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The Self-Determination Theory has been applied to explain behaviour in numerous contexts and cultures. In the exercise context, causality orientations (autonomy, control, impersonal) are important to describe individual differences in initiation and maintenance of health behaviour. The assessment of exercise causality orientations can be a key element to improve predictions of motivated health and exercise behaviour. Nevertheless, a scale to measure exercise causality orientations has not been established in German yet. Thus, it was the aim of the present work to translate the Exercise Causality Orientations Scale to German and to test it throughout three studies. The German G-ECOS questionnaire was cross-validated via confirmatory factor analyses in two separate samples. Both Study 1 (n = 306, 72.60% female, age M = 26.00, SD = 5.66; CFI = .96) and Study 2 (n = 320, 70.94% female, age M = 29.00, SD = 3.54; CFI = .95) indicated good model fits. In a further Study 3 (n = 548, 62.50% female, age M = 30.17, SD = 11.91), the relations between exercise causality orientations and other SDT related constructs were examined. The correlations indicated positive associations between autonomy causality orientation and intrinsic regulation, intrinsic exercise participation goals, and exercise basic needs satisfaction. Overall, the assessment of exercise causality orientations can be useful in analysing and potentially predicting motivated exercise behaviour. [ABSTRACT FROM AUTHOR]

Social scientists have been interested in measuring the prosperity, well-being, and quality of life of nations, which has resulted in a multiplicity of country-level indicators. However, little is known about the factor structure of these indicators. We explored the structure of quality of life, using country-level data on tens of subjective and objective indicators. Applying factor analysis, we identified three distinct factors that exhibited both overlap and complementarity. This structure was replicated in data from previous years and with a partially different set of variables. The first factor, ‘socio-economic progress’, is dominated by socio-political and economic indicators but also includes life satisfaction, which thus appears to reflect objective living conditions. The second factor, ‘psycho-social functioning’, consists of subjective indicators, such as eudaimonic well-being and positive affective states. The third, ‘negative affectivity’, comprises negatively-valenced affective states. The three macro-factors of societal quality of life demonstrated moderate intercorrelations and differential associations with cultural and ecological variables, providing support for their discriminant validity. Finally, country and regional rankings based on the three societal factors revealed a complex picture that cautions against over-reliance on any single indicator such as life satisfaction. The results underline the need for a broadly-based approach to the measurement of societal quality of life, and provide an empirically-derived multidimensional framework for conceptualizing and measuring quality of life and well-being at country level. This study is thus an initial empirical step towards systematizing the multiple approaches to societal quality of life. [ABSTRACT FROM AUTHOR]

This paper explores which demographic characteristics substantially bias self-reported physical and cognitive health status of older Europeans. The analysis utilises micro-data for 19 European countries from the Survey of Health, Ageing and Retirement in Europe to compare performance-tested outcomes of mobility and memory with their self-reported equivalents. Relative importance analysis based on multinomial logistic regressions shows that the bias in self-reported health is mostly due to reporting heterogeneities between countries and age groups, whereas gender contributes little to the discrepancy. Concordance of mobility and cognition measures is highly related; however, differences in reporting behaviour due to education and cultural background have a larger impact on self-assessed memory than on self-assessed mobility. Southern as well as Central and Eastern Europeans are much more likely to misreport their physical and cognitive abilities than Northern and Western Europeans. Overall, our results suggest that comparisons of self-reported health between countries and age groups are prone to significant biases, whereas comparisons between genders are credible for most European countries. These findings are crucial given that self-assessed data are often the only information available to researchers and policymakers when asking health-related questions. [ABSTRACT FROM AUTHOR]

Background: Quality improvement collaboratives (QICs) have been used to improve health care for decades. Evidence on QIC effectiveness has been reported, but systematic reviews to date have little information from low- and middle-income countries (LMICs). Objective: To assess the effectiveness of QICs in LMICs. Methods: We conducted a systematic review following Cochrane methods, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for quality of evidence grading, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement for reporting. We searched published and unpublished studies between 1969 and March 2019 from LMICs. We included papers that compared usual practice with QICs alone or combined with other interventions. Pairs of reviewers independently selected and assessed the risk of bias and extracted data of included studies. To estimate strategy effectiveness from a single study comparison, we used the median effect size (MES) in the comparison for outcomes in the same outcome group. The primary analysis evaluated each strategy group with a weighted median and interquartile range (IQR) of MES values. In secondary analyses, standard random-effects meta-analysis was used to estimate the weighted mean MES and 95% confidence interval (CI) of the mean MES of each strategy group. This review is registered with PROSPERO (International Prospective Register of Systematic Reviews): CRD42017078108. Results: Twenty-nine studies were included; most (21/29, 72.4%) were interrupted time series studies. Evidence quality was generally low to very low. Among studies involving health facility-based health care providers (HCPs), for “QIC only”, effectiveness varied widely across outcome groups and tended to have little effect for patient health outcomes (median MES less than 2 percentage points for percentage and continuous outcomes). For “QIC plus training”, effectiveness might be very high for patient health outcomes (for continuous outcomes, median MES 111.6 percentage points, range: 96.0 to 127.1) and HCP practice outcomes (median MES 52.4 to 63.4 percentage points for continuous and percentage outcomes, respectively). The only study of lay HCPs, which used “QIC plus training”, showed no effect on patient care-seeking behaviors (MES -0.9 percentage points), moderate effects on non-care-seeking patient behaviors (MES 18.7 percentage points), and very large effects on HCP practice outcomes (MES 50.4 percentage points). Conclusions: The effectiveness of QICs varied considerably in LMICs. QICs combined with other invention components, such as training, tended to be more effective than QICs alone. The low evidence quality and large effect sizes for QIC plus training justify additional high-quality studies assessing this approach in LMICs. [ABSTRACT FROM AUTHOR]

Background: Prior studies of healthy populations have found religious practices to be associated with survival. However, no contemporary studies have examined whether religiosity influences survival among patients discharged from the hospital after an acute coronary syndrome (ACS). The present study examined the relationship between religious practices and 2-year all-cause mortality among hospital survivors of an ACS. Methods: Patients hospitalized for an ACS were recruited from 6 medical centers in Massachusetts and Georgia between 2011 and 2013. Study participants self-reported three items assessing religiosity: strength/comfort from religion, petition prayers for health, and awareness of intercessory prayers by others. All cause-mortality within 2-years of hospital discharge was ascertained by review of medical records at participating study hospitals and from death certificates. Cox proportional hazards models were used to estimate the multivariable adjusted risk of 2-year all-cause mortality. Results: Participants (n = 2,068) were on average 61 years old, 34% were women, and 81% were non-Hispanic White. Approximately 85% derived strength/comfort from religion, 61% prayed for their health, and 89% were aware of intercessions. Overall, 6% died within 2 years post-discharge. After adjusting for sociodemographic variables (age, sex, and race/ethnicity), petition prayers were associated with an increased risk of 2-year all-cause mortality (HR: 1.64; 95% CI: 1.01–2.66). With further adjustment for several clinical and psychosocial measures, this association was no longer statistically significant. Strength and comfort from religion and intercessory prayers were not significantly associated with mortality. Conclusions: Most ACS survivors acknowledge deriving strength and comfort from religion, praying for their health, and intercessions made by others for their health. Although the reported religious practices were not associated with post-discharge survival after multivariable adjustment, acknowledging that patients utilize their religious beliefs and practices as strategies to improve their health would ensure a more holistic approach to patient management and promote cultural competence in healthcare. [ABSTRACT FROM AUTHOR]

Introduction: State lawmakers have explored numerous policy alternatives to reduce overweight and obesity. Evaluating effects of these laws is important but presents substantial methodological challenges. We present a conceptual framework that allows for classification of obesity prevention laws based on ecological level of influence and the underlying legal mechanism involved to guide analysis of the relationship between a substantial range of obesity prevention laws and BMI. Methods: Obesity prevention laws (OPLs) for all 50 states and DC were obtained via primary legal research using the LexisNexis Advanced Legislative Services (ALS) database. For legal provisions that met inclusion criteria, reviewers abstracted information on bill state, citation, passage and effective dates, target population, and obesity prevention mechanism. Laws were categorized by ecological level of influence on weight-related behaviors and the legal mechanism utilized to change behavioral determinants of BMI. Results: Laws designed to increase community-level opportunities for physical activity were the most frequently enacted OPL while laws designed to alter nutrition standards for school meals or competitive foods were comparatively less common, appearing in only 16% and 34% of states, respectively. Conclusion: Prior studies of obesity policies have focused on specific interventions. We identified and categorized state-level laws that operate at all ecological levels and found that laws passed during the initial burst of lawmaking were largely confined to measures aimed at increasing opportunities for physical activity. Creating public spaces for recreation is an important step to promoting healthier lifestyles to reduce obesity risk; more comprehensive, multilevel legal approaches should also be pursued. [ABSTRACT FROM AUTHOR]

Background: Referral networks are critical in the timely delivery of surgical care, particularly for populations residing in rural areas who have limited access to specialist services. However, in low- and middle-income countries (LMICs) referral networks are often undermined by systemic inefficiencies. If equitable access to essential surgical services is to be achieved, sound evidence is needed to ensure efficient patient care pathways. The aim of this scoping review was to investigate current knowledge regarding inter-hospital surgical referral systems in LMICs to identify the main obstacles to their functioning and to critically assess proposed solutions. Methods: MEDLINE, EMBASE and Global Health databases and grey literature were systematically searched to identify relevant studies. The search generated 2261 unique records, of which 14 studies were selected for inclusion in the review. The narrative synthesis of retrieved data is based on a conceptual framework developed though a thematic analysis approach. Results: Multiple shortages in surgical infrastructure, equipment and personnel, as well as gaps in surgical and decision-making skills of clinicians at sending hospitals, act as obstacles to safe and appropriate referrals. Comprehensive protocols for surgical referrals are lacking in most LMICs and established patient pathways, when in place, are not correctly followed. Interventions to improve coordination and communication between different level facilities may enhance efficiency of referral pathways. Strengthening capacity of referring hospitals to manage more surgical conditions locally could improve outcomes, decrease the need for referral and reduce the burden on tertiary facilities. Discussion: The field of surgical referrals is still an uncharted territory and the limited empirical evidence available is of low quality. Developing strategies for assessing functionality and effectiveness of referral systems in surgery is essential to improve access, coverage and quality of services in resource-limited settings, as well as overall health systems performance. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy is an effective treatment for improving mental health problems among university students. However, intervention components have different effects on mental health problems. This paper is a meta-analysis of the data concerning the relationship between cognitive behavioral variables and mental health status among university students. A total of five electronic databases were reviewed, and 876 articles met the initial selection criteria. Reviewers applied standardized coding schemes to extract the correlational relationship between cognitive behavioral variables and mental health status. A total of 55 articles were included in the meta-analysis. Correlations were found for three cognitive behavioral variables (attention, thought, and behavior) across nine mental health domains (negative affect, positive affect, happiness, social function, stress response, psychological symptom, quality of life, well-being, and general health). Across each cognitive behavioral process and all mental health domains, the estimated mean correlation was medium (r = .32 - .46), and varied by the domain of mental health. [ABSTRACT FROM AUTHOR]

Background: The implementation of quality HIV control programs is crucial for the achievement of the UNAIDS 90-90-90 targets and to motivate people living with HIV (PLWHIV) to link and remain in HIV-care. The aim of this mixed method cross-sectional study was to estimate the linkage and long-term retention in care of PLWHIV and to identify factors potentially interfering along the HIV-care continuum in southern Mozambique. Methods: A home-based semi-structured interview was conducted in 2015 to explore barriers and facilitators to the HIV-care cascade among individuals that had been newly HIV-diagnosed in community testing campaigns in 2010 or 2012. Linkage and long-term retention were estimated retrospectively through client self-reports and clinical records. Cohen's Kappa coefficient was calculated to measure the agreement between participant self-reported and documented cascade outcomes. Results: Among the 112 interviewed participants, 24 (21.4%) did not disclose their HIV-positive serostatus to the interviewer. While 84 (75.0%) self-reported having enrolled in care, only 69 (61.6%) reported still being in-care 3–5 years after diagnosis of which 17.4% reported having disengaged and re-engaged. An important factor affecting optimal continuum in HIV-care was the impact of the fear-based authoritarian relationship between the health system and the patient that could act as both driver and barrier. Conclusion: Special attention should be given to quantify and understand repeated cycles of patient disengagement and re-engagement in HIV-care. Strategies to improve the relationship between the health system and patients are still needed in order to optimally engage PLWHIV for long-term periods. [ABSTRACT FROM AUTHOR]

Background: The perceived risk of developing type 2 diabetes mellitus (T2DM) can motivate individuals to adopt preventive health behaviors. Compared with fathers, mothers of young children often experience unique risk factors for developing T2DM: pregnancy-related weight gain, lifestyle changes related to child care, and the increased incidence of gestational diabetes mellitus. Understanding how actual risk factors affect the perceived risk of developing T2DM can foster effective diabetes prevention interventions for this population. The aims of this study were to describe the risk, perceived and actual, of developing T2DM and to explore the influencing factors of perceived risk for Chinese mothers of preschool children in China. Methods: A multisite, cross-sectional survey was conducted and included 176 mothers (mean age of 31.19 years old) of preschool children (aged 3–7 years old) from four preschools in Changsha, the capital city of Hunan Province, China. The overall perceived risk of developing T2DM was measured by one item “Your own personal health risk is at almost no risk, slight risk, moderate risk or high risk from diabetes” from the Risk Perception Survey for Developing Diabetes (RPS-DD). PRS-DD and the Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CHINARISK) were used to assess perceived risk related worry, personal control, optimistic bias, and diabetes risk knowledge and actual risk of T2DM. Mothers also reported their height, weight, and waist circumference followed by the NIH protocol. Pearson correlation and stepwise multivariate linear regression were used to explore how the actual risk factors affected the perceived risk of developing diabetes (RPS-DD)). Results: Nearly 90% of mothers perceived almost no/slight risk for developing diabetes. Nearly half of the mothers had parents or siblings with diabetes. Roughly 70% of the mothers did not eat five servings of fruits and vegetables per day, and more than 50% did not exercise at least 30 minutes a day. In the five stepwise multivariate linear regression models, young mothers (95% CI .400–1.311) and those with a family history of diabetes (95% CI -0.74- .000) were founded a higher overall perceived risk. Mothers who reported more sedentary time (95% CI -0.029- -0.008) and less physical activity had less personal control (95% CI -0.354- -0.046). Mothers with more sedentary time had more worries about developing T2DM(95% CI 0.008–0.035) . Mothers who were older (95% CI -0.440–0.055) or had more physical activities (95% CI 0.003–0.048) had more optimistic bias of not developing T2DM. Mothers who had a higher education level (95% CI .354–1.422) and a family history of diabetes (95% CI .029–2.231) had more diabetes risk knowledge of developing T2DM. Conclusion: This study found that Chinese mothers of preschool children in urban areas reported low perceived risk of developing T2DM, although they have actual risk factors. These women did not associate anthropometric, health history, or health behavior factors with the risk of developing T2DM. Anthropometrics and risk factors associated with behavioral risk factors may be the focus of diabetes prevention programs. [ABSTRACT FROM AUTHOR]

Background: Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2-4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5-10 minutes' duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring.Methods and Findings: English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m2) adults (aged 21-60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only (n = 101), ConTxt plus health-coaching calls (n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was -0.61 (-1.99 to 0.77) in the control group, -1.68 (-3.08 to -0.27) in ConTxt only, and -3.63 (-5.05 to -2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (-3.0 [-4.99 to -1.04], p = 0.003) but not between the ConTxt-only and the control group (-1.07 [-3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (-1.95 [-3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: -7.90 [-11.94 to -3.86], p < 0.001; English contrast: -1.82 [-4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site.Conclusions: A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls.Trial Registration: ClinicalTrials.gov NCT01171586. [ABSTRACT FROM AUTHOR]

Political scientists have long known that political involvement exacts costs but they have typically defined these costs in relatively narrow, largely economic terms. Though anecdotal evidence suggests that the costs of politics may in fact extend beyond economics to frayed personal relationships, compromised emotional stability, and even physical problems, no systematic evidence on these broader costs exists. We construct and validate batteries of survey items that delineate the physical, social, and emotional costs of political engagement and administer these items to a demographically representative sample of U.S. adults. The results suggest that a large number of Americans believe their physical health has been harmed by their exposure to politics and even more report that politics has resulted in emotional costs and lost friendships. [ABSTRACT FROM AUTHOR]

Objectives: Social isolation is a particular problem among older people and social participation may reduce future isolation. However, it is unclear which types of activities and which level of participation are effective. This study examines the relationship between social participation and isolation among Japanese older people by employing a 3-year longitudinal study. Methods: A mail survey was sent to 3,518 community-dwelling older people in an urban area in 2014 (baseline: BL). We then conducted follow-up mail survey on respondents who were non-isolated at BL in 2017 (follow-up: FL), with isolation being defined as being in contact with others less than once a week. An analysis was carried out on 1,070 subjects (398 men and 672 women). Social participation is defined by participation in group activities (community, senior club, hobbies, sports, volunteering, politics, industry, and religion). A logistic regression analysis was conducted to determine the association between the types of social participation and the number of organization types at BL, and isolation at FL. Results: At FL, 75 men (18.8%) and 59 women (8.8%) were considered to be isolated. Among the men, participation in a hobby group and sports group both significantly reduced the degree of isolation. Moreover, participation in two organizations and three or more organizations significantly lowered the risk of isolation when compared to non-participants. Among women, there were no significant associations among particular types of social activities and isolation. On the other hand, participation in one organization and three or more organizations significantly reduced their isolation when compared to non-participants. There was a significant linear trend between the number of types of organizations and isolation, regardless of gender. Conclusions: Participation in social activities reduces future isolation in older people. Encouraging participation in social activities could help reduce negative health outcomes associated with social isolation later in life. [ABSTRACT FROM AUTHOR]

A range of demographic and socioeconomic factors are known to account for enormous disparities in the uptake of maternal health care in low- and middle-income countries. In contrast, contextual factors such as child marriage are far less explored as a deterrent to the uptake of maternal health care. The present study aimed to assess the total effect of child marriage on the utilization of maternal health services in Nepal. This study drew on data from the Nepal Demographic and Health Survey 2016. The study restricted its analysis to a subsample of 3,970 currently married women of reproductive age who had at least one live birth in the five years preceding the survey. After descriptive analysis, logistic regression models were constructed to estimate adjusted odds ratios. The results of logistic regression controlling for confounders suggested child marriage decreased the likelihood of antenatal care visits (AOR 0.74; 95% CI 0.63–0.86), skilled attendance at delivery (AOR 0.66; 95% CI 0.56–0.78), facility-based delivery (AOR 0.65; 95% CI 0.56–0.77), and postnatal care use (AOR 0.80; 95% CI 0.67–0.96). The findings of this study reinforced the existing evidence for the adverse effect of child marriage on maternal health-seeking behaviors. Women’s restricted access to household resources, limited autonomy in decision-making, social isolation, and the dominant power of husbands and mothers-in-law may play a role in the findings. Addressing women’s social vulnerability as a barrier to accessing health care may help to increase the uptake of maternal health services. [ABSTRACT FROM AUTHOR]

Purpose: Self-regulation is the capacity to regulate attention, emotion, and behaviour to pursue long-term goals. The current study examined the associations between role model presence and self-regulation during early adolescence, controlling for hopefulness, using a large population-based data set from the Tokyo Teen Cohort study. Methods: Adolescents, aged 12 years, identified a role model using a single item on a paper questionnaire: ‘Who is the person you most look up to?’ Level of hopefulness was also assessed using a single question: ‘To what extent do you feel hopeful about the future of your life?’ Trained investigators evaluated self-regulation. Results: Of 2550 adolescents, 2279 (89.4%) identified a role model. After adjusting for level of hopefulness, identifying a role model was associated with higher levels of self-regulation in comparison to indications of no role model. Hopeful future expectations were also associated with higher self-regulation; however, the beta coefficient was smaller than role model presence in the multivariate linear regression analysis. Conclusions: Role model presence was significantly associated with higher self-regulation among early adolescents. Educational environments should focus on support for adolescents with no role models. [ABSTRACT FROM AUTHOR]

Background: The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. Methods: A data set of 18,058 adults aged 25–69 years from three population-based national health examination surveys 1990–92, 1997–99 and 2008–11 with complete information for five healthy behavior factors was used. A ‘daily intake of both fruits and vegetables, ‘sufficient physical exercise’, ‘no current smoking’ and ‘no current risk drinking’ were assessed with self-reports and ‘normal body weight’ was calculated based on measured body weight and height. A dichotomous ‘healthy lifestyle’ indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25–34, 35–44, 45–54 and 55–69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990–92 and 2008–11. Results: In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990–92 to 13.5% in 1997–99 and to 14.7% in 2008–11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45–54 years. The RC of increasing healthy lifestyle prevalence between 1990–92 and 2008–11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990–92 and 2008–11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. Conclusions: The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990–92 to 2008–11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level. [ABSTRACT FROM AUTHOR]

The Asian longhorned beetle (ALB), Anoplophora glabripennis, is an invasive wood-borer in North America and Europe that threatens a variety of tree genera, including Acer and Populus. All invasive ALB populations occur in quarantine zones where they are under eradication, a process that is difficult and expensive, requiring extensive surveys and host tree removals. Although ALB has been described as an insect that is typically slow to disperse, some rare individuals that fly longer distances have the potential to start infestations outside of quarantine zones. Biological control using entomopathogenic fungi has been considered as another option for managing ALB infestations. The entomopathogenic fungus Metarhizium brunneum strain F52, registered for commercial use in the United States, is effective at killing ALB adults but information is lacking on how this entomopathogen affects ALB flight behavior before death. Using quarantine-reared ALB, flight mills were used to collect data on flight performance of beetles at multiple time points after infection. Healthy (uninfected) male ALB adults always flew significantly greater distances than females. The maximum observation for total flight distance was a healthy male that flew 10.9 km in 24 hours on a flight mill. ALB adults infected with M. brunneum F52 flew significantly shorter distances compared to healthy adults, starting one week after fungal exposure. Biological control of ALB with this fungal entomopathogen could help to reduce their dispersal in the environment and, thereby, decrease the risk of adults moving outside of quarantine zones. [ABSTRACT FROM AUTHOR]

Introduction: Malaria is a public health emergency in India and Odisha. The national malaria elimination programme aims to expedite early identification, treatment and follow-up of malaria cases in hot-spots through a robust health system, besides focusing on efficient vector control. This study, a result of mass screening conducted in a hot-spot in Odisha, aimed to assess prevalence, identify and estimate the risks and develop a management tool for malaria elimination. Methods: Through a cross-sectional study and using WHO recommended Rapid Diagnostic Test (RDT), 13221 individuals were screened. Information about age, gender, education and health practices were collected along with blood sample (5 μl) for malaria testing. Altitude, forestation, availability of a village health worker and distance from secondary health center were captured using panel technique. A multi-level poisson regression model was used to analyze association between risk factors and prevalence of malaria, and to estimate risk scores. Results: The prevalence of malaria was 5.8% and afebrile malaria accounted for 79 percent of all confirmed cases. Higher proportion of Pv infections were afebrile (81%). We found the prevalence to be 1.38 (1.1664–1.6457) times higher in villages where the Accredited Social Health Activist (ASHA) didn’t stay; the risk increased by 1.38 (1.0428–1.8272) and 1.92 (1.4428–2.5764) times in mid- and high-altitude tertiles. With regard to forest coverage, villages falling under mid- and highest-tertiles were 2.01 times (1.6194–2.5129) and 2.03 times (1.5477–2.6809), respectively, more likely affected by malaria. Similarly, villages of mid tertile and lowest tertile of education had 1.73 times (1.3392–2.2586) and 2.50 times (2.009–3.1244) higher prevalence of malaria. Conclusion: Presence of ASHA worker in villages, altitude, forestation, and education emerged as principal predictors of malaria infection in the study area. An easy-to-use risk-scoring system for ranking villages based on these risk factors could facilitate resource prioritization for malaria elimination. [ABSTRACT FROM AUTHOR]

Tobacco smoking has a negative impact on human health. Thus, it seems plausible for it to affect perceived quality of life as well. Information in this regard is lacking in Nepalese context. Thus, a comparative study was designed to assess association of cigarette smoking with Health Related Quality of Life (HRQoL). This study was conducted among 125 current and never cigarette smokers who attended a teaching hospital in peri-urban area of Capital city of Nepal from December 2015 to June 2016. The data regarding their socio-demographic characteristic, tobacco history and HRQoL was collected using a self administered questionnaire. QoL assessment was made with the help of valid, translated version of WHO QOL-BREF. Results showed current smokers on an average used 4 sticks of cigarettes per day. Significant proportions of current smokers also consumed alcohol compared to never smokers (p <0.05). Mean difference of both overall QoL score and domain scores among both study groups were relatively small and thus, failed to reach statistical significance. On the other hand, the socio-demographic characteristics like male gender, currently earning and attaining more than higher secondary education were predictors of better HRQoL scores. According to study results, relationship between smoking status and self reported QoL is unclear. Thus, the policy makers should also focus on wider determinants of ill health and well being and not just smoking status. Further research is still needed to understand the effect of tobacco on self perceived health related quality of life. [ABSTRACT FROM AUTHOR]

This study investigated the perceptions of Chinese physical therapy students on use of the Health Improvement Card (HIC) as a clinical tool to assess lifestyle and prescribe health education to others. The biometrics and health indices/attributes/lifestyles of these students were also evaluated with self-administration of the HIC. After a tutorial on the HIC and its clinical application, physical therapy students (n = 82) from two Chinese universities, completed the Chinese translation of the HIC followed by a questionnaire on students’ perceptions of it. Second, they invited a friend/relative to complete the HIC. Then, they provided feedback on the HIC’s strengths and challenges related to its administration. The data were analyzed with descriptive statistics and content thematic analysis. Response rate of self-completed HICs was 100% (n = 82) and that of questionnaires was 99% (n = 81). Participants’ age range was 20–34 years; mean body mass index (BMI) was 23.9±5.4 for men and 20.5±2.6 kg/m2 for women. Generally, participants had low-risk BMIs (82%) and blood pressures (BPs) (91%), moderate-risk dietary habits (90%), but fewer had low-risk exercise habits (41%). Of 81 friends/relatives who participated, 25% had high-risk exercise habits. Student participants concurred the HIC is useful in developing lifestyle education programs. Challenges included uncertainty about obtaining laboratory data, serving-size quantities and confidence to effect lifestyle change in others. Although students appeared receptive to assessing health and lifestyle behaviors using the HIC, they reported being unconfident to prescribe long-term effective lifestyle advice. We recommend introducing the HIC in physical therapy curricula as an effective way of sensitizing emerging physical therapists to their responsibility to assess health/attributes/lifestyle non-communicable diseases (NCDs) risk factors. Prescribing lifestyle education/counselling warrants greater curricular focus. Further research will establish how HIC data and information can be effectively used as a clinical assessment and education tool to target health and lifestyle, and track behavior change over time. [ABSTRACT FROM AUTHOR]

Background: Despite decades of community-based mass drug administration (MDA) for neglected tropical diseases, it remains an open question as to what constitutes the best combination of community medicine distributors (CMDs) for achieving high (>65%/75%) treatment rates within a village. Methods: Routine community-based MDA was evaluated in Mayuge District, Uganda. For one month, we tracked 6,148 individuals aged 1+ years in 1,118 households from 28 villages. Praziquantel, albendazole, and ivermectin were distributed to treat Schistosoma mansoni, lymphatic filariasis, and soil-transmitted helminths. The similarity/diversity between CMDs was observed and used to predict the division of labour and overall village treatment rates. The division of labour was calculated by dividing the lowest treatment rate by the highest treatment rate achieved by two CMDs within a village. CMD similarity was measured for 16 characteristics including friendship network overlap, demographic and socioeconomic factors, methods of CMD selection, and years as CMD. Relevant variables for MDA outcomes were selected through least absolute shrinkage and selection operators with leave-one-out cross validation. Final models were run with ordinary least squares regression and robust standard errors. Results: The percentage of individuals treated with at least one drug varied across villages from 2.79–89.74%. The only significant predictor (p-value<0.05) of village treatment rates was the division of labour. The estimated difference between a perfectly equal (a 50–50 split of individuals treated) and unequal (one CMD treating no one) division of labour was 39.69%. A direct tie (close friendship) between CMDs was associated with a nearly twofold more equitable distribution of labour when compared to CMDs without a direct tie. Conclusions: An equitable distribution of labour between CMDs may be essential for achieving treatment targets of 65%/75% within community-based MDA. To improve the effectiveness of CMDs, national programmes should explore interventions that seek to facilitate communication, friendship, and equal partnership between CMDs. [ABSTRACT FROM AUTHOR]

Background: There has been a growing interest in understanding the effects of social networks on health-related behaviour, with a particular backdrop being the emerging prominence of complexity or systems science in public health. Social network interventions specifically use or alter the characteristics of social networks to generate, accelerate, or maintain health behaviours. We conducted a systematic review and meta-analysis to investigate health behaviour outcomes of social network interventions.Methods and Findings: We searched eight databases and two trial registries from 1990 to May 28, 2019, for English-language reports of randomised controlled trials (RCTs) and before-and-after studies investigating social network interventions for health behaviours and outcomes. Trials that did not specifically use social networks or that did not include a comparator group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of health behaviours or outcomes at ≤6 months was assessed by random-effects meta-analysis. Secondary outcomes included those measures at >6-12 months and >12 months. This study is registered with the International Prospective Register of Systematic Reviews, PROSPERO: CRD42015023541. We identified 26,503 reports; after exclusion, 37 studies, conducted between 1996 and 2018 from 11 countries, were eligible for analysis, with a total of 53,891 participants (mean age 32.4 years [SD 12.7]; 45.5% females). A range of study designs were included: 27 used RCT/cluster RCT designs, and 10 used other study designs. Eligible studies addressed a variety of health outcomes, in particular sexual health and substance use. Social network interventions showed a significant intervention effect compared with comparator groups for sexual health outcomes. The pooled odds ratio (OR) was 1.46 (95% confidence interval [CI] 1.01-2.11; I2 = 76%) for sexual health outcomes at ≤6 months and OR 1.51 (95% CI 1.27-1.81; I2 = 40%) for sexual health outcomes at >6-12 months. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in haemoglobin A1c (HbA1c), and smoking cessation. Because of clinical and measurement heterogeneity, it was not appropriate to pool data on these other behaviours in a meta-analysis. For sexual health outcomes, prespecified subgroup analyses were significant for intervention approach (p < 0.001), mean age of participants (p = 0.002), and intervention length (p = 0.05). Overall, 22 of the 37 studies demonstrated a high risk of bias, as measured by the Cochrane Risk of Bias tool. The main study limitations identified were the inclusion of studies of variable quality; difficulty in isolating the effects of specific social network intervention components on health outcomes, as interventions included other active components; and reliance on self-reported outcomes, which have inherent recall and desirability biases.Conclusions: Our findings suggest that social network interventions can be effective in the short term (<6 months) and longer term (>6 months) for sexual health outcomes. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in HbA1c, and smoking cessation. [ABSTRACT FROM AUTHOR]

For small-scale societies, transitions from self-sufficiency to cash-based labor in market economies have been associated with the exacerbation of existing, and the emergence of new, social incongruities. Social incongruity occurs when two or more of a person’s status determinants (e.g. age, gender, wealth) conflict, resulting in reduced social status. A central focus of theory and research on social incongruity is the relationship between the cultural prototype of what is needed to live a good life–or lifestyle–and status determinants. Assessment of status determinants is challenging because of their relative nature at multiple levels of analysis. This study uses theory and methods from cognitive anthropology to investigate whether and how individual knowledge of a cultural lifestyle prototype conflicts with status determinants at two levels of economic transition among 101 adults from a small-scale society of forager-horticulturalists in Bolivian Amazonia, the Tsimane’. Results support cultural consensus in a 38-item model labeled market lifestyle (explaining 72.7% of sample variance). While the model includes both overlapping traditional (e.g. weaving) and market-related (e.g. education) items and behaviors, most market alternatives were rated higher. When market lifestyle was tested for social incongruity against other status determinants, only gender predicted variation. Thematically, when lifestyle was stratified by gender, men rated several items of relational wealth higher than women did. Analysis of model residual agreement revealed heterogeneity in the form of a syncretic lifestyle model (explaining 18.2% of additional variance). Participants whose knowledge better matched syncretic lifestyle rated traditional items and market alternatives closer to parity. Agreement with the syncretic model correlated with lower material wealth and less market integration. In sum, the findings document a modern, market-oriented form of Tsimane’ lifestyle that varies ontologically from past modelling and ethnographic accounts in preferred forms of livelihood and wealth. [ABSTRACT FROM AUTHOR]

Background: Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. Methods: We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. Findings: 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). Interpretation: Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage. [ABSTRACT FROM AUTHOR]

Background: In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt. Methods and findings: Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not. The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC = 13.2%, AUC = 0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata. Conclusions: The intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) is influenced by genetic, behavioral and environmental factors, while interactions between genetic and socioeconomic factors have been suggested. Aim of the study was to investigate whether socioeconomic position (SEP) interacts with a BMI-related genetic sum score (GRSBMI) to affect BMI in a population-based cohort. SEP-related health behaviors and a GRS associated with educational attainment (GRSEdu) were included in the analysis to explore potential interactions underlying the GRSBMIxSEP effect. Baseline information on SEP indicators (education, income), BMI, smoking, physical activity, alcohol consumption and genetic risk factors were available for 4,493 participants of the Heinz Nixdorf Recall Study. Interaction analysis was based on linear regression as well as on stratified analyses. In SEP-stratified analyses, the highest genetic effects were observed in the lowest educational group with a 0.24 kg/m2 higher BMI (95%CI: 0.16; 0.31) and in the lowest income quartile with a 0.14 kg/m2 higher BMI (95%CI: 0.09; 0.18) per additional risk allele. Indication for a GRSBMIxSEP interaction was observed for education (ßGRSbmixeducation = -0.02 [95%CI:-0.03; -0.01]) and income (ßGRSbmixincome = -0.05 [95%CI: -0.08; -0.02]). When adjusting for interactions with the GRSEdu and SEP-related health behaviors, effect size estimates of the GRSBMIxSEP interaction remained virtually unchanged. Results gave indication for an interaction of BMI-related genetic risk factors with SEP indicators, showing substantially stronger genetic effects in low SEP groups. This supports the hypothesis that expression of genetic risks is higher in socioeconomically disadvantaged environments. No indication was observed that the GRSBMIxSEP interaction was affected by other SEP-related factors included in the analysis. [ABSTRACT FROM AUTHOR]

Reconstruction has progressed steadily since the 2011 TEPCO’s Fukushima Daiichi Nuclear Power Station accident. However, some people still hesitate to eat foods from Fukushima or to travel there, and there are concerns about the health risks of radiation. We investigated the relationships among reconstruction-related behavior, risk perception, types of information, and information sources, in order to consider appropriate measures for providing information and promoting reconstruction-related behavior a number of years after the accident. We conducted an online questionnaire survey (n = 1000) of Tokyo residents. First, a factor analysis was conducted on knowledge associated with radiation. Two factors were extracted; namely, “physical knowledge” and “health/social knowledge.” We conducted structural equation modeling to construct a model of “knowledge,” “radiation risk perception,” and “intention concerning reconstruction-related behavior.” “Intention concerning reconstruction-related behavior” decreased with “radiation risk perception” and increased with “health/social knowledge.” In addition, “health/social knowledge” negatively affected “radiation risk perception;” this effect was not large, but it was significant. Second, respondents were clarified by information sources using a cluster analysis. Clusters that included respondents who got information from public relations materials issued by municipalities and websites of administrative agencies had a higher factor score for “health/social knowledge” than other clusters. The cluster of respondents who did not get any particular knowledge had the lowest factor score, which was significant, and also had a low “perception of reconstruction.” [ABSTRACT FROM AUTHOR]

Objectives: Maternal health care improvement and reduction of maternal and child mortality are priorities of the global health agenda. In Angola, maternal mortality remains high and the risk of pregnancy-related death was 1 in 32 during 2015. This study aims to identify demographic and social factors influencing antenatal care and health facility delivery among women in Dande and to understand their impact on birth outcomes. Methods: This study is based on community–based longitudinal data collected by the Dande Health and Demographic Surveillance System between 2009 and 2015. Data on pregnancy outcomes (10,289 outcomes of 8,066 women) were collected for all reported pregnancies, including sociodemographic information, health services utilisation and women’s reproductive history. Logistic regression was used to investigate the determinants of birth outcomes, antenatal care attendance and institutionalised delivery. Findings: Of the 10,289 pregnancy outcomes, 98.5% resulted in live births, 96.8% attended antenatal care, and 82.5% had four or more visits. Yet, 50.7% of the women delivered outside a health facility. Antenatal care attendance was a determinant of birth outcomes (stillbirth: unadjusted OR = 0.34 95% CI = 0.16–0.70; abortion: OR = 0.07 95% CI = 0.04–0.12). Older women, with lower education, living at a greater distance of a health facility and in rural areas, were less likely to use maternal health care. Having had previous pregnancies, namely resulting in live births, also decreased the likelihood of health care utilization by pregnant women. Conclusions: The study identifies relevant social determinants for the utilisation of antenatal care, place of delivery and their impact on birth outcome, thereby providing insight on how best to address inequities in health care utilization. [ABSTRACT FROM AUTHOR]

Although corporate social responsibility (CSR) activities are common in the pharmaceutical industry, there is little empirical evidence on consumer responses to CSR practices. We investigated public awareness, preferences, and expectations regarding social contribution of the pharmaceutical industry's CSR activities, and identified the factors associated with such activities. We conducted an online survey with 1,298 respondents comprising two groups: healthy individuals (546) and patients (752). Most respondents (78%) expressed interest in CSR activities undertaken by pharmaceutical companies. However, they reported a lack of awareness and experience thereof; only 26.9% were aware of and 7.9% had experience with such activities. Among our six CSR activity categories, both survey groups showed the highest preference for the "promoting public health" (healthy group: 6.34/10; patient group: 6.37/10) and "emergency disaster relief support" (6.31 and 6.35) categories. Among sub-categories, activities related to "development of innovative drugs in untreated areas" (6.63 and 6.82) and "support for research on new drug development" (6.59 and 6.84) received the highest scores. The mean expectation score of social contribution of all CSR activities was slightly higher than the mean preference score (6.37 and 6.06, respectively). The patient group exhibited a larger difference between the highest and lowest expectation scores than the healthy group (1.11 and 0.64, respectively). The results of the regression analysis revealed that being a patient, being male, and having positive attitudes toward CSR and its expected effects significantly and positively affected public preferences regarding CSR activities. We can conclude that CSR activities with high public preference might be an effective strategy to improve public awareness of the pharmaceutical industry's CSR activities. Furthermore, the highest preference for CSR activities relates to new drug development, indicating that our society believes the pharmaceutical industry's key CSR activity should be to pursue its intrinsic mission: to fulfill unmet medical needs by developing new drugs. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the influence of a trainer's interpersonal relations from the perspective of autonomy support and controlling style on sportspeople's basic need satisfaction and frustration, motivation, and resilience. The study used a cross-sectional design based on self-determination theory (SDT). Sportspeople (N = 324) completed questionnaires to measure their perceptions of trainers' autonomy-supportive and controlling coaching styles, basic need satisfaction and frustration in the sports context, motivation for sport, and resilience. Structural equation modeling of the proposed relations among variables supported SDT by showing a positive relation between perceived autonomy support and the satisfaction of basic psychological needs (β = .39, p < .001) and a negative relation with the frustration of psychological needs (β = −.17, p < .05). The coach's perceived interpersonal controlling style showed a positive relation with the frustration of psychological needs (β = .55, p < .001) and a negative relation with the satisfaction of basic psychological needs (β = −.27, p < .05). Furthermore, autonomous motivation showed a negative relation (β = −.46, p < .001) with the frustration of psychological needs and a positive relation (β = .35, p < .05) with the satisfaction of basic psychological needs and resilience (β = .60, p < .001). In addition, the resilience of sportspeople was indirectly affected to the same extent by the trainer's influence through control (β = −.38, p < .05) and perception of autonomy support (β = .16, p < .05) through the mediators of satisfaction of basic psychological needs and motivation. These results show the influence of the coach on the motivation and resilience of sportspeople. [ABSTRACT FROM AUTHOR]

Background: Despite improvements in mortality rates over the past several decades, cardiovascular (CV) disease remains the leading cause of death for African-Americans (AAs). Innovative approaches through mobile health (mHealth) interventions have the potential to support lifestyle change for CV disease prevention among AAs. We aimed to translate a behavioral theory–informed, evidence-based, face-to-face health education program into an mHealth lifestyle intervention for AAs. We describe the design and development of a culturally relevant, CV health and wellness digital application (app) and pilot testing using a community-based participatory research (CBPR) approach with AA churches. Methods: This mixed methods study used a 4-phase iterative development process for intervention design with the AA community. Phase 1 included focus groups with AA community members and church partners (n = 23) to gain insight regarding potential app end user preferences. In Phase 2, the interdisciplinary research team synthesized Phase 1 input for preliminary app design and content development. Phase 3 consisted of a sequential 3-meeting series with church partners (n = 13) for iterative app prototyping (assessment, cultural tailoring, final review). Phase 4, a single group pilot study among AA church congregants (n = 50), assessed app acceptability, usability, and satisfaction. Results: Phase 1 focus groups indicated general and health-related apps preferences: multifunctional, high-quality graphics/visuals, evidence-based, yet simple health information and social networking capability. Phase 2 integrated these preferences into the preliminary app prototype. Phase 3 feedback was used to refine the app prototype for pilot testing. Phase 4 pilot testing indicated high app acceptability, usability, and satisfaction. Conclusions: This study illustrates integration of formative and CBPR approaches to design a culturally relevant, mHealth lifestyle intervention to address CV health disparities among AAs. Given the positive app perceptions, our study supports the use of an iterative development process by others interested in implementing an mHealth lifestyle intervention for racial/ethnic minority communities. Trial registration: Clinicaltrials.gov . [ABSTRACT FROM AUTHOR]

Background: The aging of populations is rapidly accelerating worldwide. Especially, Japan has maintained the highest rate of population aging worldwide. As countermeasures, the Japanese government prioritized the promotion of local comprehensive care systems and collaboration in medical care and social (long-term) care. Development of a system to connect medical and social services in the community is necessary for the increasing older people, especially for the people in the stage of end of life. Objective: This study aimed to assess the effect of a multidisciplinary end-of-life educational intervention program on confidence in inter-professional collaboration and job satisfaction among health and social care professionals. Design: a cluster-randomized controlled trial Setting/Participants: Three professional groups (home care nurses, care managers, and heads of care workers) in an urban area participated in this trial. Intervention: We implemented a multidisciplinary end-of-life educational intervention program comprising two educational workshops and an educational booklet to support multidisciplinary care for end-of-life patients during the 7-month study period. Main outcome measure: Confidence in improved interactions among professionals and job satisfaction were assessed with the Face-to-Face Cooperative Confidence Questionnaire and the Minnesota Satisfaction Questionnaire at T1 (before intervention) and T2 (7 months after the intervention). Results: In total, 291 professionals participated in this study (experimental group n = 156; control group n = 135). Multivariate regression analyses showed significant between-group increases on all of seven subscales in participants’ face-to-face cooperative confidence over the study period; no effect was evident regarding job satisfaction. Conclusions: A multidisciplinary end-of-life educational intervention program increased confidence in multidisciplinary collaboration among health and social care professionals. Trial number: UMIN Clinical Trial Registry, Japan . [ABSTRACT FROM AUTHOR]

Background: The general benefit of physical activity (PA) to one’s mental health has been widely acknowledged. Nevertheless, the specific type and amount of PA that associates with lower risk of depression in China awaits further investigation. The present study was conducted on middle- and older-aged Chinese population with two objectives: 1) to understand the patterns of PA; 2) to measure the associations between depression and PA at different levels from various aspects. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2015), we selected 9118 community residents aged 45 years and older. Depressive symptoms were measured by 10-item Center for Epidemiologic Studies (CES-D 10). Multivariate logistic regression model was performed to examine the association between risk of depression and PA from four aspects including intensity, frequency, duration, and volume. Results: Spending 1–2 days/week (OR = 0.58, 95% CI: 0.36, 0.91), less than 30 minutes each time (OR = 0.66, 95% CI: 0.42, 1.03) or 150–299 min/week (OR = 0.49, 95% CI: 0.28, 0.87) on Moderate Physical Activity (MPA) was associated with lower odds of depression in women. Spending 3–5 days/week (OR = 1.98, 95% CI: 1.29, 3.05) or 6–7 days/week (OR = 1.50, 95% CI: 1.07, 2.11), 4 hours and longer each time (OR = 1.65, 95% CI: 1.18, 2.32), 300 min/week or longer (OR = 1.65, 95% CI: 1.22, 2.24) on Vigorous Physical Activity (VPA) in total, or 2250 Metabolic Equivalent of Task (OR = 1.73, 95% CI: 1.26, 2.38) on Moderate-to-Vigorous PA was associated with higher risk of depression in men. Conclusions: The association between depression and PA depended largely on intensity and gender. Lower frequency, shorter duration, and moderate amount of MPA was associated with lower risk of depression in women. Risk of depression was higher in men who spent higher frequency, longer duration, and overlong time on VPA. [ABSTRACT FROM AUTHOR]

Background: Increasingly studies show that immigrants have different perinatal health outcomes compared to native-born women. Nevertheless, we lack a detailed examination of the combined effects of maternal immigrant trajectory and socioeconomic status on perinatal outcomes. Our objective was to analyze the influence of time since naturalization on low birth weight and maternal socioeconomic status in Belgium. Methods: The data came from the linkage between the Brussels birth and death registers, the national register of migrant trajectories and the social security register for the years 2004–2010. We used logistic regression to estimate the odds ratios of the associations between low birth weight (LBW) and time since naturalization, by nationality groups, taking into account socioeconomic status (SES), parity and maternal age. Results: Data relate to all singleton births to Belgian, Maghrebi, Sub-Saharan African and Turkish women (n = 76 312). The results show an U-shaped of LBW according to time since naturalization for all migrant groups. LBW declines for women naturalized since less than one year and increases significantly thereafter (p<0.0001). In parallel, we observe an increase of SES among all migrant groups. Compared to Belgians, we found a lower risk of LBW among women from Maghreb (p<0.0001) and this protection is maintained even after 10 years since naturalization. In contrast, the risk of LBW for Sub-Saharan African and Turkish mothers is lower than for Belgians after one year of naturalization but similar to that of Belgians after 10 years of naturalization. Conclusion: Our results show that, despite an improvement of their SES, LBW increases among Maghrebi, Sub-Saharan African and Turkish women with time since naturalization. Mothers from Maghreb have lower rates of LBW compared to Belgians and maintain their protection even after more than 10 years of having acquired the Belgian nationality. Additional studies need to be carried out in order to gain a better understanding of the association between migration trajectories, SES and perinatal health of immigrants. [ABSTRACT FROM AUTHOR]

Access to HIV/AIDS-related health services among transgender women living with HIV is still a major public health issue in many developing countries, and Indonesia is not an exception. However, reportedly compared to other settings in the country, transgender women in Yogyakarta have a good access to the HIV-related health services. This study aimed to explore perceptions among transgender women living with HIV, locally known as waria, of factors supportive of their access to the services in Yogyakarta, Indonesia. A qualitative inquiry using in-depth interview method was conducted from December 2017 to February 2018 to collect the data from a selection of waria living with HIV (n = 29) recruited using both purposive and snowball sampling techniques. Data analysis employed a thematic approach which was guided by the framework analysis for qualitative data. The findings indicated several health service system-related determinants supportive of waria’s access to HIV/AIDS-related health services. These included the availability of the services, the simplicity and convenience of accessibility to the services and the comfort felt by the participants while accessing the services. Health professionals’ positive attitudes during healthcare provision, social relationships between waria and health professionals, proximity to healthcare facilities, free access to the services, and information sessions on HIV infection and prevention were also reported to enable participants’ access to the services. These findings call to efforts and strengthening of HIV health service system to support and provide equal access to HIV/AIDS-related services including to all Indonesians living with HIV, but more so for transgender women and other high-risk groups such as sex workers and their clients and men who have sex with men. [ABSTRACT FROM AUTHOR]

Background and aims: Increased body mass index (BMI = weight/height2; kg/m2) and weight gain is associated with increased mortality, wherefore weight loss and avoided weight gain should be followed by lower mortality. This is achieved in clinical settings, but in the general population weight loss appears associated with increased mortality, possibly related to the struggles with body weight control (BWC). We investigated whether attitudes to and experiences with BWC in combination with recent changes in body weight influenced long-term mortality among normal weight and overweight individuals. Population and methods: The study population included 6,740 individuals attending the 3rd cycle in 1991–94 of the Copenhagen City Heart Study, providing information on BMI, educational level, health behaviours, well-being, weight half-a-year earlier, and answers to four BWC questions about caring for body weight, assumed benefit of weight loss, current and past slimming experiences. Participants reporting previous unintended weight loss (> 4 kg during one year) were excluded. Cox regression models estimated the associations of prior changes in BMI and responses to the BWC questions with approximately 22 years all-cause mortality with age as ‘time scale’. Participants with normal weight (BMI < 25.0 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) were analysed separately, and stratified by gender and educational level, health behaviours and well-being as co-variables. Results: Compared with stable weight, weight loss was associated with significantly increased mortality in the normal weight group, but not in the overweight group, and weight gain was not significantly associated with mortality in either group. Participants with normal weight who claimed that it would be good for their health to lose weight or that they were currently trying to lose weight had significantly higher mortality than those denying it. There were no other significant associations with the responses to the BWC questions in either the normal weight or the overweight group. When combining the responses to the BWC questions with the weight changes, using the weight change as either a continuous or categorical variable, there were no significant interaction in their relation to mortality in either the normal weight or the overweight group. Conclusion: Attitudes to and experiences with BWC did not notably modify the association of changes in body weight with mortality in either people with normal weight or people with overweight. [ABSTRACT FROM AUTHOR]

Migration is a social phenomenon that has an impact both on the lives of the people who migrate, and on the societies who receive them; with psychological well-being being one of the most affected variables. The objective of this research is to analyze the possible mediating role of rooting in the host location on the negative effect that acculturation stress has on the level of well-being. Data for this study were collected using 699 Colombian and Peruvian immigrants who have been permanently residing in Chile for more than six months. Participants were assessed by using Riff’s Psychological Well-being Scale, rooting of Torrente et al., and Ruiz et al. scales of stress. The results demonstrated the mediating role of settling down within the host country in relation to stress and psychological well-being, except for the sub-dimension of autonomy. It is concluded that the need for rooting in the host country is a protective factor against the negative effects of stress on perceived well-being. [ABSTRACT FROM AUTHOR]

Proactive people take initiative when others do not and persist in improving their environment or themselves. Although scholars assume that how we feel influences how proactive we are, there is no experimental research yet to support this. This experiment therefore tests whether positive and negative affect influence proactive behavior and additionally investigates whether engaging in proactivity also has affective consequences. While current theory proposes that positive affect enhances proactive behavior by stimulating broad-flexible thinking, we argue that negative affect should make people proactive through stimulating systematic-persistent thinking. Furthermore, we propose that proactive behavior increases subsequent positive affect rather than positive affect increasing proactive behavior. Last, we hypothesize that affective causes and consequences of proactive behavior are different for people who are rarely proactive (trait-passive-reactive individuals) and people who are often proactive (trait-proactive individuals). We pre-tested 180 participants on trait-proactivity. In the lab, we manipulated affect (negative/positive/neutral), measured proactive behavior in a team interaction task, and repeatedly measured participants’ affective experiences and physiological activation. Results showed that the link between affect and proactive behavior differed depending on participants’ trait-proactivity. First, positive affect made trait-proactive individuals less proactive, whereas negative affect made passive-reactive individuals more proactive. Second, passive-reactive individuals reported decreased negative affect after engaging in proactivity, whereas proactive individuals reported increased positive affect. These results suggest that proactive behavior can serve an affect regulation purpose, which is different for trait proactive individuals (up regulating positive affect) than for trait passive-reactive individuals (down regulating negative affect). These results are limited to core affect (feeling pleasant or unpleasant) and do not apply to specific emotions (feeling proud or anxious), and they are limited to short term and successful proactive behavior and do not apply to more long term, or unsuccessful proactive behavior. [ABSTRACT FROM AUTHOR]

It has long been thought that emotional intelligence (EI) involves skillful emotion regulation, but surprisingly little is known about the precise links between EI and emotion regulation. To address this gap in the literature, we examined the relation between EI—operationalised as an ability—and the use of two common emotion regulation strategies—cognitive reappraisal and expressive suppression. Seven hundred and twelve participants from a community sample in Spain were assessed on ability EI (using the MSCEIT) and emotion regulation (using the ERQ). Findings revealed that EI ability was positively associated with cognitive reappraisal and negatively associated with expressive suppression. These relationships were moderated by gender and age. The strength of the association between EI and cognitive reappraisal increased with age for men, while this strength decreased with age for women. Conversely, the strength of the association between EI and suppression decreased with age for men, but increased with age for women. These findings confirm the expectation that EI is associated with greater use of generally adaptive forms of emotion regulation (reappraisal), and lesser use of generally maladaptive forms of emotion regulation (suppression), although effect sizes were quite modest. Observed differences in the strength of associations between EI and emotion regulation may be the result of gender differences in the development of emotional skills along with cultural changes in emotional education and social norms. [ABSTRACT FROM AUTHOR]

Introduction: Depressive emotions can lead to subsequent unhealthy behaviors such as Internet addiction, especially in female adolescents; therefore, studies that examine the relationships among depression, health‑related behaviors, and Internet addiction in female adolescents are warranted. Purpose: To examine (1) the relationship between depression and health-related behaviors and (2) the relationship between depression and Internet addiction. Method: A cross-sectional study design was adopted using a structured questionnaire to measure depression, health-related behaviors, and Internet addiction in female adolescents. The data were collected from students of a junior college in southern Taiwan using convenience sampling to select the participants. The questionnaire was divided into four sections: demographics, the Center for Epidemiologic Studies Depression Scale (CES-D), the Health Promoting Lifestyle Profile (HPLP), and the Internet Addiction Test (IAT). Results: The final sample comprised 503 female junior college students, with the participants mainly aged between 15 to 22 years (mean age = 17.30 years, SD = 1.34). Regarding the HPLP scores, the overall score, nutrition subscale score, and self-actualization subscale score were significantly and negatively associated with the CES-D depression score (p < 0.05–0.01). In other words, depression level was lower in students who exhibited more healthy behaviors, put more emphasis on dietary health, and had higher levels of self-admiration and confidence toward life. Regarding the IAT scores, the overall score and six domain scores were all positively associated (p < 0.01) to the CES-D depression score. In other words, the higher an individual’s Internet addiction score was, the higher her depression level was. Conclusions: The results confirmed the relationship between depression, health-related behaviors, and Internet addiction. The cultivation of health-related behaviors may help in lowering depressive symptoms. Teenagers with depression have higher risks of developing Internet addiction, and such addiction is likely to affect their daily functioning. [ABSTRACT FROM AUTHOR]

Background: In Kenya, Community Health Committees (CHC) were established to enhance community participation in health services. Their role is to provide leadership, oversight in delivery of community health services, promote social accountability and mobilize resources for community health. CHCs form social networks with other actors, with whom they exchange health information for decision-making and accountability. This case study aimed to explore the structure of a rural and an urban CHC network and to analyze how health-related information flowed in these networks. Understanding the pathways of information in community settings may provide recommendations for strategies to improve the role and functioning of CHCs. Methods: In 2017, we conducted 4 focus group discussions with 27 community discussants and 10 semi-structured interviews with health professionals in a rural area and an urban slum. Using social network analysis, we determined the structure of their social networks and how health related information flowed in these networks. Results: Both CHCs were composed of respected persons nominated by their communities. Each social network had 12 actors that represented both community and government institutions. CHCs were not central actors in the exchange of health-related information. Health workers, community health volunteers and local Chiefs in the urban slum often passed information between the different groups of actors, while CHCs hardly did this. Therefore, CHCs had little control over the flow of health-related information. Although CHC members were respected persons who served in multiple roles within their communities, this did not enhance their centrality. It emerged that CHCs were often left out in the flow of health-related information and decision-making, which led to demotivation. Community health volunteers were more involved by other actors such as health managers and non-governmental organizations as a conduit for health-related information. Conclusion: Social network analysis demonstrated how CHCs played a peripheral role in the flow of health-related information. Their perception of being left out of the information flow led to demotivation, which hampered their ability to facilitate community participation in community health services; hence challenging effective participation through CHCs. [ABSTRACT FROM AUTHOR]

Introduction: Globally, over half of pregnancies in developed countries are unplanned. Identifying and understanding the prevalence and complexity surrounding pregnancy preparation among Australian women is vital to enable sensitive, responsive approaches to addressing preconception and long-term health improvements for these women with varying motivation levels. Aim: This study evaluated the reliability and validity of a comprehensive pregnancy planning/intention measure (London Measure of Unplanned Pregnancy) in a population of pregnant women (over 18 years of age) in Australia. Methods: A psychometric evaluation, within a cross-sectional study comprising cognitive interviews (to assess comprehension and acceptability) and a field test. Pregnant women aged over 18 years were recruited in early pregnancy (approximately 12 weeks’ gestation). Reliability (internal consistency) was assessed using Cronbach’s alpha, corrected item-total correlations and inter-item correlations, and stability via a test-retest. Construct validity was assessed using principal components analysis and hypothesis testing. Results: Six women participated in cognitive interviews and 317 in the field test. The London Measure of Unplanned Pregnancy was acceptable and well comprehended. Reliability testing demonstrated good internal consistency (alpha = 0.81, all corrected item-total correlations >0.20, all inter-item correlations positive) and excellent stability (weighted kappa = 0.92). Validity testing confirmed the unidimensional structure of the measure and all hypotheses were confirmed. Conclusions: The London Measure of Unplanned Pregnancy is a valid and reliable measure of pregnancy planning/intention for the Australian population. Implementation of this measure into all maternity healthcare, research and policy settings will provide accurate population-level pregnancy planning estimates to inform, monitor and evaluate interventions to improve preconception health in Australia. [ABSTRACT FROM AUTHOR]

Contextual variables have been associated with the incidence of stroke, but their association with hospitalization of older persons remains unclear. This study evaluated the association between social context variables and hospitalization of 60 years old and older patients due to stroke in Rio de Janeiro, Brazil. An ecological cross-sectional study was conducted, with secondary data from the Brazilian Hospital Information System from 2006 to 2014. Hospitalization rates were calculated and categorized by tertiles. For subsequent analyzes, the polar extremes method was used to select the groups with extremes values. After that, Student t or Mann-Whitney tests were used to compare the contextual variables and the hospitalization rates clusters. Then, a Binary Logistic Regression analysis was used to assess the association between hospitalization rates clusters and the contextual variables. The total number of hospitalizations was 82 796; the hospitalization rate varied in extremes groups from the lowest (3.49) to the highest (11.95) (p<0.001). The highest rates group was positively associated with the proportion of elderly (p<0.001), the illiteracy rate of the aged (p = 0.01), primary care coverage (p<0.001) and ambulatory care for hypertension and diabetes, while the income ratio showed negative association with the highest rates of hospitalization (p = 0.01). In the multivariate analysis, only the proportion of elderly (OR = 1.55; 95%CI 1.07–2.25), primary care coverage (OR = 1.05; 95%CI 1.01–1.11) and income ratio (OR = 0.82; 95%CI 0.67–0.99) maintained the association. In conclusion, contextual variables in the three dimensions studied were associated with the rate of hospitalization of aged due to stroke in the municipalities in Rio de Janeiro State. Transitional care and other improvements in both the health care and social services are demanded. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RRa) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI). Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RRa 2.53, 95% CI 1.17, 5.48), conduct problems (RRa 2.35, 95% CI 1.07, 5.15), and total difficulties (RRa 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RRa 1.66, 95% CI 0.78, 3.52). Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children. [ABSTRACT FROM AUTHOR]

Background: There is need to identify targets for preventing or delaying dementia. Social contact is a potential target for clinical and public health studies, but previous observational studies had short follow-up, making findings susceptible to reverse causation bias. We therefore examined the association of social contact with subsequent incident dementia and cognition with 28 years' follow-up.Methods and Findings: We conducted a retrospective analysis of the Whitehall II longitudinal prospective cohort study of employees of London civil service departments, aged 35-55 at baseline assessment in 1985-1988 and followed to 2017. Social contact was measured six times through a self-report questionnaire about frequency of contact with non-cohabiting relatives and friends. Dementia status was ascertained from three linked clinical and mortality databases, and cognition was assessed five times using tests of verbal memory, verbal fluency, and reasoning. Cox regression models with inverse probability weighting to account for attrition and missingness examined the association between social contact at age 50, 60, and 70 years and subsequent incident dementia. Mixed linear models examined the association of midlife social contact between 45 and 55 years and cognitive trajectory during the subsequent 14 years. Analyses were adjusted for age, sex, ethnicity, socioeconomic status, education, health behaviours, employment status, and marital status. Of 10,308 Whitehall II study participants, 10,228 provided social contact data (mean age 44.9 years [standard deviation (SD) 6.1 years] at baseline; 33.1% female; 89.1% white ethnicity). More frequent social contact at age 60 years was associated with lower dementia risk (hazard ratio [HR] for each SD higher social contact frequency = 0.88 [95% CI 0.79, 0.98], p = 0.02); effect size of the association of social contact at 50 or 70 years with dementia was similar (0.92 [95% CI 0.83, 1.02], p = 0.13 and 0.91 [95% CI 0.78, 1.06], p = 0.23, respectively) but not statistically significant. The association between social contact and incident dementia was driven by contact with friends (HR = 0.90 [95% CI 0.81, 1.00], p = 0.05), but no association was found for contact with relatives. More frequent social contact during midlife was associated with better subsequent cognitive trajectory: global cognitive function was 0.07 (95% CI 0.03, 0.11), p = 0.002 SDs higher for those with the highest versus lowest tertile of social contact frequency, and this difference was maintained over 14 years follow-up. Results were consistent in a series of post hoc analyses, designed to assess potential biases. A limitation of our study is ascertainment of dementia status from electronic health records rather than in-person assessment of diagnostic status, with the possibility that milder dementia cases were more likely to be missed.Conclusions: Findings from this study suggest a protective effect of social contact against dementia and that more frequent contact confers higher cognitive reserve, although it is possible that the ability to maintain more social contact may be a marker of cognitive reserve. Future intervention studies should seek to examine whether improving social contact frequency is feasible, acceptable, and efficacious in changing cognitive outcomes. [ABSTRACT FROM AUTHOR]

Background: In Ecological models, physical environments can be important determinants of transport-related walking. With repeated exposure to the same environment, learning of a linkage between the cues in the environment and walking should occur. Subsequent encounters with the cues can prompt the behaviour relatively automatically. No studies have experimentally tested the potential learning of this linkage between cues and behaviour. Choices between stairs and escalators in public access settings were employed to test this premise for transport-related walking. Methods: Three studies investigated the effects of visual cues on stair/escalator choices (combined n = 115,062). In quasi-experimental, interrupted time-series designs, observers audited choices in public access settings. Design alone phases with art or coloured backgrounds were compared with design plus message phases in which verbal health promotion messages were superimposed on the visual cues. Analyses used bootstrapped logistic regression. Results: In initial studies, the design alone phases had no effect whereas subsequent design plus message phases reduced escalator choice. In two further studies, a 5–6 week design plus message phase that reduced escalator choice preceded a design alone phase. The visual background behind the successful health promotion message was reintroduced four weeks after the intervention was removed. The visual cue of design alone reduced escalator choice after it had been paired with the verbal health promotion message. There were no differences between art and coloured backgrounds. Conclusion: These studies demonstrate for the first time a learnt linkage between transport-related walking and environmental cues. Discussion focuses on the mechanisms that may underlie this learning and cues in the environment that are relevant to transport-related walking. [ABSTRACT FROM AUTHOR]

Background: The United Kingdom (UK) was the first European country to introduce a national immunisation program for shingles (2013–2014). That year, vaccination coverage ranged from 50 to 64% across the UK, but uptake has declined ever since. This study explored determinants of the acceptance of the shingles vaccine in the UK. Methods: Vaccinated and unvaccinated individuals, who were eligible for the last catch-up cohort of the 2014–2015 shingles vaccination campaign, were identified using the Clinical Practice Research Datalink (the National Health Service data research service) and invited to participate by their general practitioner (GP). An anonymised self-administered questionnaire was developed using the Health Belief Model as a theoretical framework, to collect data on demographic and socio-economic characteristics, health status, knowledge, influences, experiences and attitudes to shingles and the shingles vaccine. Multivariable logistic regression was used to identify the factors associated with vaccination. Physicians’ views concerning perceived barriers to vaccination were also assessed. Results: Of the 2,530 questionnaires distributed, 536 were returned (21.2%) from 69 general practices throughout the UK. The majority of responders were female (58%), lived in care homes (56%) and had completed secondary or higher education (88%). There were no differences between vaccinated and unvaccinated responders. Being offered the shingles vaccine by a GP/nurse (odds ratio (OR) = 2.3), and self-efficacy (OR = 1.2) were associated with being vaccinated (p<0.05). In contrast, previous shingles history (OR = 0.4), perceived barriers to vaccination (OR = 0.7) and perceived control of the disease (OR = 0.7) were associated with not being vaccinated against shingles (p<0.05). Less than half (44.0%) of GPs were aware of the local communication campaigns regarding shingles and the shingles vaccine. Conclusions: Socio-psychological factors largely influence shingles vaccination acceptance in this study. The results add to existing evidence that healthcare providers (HCPs) have a pivotal role against vaccine hesitancy. Campaigns focusing on GPs and accessible information offered to eligible members of the public can further enhance shingles vaccine uptake. [ABSTRACT FROM AUTHOR]

Emplaced health promotion interventions, delivered by community health workers are increasingly being used internationally. However, the application of epidemiological risk knowledge to individuals within such communities is not straightforward and creates tensions for community health workers who are part of the communities that they are serving. Situated qualitative interview data were co-produced with community health workers employed in a superdiverse, deprived, post-industrial region of the United Kingdom, using photo-voice methods, to develop an account of how they made sense of the challenges of their work. The analysis draws on and develops theories of risk work and resilience work, which draw on practice theory. The key findings were that, first, being a critical insider enabled community health workers to make sense of the diverse constraints on health and lifestyles within their community. Second, they understood their own public health role as limited by operating within this context, so they articulated their occupational identity as focused on supporting clients to make small but sustainable changes to their own and their families’ lifestyles. Third, the uncertainties of translating population based risk information to individual clients were (at least partially) resolved at an embodied level, with the community health workers identifying as accessible and trusted role models for the value of changed lifestyles. The article is important for policy and practice as it provides a critique of a rapidly evolving new mode of delivery of public health services, and insights on the development of this new public health workforce. [ABSTRACT FROM AUTHOR]