlexicalization and lexical suppression. Excluding document titles, there were 437 uses of the terms health promotion, illness prevention, disease prevention, preventive health, preventative health in the documents analysed. The term 'health promotion' was used sparingly (16% of total terms), and in many instances was coupled with the term 'illness prevention'. Conversely, the terms 'preventive health' and 'preventative health' were used extensively, and primarily used alone. The progressive invisibilization of critical health promotion has implications for the perceptions and practice of those identifying as health promotion professionals and for people with whom we work to address the social and structural determinants of health and wellbeing. Language matters, and the language and intent of critical health promotion will struggle to survive if its speakers are professionally unidentifiable or invisible.

Ethnic identity and paranoid thinking: Implicit out-group preference and language dominance predict paranoia in Emirati women.

BACKGROUND AND OBJECTIVES: Psychotic experiences including persecutory beliefs are elevated among immigrant and minority populations, especially when living in low ethnic density neighbourhoods (the ethnic density effect). Discrimination, victimization and experiencing a sense of 'not belonging' are hypothesized to play a role in this effect. Because a secure ethnic identity protects against poor self-esteem it may also protect against paranoia. This study explores the relationship between language proficiency (Arabic/English), in-group identity (implicit and explicit) and paranoia in female Emirati university students. METHODS: Female citizens of the United Arab Emirates (UAE), Emirati college women (N = 208), reported English/Arabic language proficiencies, and performed a computerized affective priming task engineered to implicitly assess in-group (Emirati) versus out-group (American) positivity. Participants also completed self-report measures of in-group identity (MIIS), and paranoia (PaDs). RESULTS: Arabic proficiency was negatively correlated with paranoia, as was implicit in-group positivity. Furthermore, participants reporting English language dominance, and those demonstrating an implicit out-group preference, reported the highest levels of paranoia. LIMITATIONS: The study is limited by its use of an all female sample. CONCLUSIONS: Implicit in-group attitudes and linguistic competence protect against paranoia and may help to explain the ethnic density effect.

Implicit out-group preference is associated with eating disorders symptoms amongst Emirati females.

Studies exploring the relationship between acculturation and eating disorders symptoms have proven equivocal. Socially desirable responding associated with the use of explicit measures may account for these mixed findings. This study explores the relationship between in-group identity, acculturation and eating disorders symptoms using both implicit and explicit assessments. Emirati female college students (N=94) completed an affective priming task (APT) designed to implicitly assess Emirati in-group evaluations. Participants also completed explicit measures, including the Westernization Survey and the Multicomponent In-group Identification Scale. Eating disorders symptoms were assessed using the Eating Attitudes Test. Only implicit in-group evaluations were correlated with eating disorders symptoms. Specifically, increases in in-group preference were associated with lower levels of eating disorders symptomatology. Furthermore, participants with an actual out-group preference had significantly higher levels of eating disorders symptomatology compared with those demonstrating an in-group preference. These findings support the acculturative stress hypothesis, and suggest that the relationship between eating disorders and acculturation may be better understood with reference to implicit rather than explicit in-group evaluations.

Weight-related teasing and internalized weight stigma predict abnormal eating attitudes and behaviours in Emirati female university students.

This cross-sectional study examined the relationship between abnormal eating attitudes, weight teasing, internalized weight stigma and self-esteem in the United Arab Emirates in a sample of 420 female Emirati undergraduate students (mean age = 23.12 years). Participants completed an online survey including validated and reliable measures. Regression and mediation analyses were used to test for relationships between the factors. Thirty percent of respondents had eating disorder symptomatology, and 44% of respondents reported being frequently teased about their weight. Eating disorder symptomatology was positively correlated with being bothered by teasing from family, friends and others, and internalized weight stigma. Weight- and body-related shame and guilt was the strongest predictor of eating disorder symptomatology. Public health authorities should consider these issues as priorities for action in order to improve the health and wellbeing of young women in the UAE. In addition, it is vital that public health and medical services do not inadvertently condone weight-based teasing or enhance weight stigma and shame.

A missing ethical competency? A review of critical reflection in health promotion.

ISSUE ADDRESSED: There is increasing emphasis in the health promotion literature on the ethical imperative for the profession to move towards critical practice. A key challenge for health promotion is that critical practice appears both under-developed and under-practiced. This is evident in the omission of critical reflection from Australian and international competencies for health promotion practitioners. METHODS: A narrative literature review was undertaken to explore the current use of critical reflection in health promotion. Critical reflection models relevant to health promotion were identified and critiqued. RESULTS: There was a dearth of literature on critical reflection within health promotion, despite recognition of its potential to support critical practice. The discipline of critical social work provided literature on the use, effect and outcome of critical reflection in practice. The interdisciplinary critical reflection model was identified as the model most applicable to health promotion. Underpinned by critical theory, this model emphasises both critical and ethical practice. CONCLUSIONS: Critical reflection is a core competency for health promotion practitioners to address the ethical imperative to move towards critical practice. There is a need to explore the application of a critical reflection model in health promotion to determine how it may support critical and ethical practice. So what? If health promotion is to meet its ethical responsibilities, then critical reflection needs to be articulated as a core health promotion competency and a model for its application in health promotion developed.

The extent to which the public health 'war on obesity' reflects the ethical values and principles of critical health promotion: a multimedia critical discourse analysis.

ISSUE ADDRESSED: The discipline of health promotion is responsible for implementing strategies within weight-related public health initiatives (WR-PHI). It is imperative that such initiatives be subjected to critical analysis through a health promotion ethics lens to help ensure ethical health promotion practice. METHODS: Multimedia critical discourse analysis was used to examine the claims, values, assumptions, power relationships and ideologies within Australian WR-PHI. The Health Promotion Values and Principles Continuum was used as a heuristic to evaluate the extent to which the WR-PHI reflected the ethical values of critical health promotion: active participation of people in the initiative; respect for personal autonomy; beneficence; non-maleficence; and strong evidential and theoretical basis for practice. RESULTS: Ten initiatives were analysed. There was some discourse about the need for participation of people in the WR-PHI, but people were routinely labelled as 'target groups' requiring 'intervention'. Strong evidence of a coercive and paternalistic discourse about choice was identified, with minimal attention to respect for personal autonomy. There was significant emphasis on the beneficiaries of the WR-PHI but minimal attention to the health benefits, and nothing about the potential for harm. Discourse about the evidence of need was objectivist, and there was no discussion about the theoretical foundations of the WR-PHI. CONCLUSION: The WR-PHI were not reflective of the ethical values and principles of critical health promotion. So what? Health promotion researchers and practitioners engaged in WR-PHI should critically reflect on the extent to which they are consistent with the ethical aspects of critical health promotion practice.

'Kids in the Kitchen' impact evaluation: engaging primary school students in preparing fruit and vegetables for their own consumption.

ISSUE ADDRESSED: Children's fruit and vegetable (FV) consumption in Australia is below levels recommended for optimal growth, development and health. METHODS: 'Kids in the Kitchen' is a classroom-based program that engages students in preparing FV. Impact evaluation was conducted with students from Grade 1 (around 6 years old) and Grade 5 (around 11 years old) who participated in the program. A questionnaire was used to collect pre- and post-program data on knowledge, attitudes and consumption of FV, FV preparation skills and environmental supports for FV consumption. A skill audit was also conducted for Grade 1 students. RESULTS: Study participants (n = 118) included 70 Grade 1 and 48 Grade 5 students. There was an increase in the median number of fruits correctly identified (from 14 to 16), tried (from 14 to 16) and liked (from 10.5 to 12; P = 0.0001 for all changes). The median number of vegetables correctly identified increased from 10 to 12 (P = 0.0001), but there was no change in the number of vegetables tried or liked. The proportion of participants who rated their skills in using a knife to prepare FV as 'not really that good' decreased by 15%, from 42% to 27% (P = 0.04). Grade 1 participants' skills in cutting, grating and peeling improved (P = 0.0001 for all changes). CONCLUSIONS: If children are involved in the preparation of FV, they are more likely to correctly identify them, try them, like them and eat them. SO WHAT? Primary schools have the potential to contribute to children's nutrition through hands-on food preparation activities.

Impact evaluation of a health promotion-focused organisational development strategy on a health service's capacity to deliver comprehensive primary health care.

A comprehensive primary health care approach is required to address complex health issues and reduce inequities. However, there has been limited uptake of this approach by health services nationally or internationally. Reorienting health services towards becoming more health promoting provides a mechanism to support the delivery of comprehensive primary health care. The aim of this study was to determine the impact of a health promotion-focused organisational development strategy on the capacity of a primary health care service to deliver comprehensive primary health care. A questionnaire and semistructured individual interviews were used to collect quantitative and qualitative impact evaluation data, respectively, from 13 health service staff across three time points with regard to 37 indicators of organisational capacity. There were significant increases in mean scores for 31 indicators, with effect sizes ranging from moderate to nearly perfect. A range of key enablers and barriers to support the delivery of comprehensive primary health care was identified. In conclusion, an organisational development strategy to reorient health services towards becoming more health promoting may increase the capacity to deliver comprehensive primary health care.

The impact of a short-term iyengar yoga program on the health and well-being of physically inactive older adults.

BACKGROUND: With the current challenge of rapidly aging populations, practices such as yoga may help older adults stay physically active, healthy, and fulfilled. METHODS: The impact of an 8-week Iyengar yoga program on the holistic health and well-being of physically inactive people aged 55 years and over was assessed. Thirty-eight older adults (mean age 73.21±8.38 years; 19 intervention, 19 control) engaged in either twice-weekly yoga classes or continued their usual daily routines. Physical health measures were muscle strength, active range of motion, respiratory function (FEV1), resting blood pressure, and immune function (salivary IgA and lysozyme). Self-perceived general, physical, mental, spiritual, and social health and well-being were assessed with the Life's Odyssey Questionnaire and the SF12v2™ Health Survey. RESULTS: Muscle strength, active range of motion, physical well-being, and aspects of mental well-being (emotional well-being and self-care) improved significantly in the yoga group (p<.05). Median changes in most of these variables were also significantly different from those in the control group. CONCLUSIONS: Participation in Iyengar yoga programs by older people is beneficial for health and well-being, and greater availability of such programs could improve quality of life.