Health education & behavior : the official publication of the Society for Public Health Education最新文献

{"title":"Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico.","authors":"Alelí M Ayala-Marín,&nbsp;Vivian Colón-López,&nbsp;Camille Vélez-Álamo,&nbsp;Natalie Fernández-Espada,&nbsp;Angela Pattatucci,&nbsp;María E Fernández","doi":"10.1177/1090198120988248","DOIUrl":"https://doi.org/10.1177/1090198120988248","url":null,"abstract":"<p><p>Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants (<i>N</i> = 300; aged ≥40 years old) enrolled in the intervention trial <i>Cultivando la Salud</i>, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"559-566"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1090198120988248","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25441340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trojan Horse: An Analysis of Targeted Advertising to Reduce Sexually Transmitted Diseases Among YMSM.","authors":"Ayla Tolosa-Kline, Elad Yom-Tov, Caitlin Hoffman, Cherie Walker-Baban, Felicia M T Lewis","doi":"10.1177/10901981211000312","DOIUrl":"10.1177/10901981211000312","url":null,"abstract":"<p><strong>Background: </strong>Men who have sex with men (MSM) increasingly use internet-based websites and geospatial apps to seek sex. Though these platforms may be useful for public health intervention, evaluations of such interventions are rare. We sought to evaluate the online behavior of young MSM of color in Philadelphia and the effectiveness of using ads to link them to DoYouPhilly.org, where users can order free condoms, lubricant, and sexually transmitted infection test kits delivered via the U.S. postal service.</p><p><strong>Method: </strong>Data collection and analyses were conducted in two phases. First, we performed keyword research and analyzed web browser logs using a proprietary data set owned by Microsoft. Subsequently, we ran a Google Ads campaign using the keywords identified in the preliminary phase, and directed targeted users to the DoYouPhilly.org condom or test kit ordering pages. Results were analyzed using MATLAB 2018.</p><p><strong>Results: </strong>Test kit advertisements received 5,628 impressions, 157 clicks, and 18 unique conversions. The condom advertisements received 128,007 impressions, 2,583 clicks, and 303 unique conversions. Correlation between the click-through rate and the conversion rate per keyword was ρ = -.35 (<i>P</i> = .0096) and per advertisement was ρ = .40 (<i>P</i> = .14). Keywords that directly related to condoms were most effective for condom ordering (42% conversion rate vs. ≤2% for other classes), while keywords emphasizing the adverse effects of unprotected sex were most effective in test kit ordering (91% conversion rate vs. 13% and 12% for other classes).</p><p><strong>Conclusions: </strong>Online advertisements seemed to affect real-world sexual health behavior, as measured by orders of condoms and test kits, among a group of young MSM living in the same community.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"637-650"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9593663/pdf/nihms-1844128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25557083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing a Multidimensional Health Literacy Framework to Assess Cervical Cancer Screening Nonadherence.","authors":"Annalynn M Galvin,&nbsp;Ashvita Garg,&nbsp;Sarah Matthes,&nbsp;Erika L Thompson","doi":"10.1177/10901981211001851","DOIUrl":"https://doi.org/10.1177/10901981211001851","url":null,"abstract":"<p><p>Health literacy is an amenable factor that can improve screening uptake. However, associations between the multidimensional health literacy domains and cervical cancer screening nonadherence are not known and should be considered to improve screening rates. The current quantitative study assessed the associations of multiple health literacy domains with cervical cancer screening nonadherence. Women aged 30 to 65 years without a hysterectomy were surveyed online (<i>N</i> = 812). Assessing, understanding, and appraising measures from the European Health Literacy Survey Questionnaire were adapted for cervical cancer screening. The outcome variable measured the application of cervical cancer information regarding adherence to the 2012 cervical cancer screening guidelines (yes/no). Adjusted logistic regression odds ratios (aORs) estimated nonadherence. Most of the women were non-Hispanic (81.4%) or White (68.1%), and aged 30 to 39 years (40%). The majority of the women (71%) were adherent to screening recommendations. The model with all domains of health literacy had the best model fit statistics compared with other models with different health literacy components. Older age and lack of insurance were statistically significant for screening nonadherence. Difficulty understanding health information (aOR = 3.15; 95% confidence interval [CI; 1.80, 5.51]) and less worry about cervical cancer (aOR = 1.74; 95% CI [1.03, 2.94]) were associated with higher odds of nonadherence. Higher cervical cancer knowledge (aOR = 0.93; 95% CI [0.87, 0.98]) and Hispanic ethnicity (aOR = 0.36; 95% CI [0.21, 0.61)] were associated with lower odds of nonadherence. Incorporating a multidimensional health literacy framework may better inform the need to develop easily understood interventions that address cervical cancer perceived vulnerability and acknowledge systemic sociodemographic influences on screening perceptions.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"710-718"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10901981211001851","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25586626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BAILAMOS With mHealth Technology! Improving Physical Activity and Well-Being in Middle-Aged and Older Latinxs: A Pre-Post Feasibility Study.","authors":"Susan Aguiñaga,&nbsp;Isabela G Marques,&nbsp;Spyros Kitsiou,&nbsp;Guilherme M Balbim,&nbsp;Ben S Gerber,&nbsp;Susan W Buchholz,&nbsp;Eduardo E Bustamante,&nbsp;David X Marquez","doi":"10.1177/10901981211027517","DOIUrl":"https://doi.org/10.1177/10901981211027517","url":null,"abstract":"<p><p>Older Latinxs engage in lower levels of leisure-time physical activity (PA) compared with non-Latinx Whites. Latin dance is a culturally relevant type of leisure-time PA that may engage older Latinx populations, particularly when coupled with mobile health technologies (mHealth). This single group pre-post feasibility study described the PA and health outcomes of middle-aged and older Latinxs participating in BAILA TECH-an intervention that combines the BAILAMOS Latin dance program with mHealth (Fitbit Charge 2, Fitbit app, and motivational text messages). Participants (<i>n</i> = 20, <i>M</i>_age = 67 ± 7.1, female <i>n</i> = 15, 75%) were enrolled in the 16-week BAILA TECH intervention held twice a week. Participants received a Fitbit Charge 2 to assess PA at baseline, during the intervention, and postintervention. An mHealth platform (iCardia) collected Fitbit data and staff delivered weekly motivational and informational text messages. Participants completed questionnaires about PA, sedentary behavior, cardiorespiratory fitness, social support, quality of life, and cognitive function at baseline and postintervention. Paired <i>t</i> tests evaluated change in pre-post measures. There was a significant increase in device-assessed moderate-to-vigorous PA (<i>d</i> = 0.69), self-reported light-leisure (<i>d</i> = 1.91) and moderate-to-vigorous PA (<i>d</i> = 1.05), moderate-to-vigorous leisure PA (<i>d</i> = 1.55), predicted cardiorespiratory fitness (<i>d</i> = 1.10), and PA social support (<i>d</i> = 0.81 [family]; <i>d</i> = 0.95 [friends]) from baseline to postintervention. Although nonsignificant, there was a small effect on physical health-related quality of life (<i>d</i> = 0.32) and executive function (<i>d</i> = 0.29). These data describe an increase in PA levels and health-related outcomes of middle-aged and older Latinxs from participation in an mHealth-infused Latin dance intervention. An adequately powered trial is necessary to establish efficacy.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"575-583"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39415545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Participatory, State-Community-Academic Model to Improve Pregnancy Outcomes in Texas: The Healthy Families Initiative.","authors":"Divya A Patel,&nbsp;Meliha Salahuddin,&nbsp;Melissa Valerio,&nbsp;Nagla Elerian,&nbsp;Krystin J Matthews,&nbsp;Paul McGaha,&nbsp;Robert Nelson,&nbsp;David L Lakey","doi":"10.1177/1090198120977156","DOIUrl":"https://doi.org/10.1177/1090198120977156","url":null,"abstract":"<p><strong>Background: </strong>While the Texas infant mortality rate (IMR) is below the Healthy People 2020 objective (5.7 per 1,000 live births), stark differences in IMR are seen across Texas communities. Health indicators for the state suggest important missed opportunities for improving maternal and infant outcomes. The Healthy Families initiative was a collaboration between a Texas state agency, community partners, and academic institutions to understand how evidence-based interventions could be identified, adapted, and implemented to address community priorities and reduce disparities in pregnancy outcomes.</p><p><strong>Method: </strong>The Healthy Families initiative included two Texas counties, one with low utilization of prenatal care and one with persistent disparities in infant mortality. The model served to (1) identify community factors influencing IMR and maternal morbidity through stakeholder engagement and secondary data, (2) build community capacity to link pregnant women with existing and newly developed services, and (3) develop partnerships within the community and clinics to improve access to and sustainability of services.</p><p><strong>Results: </strong>A community-based participatory approach focused on stakeholder engagement was used to identify, design, and adapt strategies to address community-identified priorities.</p><p><strong>Conclusions: </strong>The Healthy Families initiative is a unique state-community-academic partnership aimed at improving pregnancy outcomes in vulnerable communities, with a focus on promotion of capacity building, maintenance, and sustainability of maternal and infant health programs.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"690-699"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1090198120977156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38704128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#TripleNegativeBreastCancer on Instagram.","authors":"Alesha Henderson,&nbsp;Carrie A Miller,&nbsp;Arnethea L Sutton,&nbsp;Jeanine P D Guidry","doi":"10.1177/1090198120985450","DOIUrl":"https://doi.org/10.1177/1090198120985450","url":null,"abstract":"<p><p>Little is known about how triple negative breast cancer (TNBC) is discussed on the visual social media platform, Instagram. A greater understanding of the experiences of TNBC survivors that are documented on this platform may inform us of how this group of survivors cope with this rare, but aggressive form of breast cancer. This study analyzed a random sample (<i>N</i> = 501) of Instagram posts using the hashtag #triplenegativebreastcancer. Using a quantitative content analysis, posts were coded for the presence of health belief model constructs as well as the presence of treatment-related experiences, social support, and hereditary breast cancer genetic mutations (BRCA 1/2). Our findings suggest that health organizations and agencies are not utilizing Instagram as a conduit of health communications about TNBC to reach individuals worldwide. This article provides insights into potential strategies that can be used by these entities to promote user engagement with posts about TNBC, such as utilizing health messaging that is episodic in nature, uses supportive and encouraging words, and provides information about chemotherapy.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"567-574"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1090198120985450","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38804325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Is Talking About Adverse Childhood Experiences? Evidence From Twitter to Inform Health Promotion.","authors":"Aditi Srivastav,&nbsp;Kaitlyn Park,&nbsp;Alyssa Koziarski,&nbsp;Melissa Strompolis,&nbsp;Jonathan Purtle","doi":"10.1177/10901981211019280","DOIUrl":"https://doi.org/10.1177/10901981211019280","url":null,"abstract":"<p><strong>Background: </strong>Growing availability of research about addressing adverse childhood experiences (ACEs) has recently been embraced by the mainstream media and public. Social media, especially Twitter, provides a unique forum and platform for the public to access and share information about this topic.</p><p><strong>Objective: </strong>This study aims to better understand how the public is framing, sharing, and using research about ACEs on Twitter and to examine the information being commonly discussed about ACEs.</p><p><strong>Method: </strong>We obtained tweets on the topics of ACEs, childhood resilience, and childhood trauma between January 1, 2018, and December 31, 2019. This timeframe was determined based on key related events in the mainstream media. Crimson Hexagon, a social media analytics system using Boolean logic, was used to identify salient topics, influencers, and conduct a content analysis.</p><p><strong>Results: </strong>A total of 195,816 relevant tweets were obtained from our search. The weekly volume was approximately 1,864 tweets. Key topics included general use of the term ACEs (23%), trauma and ACEs (19%), long-term impact of ACEs (12%), preventing ACEs (11%), short-term effects of ACEs (8%), the 1997 ACE Study (5%), and students with ACEs (5%). The top two sentiments were fear and joy. Top conversation influencers included pediatricians, child health advocacy organizations, California's state government, the Centers for Disease Control and Prevention, and National Public Radio.</p><p><strong>Conclusion: </strong>This analysis provides insight to the ways the public is conversing about ACEs and related topics. Results indicated that conversations focus on increasing awareness of ACEs by content experts and public health organizations. This presents an opportunity to leverage social media tools to increase public engagement and awareness.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"615-626"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10901981211019280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39032283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of March of Dimes Supportive Pregnancy Care on Social Support and Postpartum Depression.","authors":"Heather Hensman Kettrey,&nbsp;Katarzyna T Steinka-Fry","doi":"10.1177/10901981211019919","DOIUrl":"https://doi.org/10.1177/10901981211019919","url":null,"abstract":"<p><strong>Purpose: </strong>Group prenatal care, which integrates medical care with patient education and empowerment in a group setting, has the potential to build social support among pregnant women and reduce the risk of postpartum depression (PPD). Past research on group care's effects on social support or PPD has produced inconsistent findings. Studies have tended to (1) examine direct effects on social support or PPD and (2) treat group care participation as a dichotomous variable. This study tests the hypothesis that group care has an indirect effect on PPD through its effect on social support. It uses both a dichotomous measure of group care participation and an ordinal measure of social contact with group members.</p><p><strong>Method: </strong>This study used survey data from 199 women at two Tennessee health care sites who participated in traditional care (TC) or Supportive Pregnancy Care (SPC), a new group program developed by March of Dimes. Path analysis was employed, estimating standardized path coefficients with propensity score weighted multilevel modeling.</p><p><strong>Results: </strong>The study found no evidence of an indirect relationship between SPC and PPD symptoms when modeling the dichotomous measure. Modeling the ordinal measure revealed more favorable PPD outcomes among women reporting high group member contact (compared with TC) and adverse outcomes among women reporting low group member contact.</p><p><strong>Conclusion: </strong>SPC may be useful for preventing PPD symptoms among women socially engaged with other group care patients. Given the adverse effect among women who do not engage with other group members, group facilitators should encourage women to interact outside of scheduled sessions.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"670-679"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10901981211019919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39066026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Health-Seeking Behavior and Associated Factors in the Democratic Republic of the Congo.","authors":"Fuyu Guo,&nbsp;Huayi Xiong,&nbsp;Xinran Qi,&nbsp;Rie Takesue,&nbsp;Siyu Zou Bm,&nbsp;Qiwei He PhD,&nbsp;Eric Frasco,&nbsp;Hanyu Wang,&nbsp;Kun Tang","doi":"10.1177/10901981211010438","DOIUrl":"https://doi.org/10.1177/10901981211010438","url":null,"abstract":"<p><p>Maternal health-seeking behavior (MHSB) is crucial for maternal health. However, little is known about MHSB in the Democratic Republic of the Congo (DRC). This study aims to evaluate the situation and socioeconomic associates of MHSB in the DRC. Based on the responses of 8,360 participants in a nationally representative survey, we adopted a K-modes cluster analysis algorithm to categorize women into three groups (i.e., infrequent service-users, partial service-users, and full service-users) according to their recent MHSB. Multinomial logistic regression was applied to identify the associated predictors of MHSB. The results show that most women (90.29%) did not receive integral maternal health services, including antenatal care, institutional delivery, and postnatal care. Compared with their counterparts, women who received higher maternal educational attainment, had good HIV-related knowledge, lived in urban regions, and lived in wealthier households were more likely to be partial service-users or full service-users. Women exposed to mass media at least once a week were more likely to be full service-users rather than infrequent service-users. The majority of participants who lived in Kasai and near provinces were infrequent service-users, indicating poor MHSB status in the region. Interventions to promote maternal health knowledge and awareness are highly recommended to improve MHSB in the DRC.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"700-709"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10901981211010438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38934381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing Health Equity: Qualitative Perspectives on the Value and Limits of Equity Images.","authors":"Sarah S Willen,&nbsp;Colleen C Walsh,&nbsp;Abigail Fisher Williamson","doi":"10.1177/1090198121994520","DOIUrl":"https://doi.org/10.1177/1090198121994520","url":null,"abstract":"<p><strong>Background: </strong>Health educators and advocacy groups often use side-by-side visual images to communicate about equity and to distinguish it from equality. Despite the near-ubiquity of these images, little is known about how they are understood by different audiences.</p><p><strong>Aims: </strong>To assess the effectiveness of an image commonly used to communicate about health equity.</p><p><strong>Method: </strong>In 167 interviews with health stakeholders in Greater Cleveland, Ohio, in 2018 to 2019, a commonly used health equity image was shown to participants, who were asked to interpret its meaning. Interviewees included 21 health professionals, 21 clinicians, 22 metro-wide decision makers, 24 community leaders, and 79 community members.</p><p><strong>Results: </strong>About two thirds of our socioeconomically, racial/ethnically, educationally, and professionally diverse sample said the equity image helped clarify the distinction between \"equality\" and \"equity.\" Yet less than one third offered an interpretation consistent with the image's goals of foregrounding not only injustice but also a need for systemic change. Patterns of misinterpretation were especially common among two groups: ideological conservatives and those of lower socioeconomic status. Conservatives were most likely to object to the image's message.</p><p><strong>Conclusions: </strong>Equity images are widely used by public health educators and advocates, yet they do not consistently communicate the message that achieving equity requires systemic change. In this moment of both public health crisis and urgent concern about systemic racism, new visual tools for communicating this crucial message are needed.</p>","PeriodicalId":520637,"journal":{"name":"Health education & behavior : the official publication of the Society for Public Health Education","volume":" ","pages":"595-603"},"PeriodicalIF":4.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1090198121994520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25494494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}