This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Library of Congress Cataloging-in-Publication Data For more information on this publication, visit www.rand.org/t/RR1695Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2018 RAND CorporationR® is a registered trademark. Cover photo credits from top to bottom:Photo by Cpl PrefaceThe Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's flagship survey for understanding the health, health-related behaviors, and well-being of service members. Originally implemented to assess substance use (i.e., illicit drugs, alcohol, and tobacco), the survey now includes content areas-such as mental and physical health, sexual behavior, and postdeployment problems-that may affect force readiness or the ability to meet the demands of military life. The HRBS is intended to supplement administrative data already collected by the armed forces. In 2014, the Defense Health Agency asked the RAND Corporation to review previous iterations of the HRBS, update survey content, administer a revised version of the survey, and analyze data from the resulting 2015 HRBS of active-duty personnel. The 2015 HRBS included U.S. Air Force, Army, Marine Corps, Navy, and Coast Guard personnel, and this report details the survey methodology and results. No expertise in health, health-related behaviors, or health care is required to read this report. However, it may be of most use to individuals who provide direct care related to the health and health-related behaviors of active-duty service members or who are responsible for making related policy decisions. Additional information can be found in a series of online appendixes.This research was sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelli...

Using a community-based participatory research approach, we explored adolescent, parent, and community stakeholder perspectives on barriers to healthy eating and physical activity, and intervention ideas to address adolescent obesity. We conducted 14 adolescent focus groups (n = 119), 8 parent focus groups (n = 63), and 28 interviews with community members (i.e., local experts knowledgeable about youth nutrition and physical activity). Participants described ecological and psychosocial barriers in neighborhoods (e.g., lack of accessible nutritious food), in schools (e.g., poor quality of physical education), at home (e.g., sedentary lifestyle), and at the individual level (e.g., lack of nutrition knowledge). Participants proposed interventions such as nutrition classes for families, addition of healthy school food options that appeal to students, and non-competitive physical education activities. Participants supported health education delivered by students. Findings demonstrate that community-based participatory research is useful for revealing potentially feasible interventions that are acceptable to community members.

Purpose-We used principles of community-based participatory research (CBPR) to develop and pilot test a 5-week intervention for middle school students, Students for Nutrition and eXercise (SNaX). SNaX aimed to translate school obesity-prevention policies into practice with peer advocacy of healthy eating and school cafeteria changes.Methods-425 7 th graders in the intervention school (63% of all 7 th graders) were surveyed at baseline regarding cafeteria attitudes and sugar-sweetened beverage (SSB) consumption; of the 425 students, 399 (94%) were surveyed again at one-month post-intervention. School cafeteria records were obtained from the intervention school and a non-randomly selected comparison school with similar student socio-demographic characteristics.Results-140 intervention school students were trained as peer advocates. In the intervention school, cafeteria attitudes among peer advocates significantly improved over time (~one-third of a standard deviation), whereas non-peer advocates' cafeteria attitudes remained stable; the improvement among peer advocates was significantly greater than the pre-post change for nonpeer advocates (b = 0.71, p <.001). Peer advocates significantly reduced their SSB intake (sports and fruit drinks), from 33% pre-intervention to 21% post-intervention (p = .03). Cafeteria records indicated that servings of fruit and healthier entrees (salads, sandwiches, yogurt parfaits) significantly decreased in the comparison school and significantly increased in the intervention school; the magnitude of changes differed significantly between schools (p <.001).Conclusions-Peer advocates appeared to benefit from the intervention more than did non-peer advocates. Future research should consider engaging parents, students, and other key community stakeholders to determine acceptable and sustainable cafeteria changes.

Purpose To conduct a randomized controlled trial of Students for Nutrition and eXercise (SNaX), a 5-week middle-school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Methods We randomly selected schools (five intervention, five wait-list control) from the Los Angeles Unified School District. School records were obtained for number of fruits and vegetables served, students served lunch, and snacks sold per attending student, representing an average of 1,515 students (SD=323) per intervention school and 1,524 students (SD=266) per control school. A total of 2,997 seventh-graders (75% of seventh-graders across schools) completed pre-and post-intervention surveys assessing psychosocial variables. Consistent with community-based participatory research principles, the school district was an equal partner and a community advisory board provided critical input. Results Relative to control schools, intervention schools showed significant increases in the proportion of students served fruit and lunch and a significant decrease in proportion of students buying snacks at school. Specifically, the intervention was associated with relative increases of 15.3% more fruit served (p=0.006), 10.4% more lunches served (p<0.001), and 11.9% fewer snacks sold (p<0.001) than would have been expected in its absence. Pre-to-post intervention, intervention school students reported more positive attitudes about cafeteria food (p=0.02) and tap water (p=0.03), greater obesity-prevention knowledge (p=0.006), increased intentions to drink water from the tap (p=0.04) or a refillable bottle (p=0.02), and greater tap water consumption (p=0.04) compared to control school students. Conclusions Multi-level school-based interventions may promote healthy adolescent dietary behaviors.

Comparative case studies were used to explore religious congregations' HIV involvement, including types and extent of activities, interaction with external organizations or individuals, and how activities were initiated and have changed over time. The cases included 14 congregations in Los Angeles County representing diverse faith traditions and races-ethnicities. Activities fell into three broad categories: (1) prevention and education; (2) care and support; and (3) awareness and advocacy. Congregations that engaged early in the epidemic focused on care and support while those that became involved later focused on prevention and education. Most congregations interacted with external organizations or individuals to conduct their HIV activities, but promoting abstinence and teaching about condoms were conducted without external involvement.Correspondence to: Kathryn Pitkin Derose, derose@rand.org. NIH Public AccessAuthor Manuscript AIDS Behav. Author manuscript; available in PMC 2012 August 1. Opportunities exist for congregations to help address a variety of HIV-related needs. However, activities that are mission-congruent, such as providing pastoral care for people with HIV, raising HIV awareness, and promoting HIV testing, appear easier for congregations to undertake than activities aimed at harm reduction.