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While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender.

Interpersonal violence is a pervasive experience affecting one billion children and adolescents annually, resulting in adverse health and well-being outcomes. Evidence suggests that polyvictimization, the experience of multiple forms of violence, is associated with more harmful consequences for adolescents than experiencing individual types of violence, although data from low-and middle-income countries are limited. This study analyzed data on over 4100 adolescents from the Gender and Adolescence, Global Evidence Study in Ethiopia to examine the association between polyvictimization and adolescent mental and physical health and the mediating role of resilience using linear regression and path analysis. We hypothesized that adolescents experiencing polyvictimization would experience worse mental and physical health than those experiencing no types or individual types of victimization, and that resilience would mediate these relationships. Half of sampled girls and over half of boys experienced polyvictimization. Among both sexes, polyvictimization was associated with worse mental but not worse physical health. Resilience mediated the association between polyvictimization and mental health among girls only. Strengthening resilience among girls may be an effective avenue for mitigating polyvictimization's negative mental health effects, but additional research and programming for preventing and identifying polyvictimized adolescents and linking them to care is needed.

Background: Previous studies have reported that physical activity can prevent the onset of depression and reduces anxiety. In the present study, the hypothesis that total physical activity time influences depressive symptoms via state and trait anxiety was tested by a path analysis., Methods: Self-administered questionnaires were used to survey 526 general adult volunteers from April 2017 to April 2018. Demographic information, physical activity, and state and trait anxiety were investigated., Results: The association between physical activity time and depressive symptoms was expressed as a U-shape curve. The results of the covariance structure analysis showed that differences from the optimal physical activity time (DOT) had direct positive effects on state and trait anxiety. DOT affected depressive symptoms only via trait anxiety, and this was a complete mediation model., Conclusion: The present study suggests that an optimal physical activity time exists for depressive symptoms. The path model demonstrated an association between the three factors of optimal physical activity time, trait anxiety, and depressive symptoms, and the effect was fully mediated by trait anxiety.

The COVID-19 pandemic precipitated an overall increase in the global prevalence of mental health disorders and psychological distress. However, against this backdrop, there was also evidence of adaptation and coping, which suggested the influence of protective factors. The current study aims to extend previous research on the role of protective factors by investigating the health-sustaining and mediating roles of resilience in the relationship between perceived vulnerability to disease, loneliness, and anxiety. Participants consisted of a convenience sample of schoolteachers (N = 355) who completed the Perceived Vulnerability to Disease Questionnaire, the short form of the Connor-Davidson Resilience Scale, the University of California, Los Angeles Loneliness Scale, and the trait scale of the Spielberger State-Trait Anxiety Scale, through an online link created with Google Forms. The results of path analysis indicated significant negative associations between resilience and both loneliness and anxiety. These results indicate the health-sustaining role of resilience. In addition, resilience mediated the relationships between germ aversion and perceived infectability, on the one hand, and loneliness and anxiety, on the other hand. The findings confirm that resilience can play a substantial role in counteracting the negative impact of the pandemic on mental health.

While studies on the damaging effects of PM2.5 air pollution are abundant, studies seeking to understand the factors that influence human behaviors for the avoidance of exposure to PM2.5 are lacking. Theory of Planned Behavior (TPB) can be used to investigate the effects of Attitudes (AT), Subjective Norms (SN), and Perceived Behavioral Controls (PBC) in the Behavioral Intentions (BI) of parents with young children against exposure to PM2.5. Questionnaires, based on the TPB used to predict BI, were distributed to 610 parents in Taipei City and New Taipei City. Our results revealed that the AT of both groups had a significant positive predictive effect on their PBC and BI. While the SN of the Taipei group affected BI directly, there was no significant effect on the BI from the SN of the New Taipei group. Using path analysis, Taipei City and New Taipei City groups had different BI paths: All five hypotheses are statistically significant and form four paths in the Taipei City group. While only four hypotheses in the New Taipei City group formed three paths and no path for SN-BI. Both groups formed behaviors that were based on the SN/PBC around them, which ultimately contributed to the BI of their protective behaviors.

Background: Sarcopenia is an age-related progressive, generalized skeletal muscle disorder involving the accelerated loss of muscle function and muscle mass. The aim of this study was to assess the complex relationship between sarcopenia, malnutrition, cognitive impairment, physical activity, and depression in the elderly, with the potential role of quality of life as a mediator in these associations., Methods: A cross-sectional study was conducted on a sample ( n = 298) of elderly patients admitted to Special Hospital for Rehabilitation "Termal", Vrdnik, Serbia. Sarcopenia, the risk for malnutrition, cognitive impairment, physical activity, quality of life, and depressive symptoms were measured by standardized instruments. Additional data included sociodemographic characteristics. Simultaneous assessment of the direct and indirect relationships of all determinants was performed by path analysis., Results: A total of 40% ( n = 120) of the elderly were diagnosed with sarcopenia, and 42.6% had depression symptoms. The risk of malnutrition was present in 23.5%, cognitive impairment in 5.4%, and a low level of physical activity was reported in 26.2% of elderly participants. The mean reported quality of life measured by Sarcopenia and Quality of Life Questionnaire was 60 (on the scale ranging from 0 to 100; where a higher score reflects a higher quality of life). The best-fitted model (χ 2 /DF = 1.885, NFI = 0.987, CFI = 0.993, GFI = 0.997, RMSEA = 0.055) highlighted the mediating effect of quality of life between sarcopenia, malnutrition, cognitive impairment, lower level of physical activities and depression. According to the model, quality of life was a direct negative predictor of depressive symptoms in the elderly, while malnutrition positively affected depression., Conclusions: The presented path model may assist rehabilitation centers in developing strategies to screen for sarcopenia and risk of malnutrition, and promote physical activity in elderly, aiming to prevent their negative effects on mental health. For the elderly currently affected by sarcopenia, we consider regenerative medicine and stem cell therapy, which, in view of their etiology, could be a potential therapeutic strategy for sarcopenia.

This study aimed to perform a path analysis to understand the effects of quality characteristics on perceived usefulness, perceived ease to use, involvement, and acceptance intention of healthcare kiosks in elderly using the extended technology acceptance model. We performed structural equation modeling (SEM) with data from 300 elderly. The following results were obtained. Firstly, elderly's perceived quality characteristics of healthcare kiosks had a partial positive effect on perceived usefulness. Secondly, elderly's perceived quality characteristics of healthcare kiosks had a partial positive effect on perceived ease to use. Thirdly, elderly's perceived ease to use healthcare kiosks had a partial positive effect on perceived usefulness. In addition, elderly's perceived usefulness of healthcare kiosks had a positive effect on acceptance intention. Lastly, elderly's perceived ease to use healthcare kiosks had a positive effect on acceptance intention.

The prevalence of reported mental health problems among university students has increased at alarming rates in recent years. While various negative life events (from personal events such as relationship breakdowns to more global events such as COVID-19 [SARS-CoV-2] pandemic) have been found to be important predictors of poor mental health in this population, some individuals have been found robustly to fare better than others in confronting such events. Identifying factors that predict these individuals' mental health, along with the specific coping strategies they utilize may have significant practical implications when confronted by adverse events such as COVID-19. This study investigated relationships between the impact of the COVID-19 pandemic on 828 (453 females, 374 males, and one "Other") Chinese university students' mental health, and their internal strengths, personality characteristics, and demographic profiles. We also investigated whether students' use of specific coping strategies mediated these relationships. Stepwise multiple regression analyses (MRAs) and a path analysis revealed that students who resided in their home country, had higher levels of internal strengths, a lower level of neuroticism and a higher level of agreeableness and reported fewer negative mental health changes than did other respondents during COVID-19 in the second half of 2020. Self-regulation and withdrawal coping strategies were both important mediators of these relationships. These findings have important implications for universities in identifying and assisting students in the face of adverse events such as COVID-19., Competing Interests: The authors declare no conflict of interest.

The driving mechanism of expansion is the basis for policymaking in urban land management and control. In this study, Yangzhou city in China was used as an example. Based on the supply and demand theory of land, a framework was constructed to analyze the driving factors behind urban land expansion. Path analysis was used to determine the direct and indirect factors driving urban land expansion. The results showed the following: (1) Urban land in Yangzhou city expanded 32,831.10 hm 2 from 2005 to 2018, mainly in terms of farmland. This rapid expansion arose from the contraction of rural residential areas, threatening ecological spaces such as water bodies. (2) Path analysis indicated that fixed-asset investment, the added value of secondary and tertiary industries, urban population, distance to the city center, and farmland area are the direct factors driving urban land expansion. Land finance, technology input, and transportation ability indirectly influence urban land by affecting other driving factors. (3) Increasing the level of urban land-use intensification, properly adjusting economic development goals, reasonably controlling the population, exploring the retention of construction land in city centers, and optimizing farmland and basic farmland plans need to be considered in the management and control of urban land expansion. Furthermore, to guide the orderly expansion of urban land, improving land management systems, promoting scientific and technological progress, and scientifically designing transportation land are necessary strategies.

One of the major obstacles to the adoption of the circular economy is the lack of consumer interest and awareness. Despite this, the unique role of consumers in the circular economy is an understudied topic, as the literature tends to focus rather on the application of circular practices in the organizational and industrial sectors. This paper aims to examine the individual-level factors that have an influence over circular purchasing behavior. Specifically, this paper elaborates an explicative path model of purchasing circular products that takes into account environmental concern, climate skepticism, and the attitudinal factor towards circular products. The final sample consisted of 566 respondents from Romania. Our findings showed that environmental concern has a positive significant impact on circular purchase behaviour and this relationship is mediated by the attitude towards circular products. Moreover, those with high levels of climate skepticism showed an increased level of perceived greenwashing among organizations.

Background: Research indicates that exposure to polychlorinated biphenyls (PCBs) can cause neurobehavioral impairments in neonates and adults, but the way specific PCBs’ congeners impact cognition functions at a low exposure level in a real-life co-exposure system remains poorly understood. This study aimed to investigate the association of PCBs burden with cognition function among elderly adults. Methods: Based on the Weitang Geriatric Diseases study (2014−2015), the current study measured the plasma concentrations of six indicator-PCBs by GC-MS/MS and assessed the cognitive dysfunction (CoD) via an Abbreviated Mental Test in 266 participants (ages 61−90). Sequential logistic regression was used to analyze the effects of PCBs on cognition functions. Female participants aged less than or equal to 80 years were selected, and path analysis was used to determine the direct or indirect impacts of co-exposure PCBs on CoD by structural equation modeling. Results: After sequential adjustments to potential confounding factors and correction by the Bonferroni, no statistically significant correlation between PCBs exposure and CoD was found in participants (p > 0.05). However, in the co-exposure system, after controlling for co-exposures and confounders, exposure to PCB28 had a direct effect on CoD in females aged between 61 and 80, with a factor load of 0.670. Conclusions: After adjusting for the co-exposures and confounders, exposure to PCB28 can directly increase the risk of cognitive impairment in older Chinese females.

Given that Social Networking Service (SNS) has emerged as the most influential platform, which can lead users to addictive smartphone use, it is necessary to investigate which psychological variables lead smartphone-based SNS users to addictive smartphone use. Still, studies on the relationship between psychological variables and addictive smartphone use among smartphone-based SNS users remain to be explored. Therefore, this study aims to investigate the role of psychological factors on smartphone addiction proneness (SAP). A total of 433 smartphone-based SNS users were collected from 5003 adults in Korea. Data were analyzed with descriptive statistics, Pearson's correlation coefficients, and path analysis using SPSS 21.0 and AMOS 23.0. The results of a parallel-mediation path analysis demonstrated that Behavioral Inhibition (BIS), Behavioral activation (BAS) drive, anxiety, and low self-control directly influenced SAP, separately. BIS and BAS _drive also had significant indirect effects on SAP through the effect of anxiety. BIS and BAS_fun had significant indirect effects on SAP through the effect of low self-control. The study variables accounted for 38.4 of the total variances of SAP. Thus, when establishing interventions to reduce the users' addictive smartphone use, these interactive relationships of the variables should be considered.

Submicroscopic nanoparticles (NPs) in air have received much attention due to their possible effects on health and wellbeing. Adverse health impacts of air pollution may not only be associated with level of exposure, but also mediated by the perception of the pollution and by beliefs of the exposure being hazardous. The aim of this study was to test a model that describes interrelations between NP pollution, perceived air quality, health risk perception, stress, and sick building syndrome. In the NanoOffice study, the level of NPs was measured and a survey on health risk perception was conducted among 260 employees in twelve office buildings in northern Sweden. Path analyses were performed to test the validity of the model. The data refute the model proposing that the NP exposure level significantly influences stress, chronic diseases, or SBS symptoms. Instead, the perceived exposure influences the perceived risk of NP, and the effect of perceived exposure on SBS and chronic disease is mediated by stress. There was little concern about nanoparticles, despite relatively high levels in some facilities. Perceived pollution and health risk perception may explain a large part of the environmentally induced symptoms and diseases, particularly in relatively low levels of pollution. The research results raise important questions on the physiologically or psychologically mediated health effects of air pollution.

This paper examines the relationships between a range of well-being factors and two commonly used subjective well-being measures-happiness and life satisfaction. Data from the second cycle of the Quality of Life (QoL) Survey in Abu Dhabi were used, which included 32,087 working adults. The well-being factors included in the analysis covered various aspects of life themes: income and jobs, work-home balance, health and physical activities, social and community services, living environment, and family/friends' relationships and connections. Using standardized data, path analysis yielded an optimal path model that suggested the presence of a reciprocal relationship between happiness and life satisfaction. In addition, the final model suggested that four variables-job satisfaction, mental health, satisfaction with relationships with people, and the size of the social support network-had direct effects on happiness and life satisfaction. The model also identified three variables-satisfaction with family life, mental health, and job satisfaction-to have the most significant effect on happiness.

Background: Although the relationship between problematic social media use (PSMU) and happiness has been already explored, less is known about the mechanisms that translate PSMU into lower happiness through lifestyle habits. Therefore, the current study focuses on the association between PSMU and happiness, exploring a mediating effect of lifestyle habits (e.g., difficulties in getting to sleep and frequency of physical activity) among Italian adolescents. Methods: A total of 58,976 Italian adolescents (mean age = 13.6, SD = 1.63; age range = 10.5−16.5; 49.4% females) were included. The pattern of relationships specified by the theoretical model was examined through path analysis. Results: Difficulties in getting to sleep (β = −0.037, p < 0.001) and frequency of physical activity (β = −0.012, p < 0.001) were mediators in the relationship between PSMU and happiness. Multi-group analyses across gender and age groups (11, 13, and 15 years old) showed that the chain mediating effect of the frequency of physical activity on the difficulties in getting to sleep was not significant for females but significant for males and for all of the three age groups. Overall, females and older ages were sensitive to the whole model. Conclusion: Along with difficulties in getting to sleep and the frequency of physical activity, lifestyle habits may contribute to the association between PSMU and happiness. We also recommend that future studies focus on PSMU in females and older adolescents, as they show more general sleep problems and reduced physical activity.

It has been recently proposed that mindfulness can improve sleep quality through the mediating role on psychological distress and that acceptance may play a pivotal role in mindfulness beneficial effects. The aim of the present work was to understand the effects of the COVID-19 lockdown on dispositional mindfulness, sleep, and distress, and on their relationships. In particular, we wanted to test the hypothesis that the detrimental effects of lockdown on sleep depended on mindfulness and distress (including anxiety and depression) and that the acceptance facet of mindfulness played the leading role. A longitudinal study based on self-report questionnaires was conducted on 39 Italian adults (M age = 35.03, SD = 14.02; 21 men) assessing mindfulness, distress, and sleep quality before (23 December 2019-8 March 2020) and during (27 April 2020-10 May 2020) the first Italian COVID-19 lockdown. Lockdown decreased mindfulness while increasing distress and sleep problems. Path analysis showed that the effects of lockdown on sleep were fully mediated by mindfulness and distress. Furthermore, a more detailed analysis showed that these effects were mainly dependent on the acceptance component of mindfulness working through anxiety. The present study confirms, in the context of the COVID-19 lockdown, a model according to which mindfulness, and specifically acceptance, influences sleep through the mediating role of distress.

Decision making using evidence-based practice (EBP) is generally universally accepted by nurses. Such acceptance may affect the personnel's behaviour towards patients, which is also demonstrated by taking into consideration the patient's preferences, including the patient's spiritual needs, in the care plan. The provision of such care requires the development of an attitude of approval and an adequate level of communicative competence, which will enable the actual implementation of the EBP. The purpose of our study was to assess the perception of spirituality and the nurse's role in providing spiritual care, as well as the perception of the significance of communication skills in the approval of EBP in professional practice. A multi-centre cross-section study was conducted on a population of 1176 participants (459 undergraduate (bachelor's programme, BP) and 717 postgraduate students (master's programme, MP)) from 10 medical universities in Poland. Three tools were used in the study to evaluate the participants' approach: Evidence-Based Practice Competence Questionnaire (EBP-COQ), The Spirituality and Spiritual Care Rating Scale (SSCRS), and Communication Skills Attitude Scale (CSAS). Structural equation modelling was used for the analysis. An analysis of structural equations revealed the presence of positive relationships of the attitude to spiritual care and the role of communicative competences with the approach to EBP regardless of the cohort. A significant difference was found related to the influence of age on the attitude towards learning communicative competences. The approval in this respect was observed to decrease with age in the MP group. Increasing approval of EBP requires strengthening the approach to activity-centred spiritual care, with the simultaneous development of a positive attitude towards learning communicative competences. The model reveals the need to integrate a humanistic approach with EBP, which can be achieved by planning different interventions in different groups of recipients: nurses, academic teachers and students.

Background: Childhood cancer is a disease with a psychosocial impact on parents who experience health problems and distress. Their reactions depend on the relationship of multiple factors. The objective of this paper is to evaluate the interrelationships between flourishing and the variables linked to the health and wellbeing of parents of children with cancer., Methods: Mothers/fathers of children with cancer participated in an exploratory study in response to a series of questionnaires. Likert-type scales were used to measure perceived health, wellbeing, flourishing, stress, coping, and social support., Results: Out of a total of 94 children, 138 parents (60 men/78 women) are represented. Participants show physical symptoms and an unstable coping pattern. A path analysis model is presented. As to the goodness of adjustment of the statistics used, good results were obtained. Flourishing tends to coexist with wellbeing, while flourishing coexists negatively with symptoms. There is an indirect relationship between flourishing and poor health. There is a positive relationship between flourishing and coping, as well as between flourishing and satisfaction with the support received (especially from sons/daughters). This support was negatively related to the subjective health report., Conclusions: Flourishing is shown as a healthy coping strategy. The results can enrich the development of psychosocial interventions aimed at promoting adequate adaptation.

(1) Background: With the rapid global spread of the coronavirus disease 2019 (COVID-19) and the relatively high daily cases recorded in a short time compared to other types of seasonal flu, the world remains under continuous threat unless we identify the key factors that contribute to these unexpected records. This identification is important for developing effective criteria and plans to reduce the spread of the COVID-19 pandemic and can guide national authorities to tighten or reduce mitigation measures, in addition to spreading awareness of the important factors that contribute to the propagation of the disease. (2) Methods: The data represents the daily infections (210 days) in four different countries (China, Italy, Iran, and Lebanon) taken approximately in the same duration, between January and March 2020. Path analysis was implemented on the data to detect the significant factors that affect the daily COVID-19 infections. (3) Results: The path coefficients show that quarantine commitment (β = -0.823) and full lockdown measures (β = -0.775) have the largest direct effect on COVID-19 daily infections. The results also show that more experience (β = -0.35), density in society (β = -0.288), medical resources (β = 0.136), and economic resources (β = 0.142) have indirect effects on daily COVID-19 infections. (4) Conclusions: The COVID-19 daily infections directly decrease with complete lockdown measures, quarantine commitment, wearing masks, and social distancing. COVID-19 daily cases are indirectly associated with population density, special events, previous experience, technology used, economic resources, and medical resources.

Cognitive complaints, defined as perceived cognitive dysfunction in daily living, are associated with depressive symptoms. The associations of cognitive complaints and depressive symptoms with health-related quality of life (HRQoL) and perceived overall health in Japanese adults remains unknown. To investigate these relationships, we evaluated a convenience sample of 525 Japanese adult volunteers (Mage: 41.3 ± 11.7; 238 male and 287 female). We used the Cognitive Complaints in Bipolar Disorder Rating Assessment (evaluating cognitive complaints), Patient Health Questionnaire-9 (evaluating depressive symptoms), EuroQol-5 Dimension-5 Level (EQ-5D-5L; evaluating HRQoL), and EuroQol-Visual Analogue Scale (EQ-VAS; evaluating perceived overall health). Our path analyses suggested that both cognitive complaints and depressive symptoms had significant total effects on HRQoL and perceived overall health. Furthermore, cognitive complaints were not significantly associated directly with HRQoL and perceived overall health, whereas cognitive complaints were significantly associated with HRQoL and perceived overall health indirectly via depressive symptoms. Depressive symptoms were significantly associated directly with HRQoL and perceived overall health. This study suggests that depressive symptoms may mediate the associations of cognitive complaints with HRQoL and perceived overall health. Thus, to address the HRQoL and perceived overall health associated with cognitive complaints, evaluation and intervention for depressive symptoms may be useful in public health.

Background: The objective of this study was to assess the complex relationship between the multiple determinants of the caregiving process, the caregiver burden, and depression during the COVID-19 pandemic in Serbia., Methods: A cross-sectional study was conducted on a nationally representative sample (n = 798) during the COVID-19 pandemic in Serbia from March to September 2020. A nine-section questionnaire designed for this study included the characteristics of caregivers, characteristics of care and care recipients, COVID-19 related questions, and the following standardized instruments: 12-Item Short-Form Health Survey, Fatigue Severity Scale, Activities of Daily Living Scale and Instrumental Activities of Daily Living Scale, Zarit Caregiver Burden Scale, and Beck Depression Inventory. Path analysis was used for the simultaneous assessment of the direct and indirect relationships of all determinants., Results: More than two thirds (71.9%) of informal caregivers experienced a burden, and more than one quarter (27.1%) had depression symptomatology. Self-rated physical health, need for psychosocial support, and caregiver burden were the main direct predictors of depression. Multiple determinants of the caregiving process had indirect effects on depressive symptomatology via the caregiver burden as a mediating factor., Conclusions: The subjective burden presented a significant risk factor for depressive symptoms in caregivers during the COVID-19 pandemic. The provision of psychosocial support was identified as an important opportunity to reduce depressive risk in informal caregivers.

Job satisfaction (JS) is an indicator of individual psychosocial health. Consistent evidence showed that voluntary extra-role behavior in organizations, namely organizational citizenship behavior (OCB), can also contribute to individual psychological health. JS has been found to positively influence employees' OCB, and both JS and OCB have been found to predict employees' task performance (TP). The purpose of this study was to investigate whether employees' OCB mediates the relationship of JS with TP, taking into consideration gender as a potential moderator, and other sociodemographic and work-related characteristics as confounding variables. A total of 518 employees, 54.6% women, aged 19-66 years with a mean age of about 36 years, completed measures of JS, OCB, and TP. Results showed a partial mediation of OCB in the JS-TP relationship, which was invariant across gender. A potential practical implication of findings is that human resource managers and practitioners might ultimately benefit male and female employees' well-being as well as the organizations' productivity by developing targeted individual- and group-level trainings and interventions to enhance JS and OCB.

It is mainly children and adolescents who are involved in video gaming. The lockdown caused by the COVID-19 pandemic may have further increased their use of video games and, consequently, the risk of gaming disorder (GD) symptoms. However, currently, we do not have exhaustive knowledge of this issue. To fill this gap, the current study aims to analyze video gaming habits in children and adolescents during the lockdown, starting in March 2020 in Italy, the first European country affected by the pandemic. Specifically, we aim to understand how variables related to parents-for instance, knowledge of their offspring's life, the monitoring of their video gaming habits, and parental use of video games-are related to their offspring's time spent on video games and GD symptoms. A web-based survey involving parents ( n = 554, 79% mothers, mean age = 45.39) of 554 children and adolescents (73% males, mean age = 11.11) was utilized. The results showed that they were involved in video games, particularly boys and adolescents, with high rates of GD symptoms. The parents also spent a considerable amount of time playing video games. A path model that explained the mechanisms through which parental variables were related to their offspring's time spent on video games and GD symptoms, controlling for gender and age, was verified. Overall, the findings indicate the importance of educating parents to behave effectively with respect to video games and monitor their offspring's video gaming habits.

Hypertension has been identified as the most prevalent chronic disease, accounting for the majority of premature deaths in people with physical disability in South Korea. Self-care is vital in controlling high blood pressure. Health literacy has been implicated in self-care behaviors; however, the mechanisms behind this relationship remain unclear. Therefore, the present study aimed to test a hypothetical path model estimating the association between health literacy and hypertension self-care behaviors and to verify the mediating effects of access to healthcare, provider-patient interactions, hypertension knowledge, and hypertension control self-efficacy in hypertensive people with physical disability. In total, 211 hypertensive adults with physical disability completed an online survey. A path analysis using a multi-mediation model was performed using AMOS 17.0 (IBM SPSS Inc., Chicago, IL, USA), and indirect effects were estimated using phantom variables. As a result, the model fit indices were deemed excellent. Significant indirect pathways were determined from health literacy to hypertension self-care behavior via provider-patient interactions, knowledge, and self-efficacy, although no direct association was found between health literacy and self-care behaviors. The study findings supported the importance of provider-patient interactions, knowledge, and self-efficacy, which play a role in linking health literacy and self-care behavior in hypertensive patients with physical disability.

Non-communicable diseases (NCDs) are one of the major health threats in the world. Thus, identifying the factors that influence NCDs is crucial to monitor and manage diseases. This study investigates the effects of social-environmental and behavioral risk factors on NCDs as well as the effects of social-environmental factors on behavioral risk factors using an integrated research model. This study used a dataset from the 2017 Korea National Health and Nutrition Examination Survey. After filtering incomplete responses, 5462 valid responses remained. Items including one's social-environmental factors (household income, education level, and region), behavioral factors (alcohol use, tobacco use, and physical activity), and NCDs histories were used for analyses. To develop a comprehensive index of each factor that allows comparison between different concepts, the researchers assigned scores to indicators of the factors and calculated a ratio of the scores. A series of path analyses were conducted to determine the extent of relationships among NCDs and risk factors. The results showed that social-environmental factors have notable effects on stroke, myocardial infarction, angina, diabetes, and gastric, liver, colon, lung, and thyroid cancers. The results indicate that the effects of social-environmental and behavioral risk factors on NCDs vary across the different types of diseases. The effects of social-environmental factors and behavioral risk factors significantly affected NCDs. However, the effect of social-environmental factors on behavioral risk factors was not supported. Furthermore, social-environmental factors and behavioral risk factors affect NCDs in a similar way. However, the effects of behavioral risk factors were smaller than those of social-environmental factors. The current research suggests taking a comprehensive view of risk factors to further understand the antecedents of NCDs in South Korea.

Walking is a sustainable mode of transport which has well established health and environmental benefits. Unfortunately, hundreds of thousands of pedestrians lose their lives each year over the world due to involvement in road traffic crashes, and mid-blocks witness a significant portion of pedestrian fatalities. This study examined the direct and indirect effects of various contributing factors on the pedestrian injury severity in vehicle-pedestrian crashes at mid-blocks. Data of vehicle-pedestrian crashes during 2002-2009 were extracted from the NASS-GES, with pre-crash behaviors and injury severity included. The SEM path analysis method was applied to uncover the inter-relationships between the pedestrian injury severity and various explanatory variables. Both the direct and indirect effects of these explanatory variables on the pedestrian injury severity were calculated based on the marginal effects in the multinomial and ordered logit models. The results indicate some variables including number of road lanes and the age of pedestrian have indirect impacts on the injury severity through influencing the pre-crash behaviors. Although most indirect effects are relatively small compared with the direct effects, the results in this study still provide some valuable information to improve the overall understanding of pedestrian injury severity at mid-blocks.

We explored possible paths from physical and mental health-related quality of life, self-efficacy, optimism, and social support to happiness in older adults, considering hedonic balance and life satisfaction as mediators. A total of 154 Spanish male and female (50%) older adults (65-96 years old, M = 77.44, SD = 8.03; 64% noninstitutionalized elderly) voluntarily participated in this correlational, cross-sectional study. The participants completed self-reports on their perceived health status, self-efficacy, social support, optimism, and global subjective well-being (SWB) as well as its dimensions. Path analysis was used to examine direct and indirect relationships. The final model had an excellent fit with the data (χ2(10) = 11.837, p = 0.296, χ2/df = 1.184; SRMR = 0.050, CFI = 0.994, RMSEA = 0.035), revealing the unique causal effects of all the included predictors on happiness. With the exception of self-efficacy, the psychosocial resources predicted older adults' current happiness, and this relationship was fully mediated by hedonic balance and life satisfaction, which were found to be putative intermediary factors for SWB. Self-efficacy in turn predicted the remaining psychosocial resources. Our findings extend the existing evidence on the influences of health-related quality of life, self-efficacy, optimism, and social support on SWB. Furthermore, they support the proposal of hedonic balance and life satisfaction as dimensions of SWB, thus supporting the tripartite hierarchical model of happiness. These results may inform future interventions seeking to improve happiness in late adulthood.

Empirical research provides evidence that, in neighborhoods with higher walkability, individuals make more walking trips. However, it is not clear what the exact nature is of the relationships between neighborhood walkability and walking trips, since a higher walking frequency can be explained in different ways. This study examined whether the extra walking trips in better walkable neighborhoods are related primarily to trip generation, destination choice, or transport mode choice and whether this is the same for different age groups. A neighborhood fixed effects regression analysis was conducted in a first step to obtain a walkability measure for each neighborhood in the Netherlands including systematic as well as unobserved effects. Subsequently, the estimated fixed effects were used as walkability data for a path analysis based on a causal model to test the hypotheses stated. The results of the path analysis show direct relationships of neighborhood walkability with trip generation, destination choice, and transport mode choice, after controlling for the mutual relationships between the activity and trip variables. Comparing different age groups (i.e., children, adults, and elderly), the differences found mostly concerned the relationship between neighborhood walkability and trip generation. We concluded therefore that conditions for walkability are not the same for all age groups.