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AIMS: To describe sources of health information and health-seeking behaviours of adults (aged ≥18) living in medically underserved communities in the Philippines. DESIGN: This is a secondary, quantitative analysis from a cross-sectional parent study. Participants completed a 10-item, self-report survey on their sources of health information, healthcare providers sought for health and wellness and health-seeking behaviours when ill. Responses were evaluated across two age groups (

Summary Background Methods Results Conclusion The COVID‐19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self‐esteem, self‐concept) in children.We measured 247 children before school closure (October–November 2019) and after school reopening (October–November 2021) (COVID‐19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age‐matched children with cross‐sectional measurements in October–November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two‐way ANOVA was used to test age‐by‐group interactions, indicating an effect of school closure.In 7‐to‐9‐year‐old children, the COVID‐19 group had larger‐than‐expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger‐than‐expected increases in fat percentage (by 6.1 percent point). In 8‐to‐10‐year‐old children, the COVID‐19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger‐than‐expected increases in fat percentage (by 8.3 percent points), z‐score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9‐to‐11‐year‐old children, the COVID‐19 group had larger‐than‐expected decreases in physical activity (by 0.3 points) and increases in self‐concept (by 0.2 points). The response in dietary habits, fitness, or self‐esteem was not different between groups.Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children. [ABSTRACT FROM AUTHOR]

Based on the vulnerability-stress model and coping theory, this study of 1920 people in Scotland investigated how sex, age, occupational factors, anxiety, depression and maladaptive coping behaviours are associated with cardiovascular health. Structural equation modelling and serial Sobel mediation tests were conducted. Anxiety was associated with past arrhythmia, whereas depression was associated with past heart attacks, stroke and angina. Females reported more anxiety, past arrhythmia, confectionary and alcohol consumption, whereas males had more heart attacks. Confectionary consumption was associated with past arrhythmia, and alcohol consumption was associated with past heart attacks. Being older was associated with depression, past stroke, arrhythmia and alcohol consumption. Being younger was associated with anxiety and smoking. Depression and smoking mediated the relationship between type of working and cardiovascular health history, potentially because of socioeconomic factors. Clinicians can use these results to advise clients about cardiovascular risks associated with anxiety, depression, demographics and health-related coping behaviours. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is a debilitating inflammatory condition which has a high disease burden. While there is emerging evidence that certain foods and diets could have anti-inflammatory properties and there are published 'anti-inflammatory' diets, there is very little understanding of patient beliefs and perceptions about the impact of diet on symptom management or attitudes to particular dietary interventions. This scoping review aims to summarize the existing literature around the beliefs that patients with rheumatoid arthritis hold regarding the impact of diet on disease activity and joint pain. It also examines the current state of evidence regarding the impact of specific dietary interventions on patient reported and objective parameters of RA disease activity. A search was conducted across seven databases for studies which included reporting on dietary beliefs related to disease management or investigations on the effect of particular diets on disease activity or joint pain. Articles were excluded if they examined extracted compounds or individual dietary supplements. Included studies were synthesized narratively. We retrieved 25,585 papers from which 68 were included in this review: 7 assessed dietary beliefs, 61 explored dietary interventions. The available literature on patient beliefs has been largely limited to quantitative studies with limited qualitative exploration. The Mediterranean, fasting and vegan diets appear to have the most benefit with regards to rheumatoid arthritis outcomes for patients. Research which examines RA patient's beliefs and attitudes about the impact of diet on their RA symptoms and disease is currently lacking. [ABSTRACT FROM AUTHOR]

Objective: Multimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions. Methods: Using Baseline (2011–2015), Follow-up One (2015–2018), and Follow-up Two (2018–2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health. Results: Among all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster. Discussion: This research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance. [ABSTRACT FROM AUTHOR]

Summary: Background: Socioeconomic inequalities contribute to childhood overweight. Identifying mediators could help reduce these inequalities. Objective: We assessed to what extent and how parental health literacy and health behaviours mediate the relationship between parental socioeconomic status and childhood overweight. Methods: Data were taken from the multigenerational prospective Dutch Lifelines Cohort Study. We included 6683 children, baseline age 9.8 years (SD = 2.6), with an average follow‐up of 36.2 months (SD = 9.3). Overweight was defined using age‐ and sex‐specific cut‐offs. Three indicators of socioeconomic status were included: education, income and occupation. We assessed the mediating role of parental health literacy and health behaviours (smoking, diet, physical activity and alcohol) using causal mediation. Results: Four additional years of education and an SD‐increase in both income and occupation decreased the odds of childhood overweight by 42%, 12% and 20%, respectively. Only parental smoking independently mediated the relationship of both education (6.6%) and occupation (5.7%) with overweight. Parental health behaviours jointly explained 8.4% (education), 19.4% (income) and 9.8% (occupation) per relationship. Lastly, adding parental health literacy explained 10.8% (education), 27.4% (income) and 13.3% (occupation) of these relationships. Conclusions: We found large socioeconomic inequalities in childhood overweight. Remarkably, parental smoking was a key mediator. Therefore, prevention targeting smoking may reduce socioeconomic inequalities in childhood overweight. [ABSTRACT FROM AUTHOR]

Worry and rumination (Perseverative Cognition, PC) have been associated with health behaviours, but the underlying mechanisms are unknown. Given the role of physiological experiences on perceived behavioural control (PBC) and emotion regulation on intention-health behaviour relationships, we tested whether: PC prospectively predicts poorer health behaviours; PC moderates the relationship(s) between intentions/PBC and health behaviour, as well as whether the relationship between PC and health behaviour is mediated by intentions and PBC. In a prospective design, 650 participants (mean age = 38.21 years; 49% female) completed baseline measures of intentions, PBC and PC (worry and rumination) and 590 (mean age = 38.68 years; 50% female) completed follow-up (Time 2) measures of health behaviours (physical activity, sleep, sedentary activity, unhealthy snacking) 1-week later. Worry and rumination (at T1) predicted poorer sleep quality. Worry, but not rumination, moderated PBC-physical activity frequency relations. Consistent with mediation, the indirect paths from both worry and rumination, through PBC, to sleep quality and total sleep time were significant. PC is associated with poorer sleep quality and PBC can play a mediating role in such relationships. Future research should further consider the role that PBC plays in PC-health behaviour relations. [ABSTRACT FROM AUTHOR]

Aim: To explore the health beliefs and health behaviours of older Vietnam‐born people living with chronic disease in Western Australia. Design: This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. Methods: Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. Results: This study included 12 participants. The health perspectives and practices of older Vietnam‐born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self‐blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese‐oriented and Westernized‐orientated practices. Individual factors were also identified as contributing to chronic disease self‐care among participants. Conclusion: This study emphasizes culture played a significant role in shaping the way that older Vietnam‐born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. Implications: A better understanding of the health beliefs and practices of older Vietnam‐born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. Patient and public contribution: This study encompassed the contribution of 12 older Vietnam‐born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants. [ABSTRACT FROM AUTHOR]

The public health response to the COVID-19 pandemic may have changed leisure-time physical activity (PA) behaviour, as many 'Stay-at-Home' policies mandated closure of indoor recreational facilities. This study examined changes in adult leisure-time PA in more and less active groups during and after COVID-19 restrictions in a relatively active region where outdoor PA was not limited. Self-reported data on walking, moderate, and vigorous PA before, during, and after restrictions were collected via a retrospective internet survey with convenience and snowball sampling. Respondents (N = 183) were categorised as either meeting (n = 129) or not meeting (n = 54) the national recommendation of 150 minutes/week of moderate-to-vigorous aerobic PA (MVPA) during the period before restrictions. Minutes of walking, MVPA, and total PA were compared across groups and periods with two-way repeated-measure ANOVAs. Those who met PA guidelines decreased MVPA by 51.0 minutes/week during restrictions compared to before. Those not meeting PA guidelines increased total PA by 88.1 minutes/week during restrictions. This study highlights a need to better understand interactions between built environment and social cognitive factors related to leisure-time PA, which may help inform future PA interventions. [ABSTRACT FROM AUTHOR]

Abstract Objective Multimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions. Methods Using Baseline (2011–2015), Follow-up One (2015–2018), and Follow-up Two (2018–2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health. Results Among all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster. Discussion This research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.

Objectives: The aim of this study was to examine the temporal dynamics of multiple health behaviours (physical activity, alcohol consumption, healthy eating, cigarette consumption, recreational drug use, vaping), and pandemic‐related health behaviours (e.g., hand washing, physical distancing) using network psychometrics. Design: The International COVID‐19 Awareness and Responses Evaluation (iCARE) study is an international multi‐wave observational cohort study of public awareness, attitudes, and responses to public health policies implemented to reduce the spread of COVID‐19 on people around the world. A sub‐sample of longitudinal data from Canadians (n = 254) was analysed across four waves (February–July 2020). Methods: We used temporal network models to fit temporal networks, contemporaneous networks, and between‐subject networks from items within the iCARE survey. Results: Positive temporal associations were observed between physical activity and healthy eating, and a bidirectional relationship was evident between outdoor mask use and vaping. A contemporaneous network revealed positive associations between consumption behaviours (vaping, cigarette use, alcohol use, and recreational drug use), and negative associations between physical activity and drug use, and healthy eating and cigarette use. Conclusions: Health behaviours are interconnected and can be modelled as networks or behavioural systems. The application of temporal network analysis to the study of multiple health behaviours is well suited to address key research questions in the field such as 'how do multiple health behaviours co‐vary with one another over time'. Future research using time series data and measuring affective and cognitive mediators of behaviour, in addition to health behaviours, has the potential to contribute valuable hypothesis‐generating insights. [ABSTRACT FROM AUTHOR]

Objectives: The United Nations recognize the importance of balancing the needs of people and the planetary systems on which human health relies. This paper investigates the role that climate change has on human health via its influence on climate anxiety. Design: We conducted an intensive longitudinal study. Methods: Participants reported levels of climate anxiety, generalized anxiety and an array of health behaviours at 20 consecutive time points, 2 weeks apart. Results: A network analysis shows climate anxiety and generalized anxiety not to covary, and higher levels of climate anxiety not to covary with health behaviours, except for higher levels of alcohol consumption at the within‐participant level. Generalized anxiety showed completely distinct patterns of covariation with health behaviours compared with climate anxiety. Conclusions: Our findings imply that climate anxiety, as conceptualized and measured in the current study, is not in itself functionally impairing in terms of associations with unhealthy behaviours, and is distinct from generalized anxiety. The results also imply that interventions to induce anxiety about the climate might not always have significant impacts on health and well‐being. [ABSTRACT FROM AUTHOR]

Abstract Background Despite WHO’s recommendation of limited screen time for children

Abstract This paper studies multigenerational health transmission mechanisms in Australian panel data. Using inequality-of-opportunity (IOP) models, we demonstrate that grandparental socioeconomic status (SES) is an important determinant of personal health, even after controlling for health and SES at the parental level. Our findings hold over a range of health/biomarkers of individuals’ physical and mental well-being and appear to be especially sensitive to educational outcomes on the father’s side. Since ingrained socioeconomic (dis)advantages that persist over multiple generations may be indicative of social class, our results suggest that subtle attitudinal and behavioural characteristics associated with this variable may be a key factor driving health disparities.

Abstract Background Due to the introduction of a number of changes to the health care system and the work nature of medical staff, theCOVID-19 pandemic still pose a public health challenge. The objective of the study was to characterize the health behaviours of Polish professionally active physiotherapists during the COVID-19 pandemic. Methods The study included 104 Polish licensed and professionally active physiotherapists in whom health behaviours were assessed using an original questionnaire contained, among others, questions from the Global Physical Activity Questionnaire (GPAQ), the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS), available via social media platforms. Results Among the physiotherapists, 34% worked directly with COVID-19 patients and 49% with those who had survived COVID-19. There were no statistically significant differences in most of the rates of physical activity undertaken by the physiotherapists surveyed (P > 0.05). Men were more likely to report taking up movement-related physical activity than women (P > 0.05). However, they spent more time sitting or lying down on a typical day (P > 0.05). The average time spent on the above-mentioned physical activities was also higher among the male participants than in the group of women (P > 0.05). There was an increase in the proportion of physiotherapists working over 40 h per week, from 29% before the pandemic to 38% during the pandemic. Statistically significant differences were observed for the products constituting the basison which of the diet of the examined physiotherapists was based (P 0.05). Stress related to the risk of contracting COVID-19, as well as concerns about the health of loved ones were more common and severe in the group of female subjects (P

Abstract This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (

Abstract Background Lifestyle-related risk factors can increase complications during pregnancy and negatively impact the health of a mother and her child. Knowledge about these compliances among many pregnant women and women of childbearing age is lacking. In the study AOK-Family + , we propose the evaluation of a newly developed counselling intervention. The intervention aims to raise awareness and to provide relevant information about the impact of lifestyle-related risk factors during pregnancy. The aim of the proposed study is to evaluate the effect of this counselling intervention on women’s knowledge of lifestyle-related risk factors during pregnancy and the concomitant healthy behaviours. Methods A cluster-randomised trial with three arms in Baden-Wuerttemberg, Germany, is proposed. Pregnant women and women of childbearing age will be allocated to one of three groups: online intervention, on-site intervention, or a waiting-list control. Trained counsellors from AOK Baden-Wuerttemberg, a German statutory health insurer, will conduct the counselling sessions. Data collection is conducted throughout validated questionnaires administered at three intervals: before counselling (t0), directly after counselling (t1), and at a 6-week follow-up (t2). The primary outcomes will be health knowledge and healthy behaviours relating to LRFFs during pregnancy. A process evaluation will examine the processes, used resources, and future implementations through additional quantitative questions and qualitative interviews and focus groups. Discussion Based on this study, an implementation strategy for future conduction of lifestyle consultation during pregnancy could be developed with the aim of reducing pre- and post-mortem mobility and mortality. Trial registration The German Clinical Trials Register DRKS00027804. Registered on 2022/01/12.

Abstract Background Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians’ attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility and implementation of MI sessions in everyday practice are missing from the physicians’ point of view. Method The present study was conducted as a mixed methods design. Twenty paediatricians were randomized to a 2-day MI course followed by MI consultations. Data were collected through a questionnaire one year after MI training. Factors for effective training and possible barriers to successful use of MI were examined. Results Completed questionnaires were returned by 19 of 20 paediatricians. The paediatricians’ experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95% of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7% percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow. Conclusions MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and provided a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly. Trial registration The study was registered in the German Clinical Trials Register (DRKS00014043) on 26/04/2018.

Abstract Background There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen’s Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology. Methods Three group discussions were conducted with a total of 23 participants: (1) young women aged 18–24 with no children; (2) women aged 35–45 with primary school aged children; and (3) men aged 35–50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food– internal factors; food– external factors; personal-state factors; cognitive factors; and sociocultural factors. Results We found that food choice was complex, with all five determinants evident from the discussions. However, the “Social environment” sub-category of “Food-external factors”, which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the “Cognitive factor” category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components. Conclusions We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people’s eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly.

Background: Despite WHO's recommendation of limited screen time for children < 2 years, they are worldwide established screen users. Several negative consequences are connected to excessive screen use among children. As parents are key actors in introducing screens to children, it is important to explore children's screen habits and parents' perspectives on screen in different populations, which could support the development of guidelines for healthier screen use. This study aimed to explore young children's screen use habits and describe first-time parents' reflections on children's screen use in socioeconomically disadvantaged Swedish settings. Methods: This mixed methods study was a part of larger studies within Stockholm County. The data were collected through semi-structured questionnaire-based interviews, among first-time parents (N = 386) of 15–18 months-olds at local Child Health Care centres during 2019–2022. Quantitative and qualitative data analyses conducted in parallel resulted in descriptive statistics and qualitative categories. Results: Most children (92.4%) used screens by the age of 15–18 months, commonly for a maximum of 30 min (48.5%) per day. Participants stated the most suitable age for starting screen use to be after (41.7%) or at (37.9%) the age of two years. Parents' reflections on screen use formed three main categories, each having two sub-categories: screen use patterns (screen-related time and reasons for screen use), perceived concerns with screen use (child development and social issues), and attitudes related to screen use (parents' attitudes towards screens and child's response to screens). Conclusions: First-time parents in socioeconomically disadvantaged settings expressed awareness of possible negative screen-related effects and recommendations but did not always focus on long-term consequences when using screens in everyday life. Screens used as a short distraction, time spent together with screens, infants' contact with relatives overseas, and pedagogical children's programs and apps can be regarded as screen-related benefits. Encouraging parents' self-reflection on their screen use may be a way of contributing to healthier screen habits among young children. Future studies are suggested regarding parents' and children's excessive interest in screens and how to manage screen use as a family. Trial registration: Retrospectively registered 18 February 2020 (ISRCTN10336603) and 24 May 2021 (ISRCTN66190787) in ISRCTN registry. [ABSTRACT FROM AUTHOR]

Background: Due to the introduction of a number of changes to the health care system and the work nature of medical staff, theCOVID-19 pandemic still pose a public health challenge. The objective of the study was to characterize the health behaviours of Polish professionally active physiotherapists during the COVID-19 pandemic. Methods: The study included 104 Polish licensed and professionally active physiotherapists in whom health behaviours were assessed using an original questionnaire contained, among others, questions from the Global Physical Activity Questionnaire (GPAQ), the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS), available via social media platforms. Results: Among the physiotherapists, 34% worked directly with COVID-19 patients and 49% with those who had survived COVID-19. There were no statistically significant differences in most of the rates of physical activity undertaken by the physiotherapists surveyed (P > 0.05). Men were more likely to report taking up movement-related physical activity than women (P > 0.05). However, they spent more time sitting or lying down on a typical day (P > 0.05). The average time spent on the above-mentioned physical activities was also higher among the male participants than in the group of women (P > 0.05). There was an increase in the proportion of physiotherapists working over 40 h per week, from 29% before the pandemic to 38% during the pandemic. Statistically significant differences were observed for the products constituting the basison which of the diet of the examined physiotherapists was based (P < 0.05). The majority of the respondents reported no problems with falling asleep (p > 0.05). Stress related to the risk of contracting COVID-19, as well as concerns about the health of loved ones were more common and severe in the group of female subjects (P < 0.05). Conclusions: During the COVID-19 pandemic, the health behaviours in some physiotherapists changed. Further studies are required to assess whether physiotherapists' health behaviours returned to baseline levels or slightly improved compared to the initial results. Also, it is necessary to introduce health-promoting initiatives that would focus on physiotherapists, support their positive health behaviours and provide special recommendations helping them to maintain health during a pandemic. [ABSTRACT FROM AUTHOR]

Issue Addressed: People with a mental health condition are at risk of developing chronic physical disease due to smoking tobacco, inadequate nutrition, high alcohol consumption, low physical activity and poor sleep (SNAPS). Community managed organisations (CMOs) represent an opportune setting to support mental health consumers to improve their health behaviours through providing preventive care. Reporting of methods used to co‐develop implementation strategies to assist CMO staff to deliver preventive care for SNAPS are scarce yet warranted. Objectives: This study aims to: (1) describe a co‐development workshop involving CMO staff and researchers to identify preferred implementation support strategies to help staff routinely provide preventive care; (2) describe the strategies that emerged from the workshop; and (3) report staff ratings of the workshop on four co‐development principles. Methods: A three‐hour co‐development workshop was conducted on two occasions with staff of one CMO in New South Wales, Australia. Twenty staff participated in the workshops. Results: Participants generated and ranked a total of seven discrete implementation strategies within five categories (training, point of care prompts, guidelines, continuous quality improvement and consumer activation). Training for staff to have difficult conversations about behaviour change was ranked highest in both workshops. Participants rated the workshops positively across four co‐development principles. Conclusions: The co‐development workshop enabled implementation strategies to be developed within the context in which they were to be delivered and tested, potentially increasing their feasibility, acceptability, appropriateness and impact. So What?: Implementation strategies selected from the workshops will inform a pilot implementation support trial to assist CMO staff to provide preventive care to people with mental health conditions. [ABSTRACT FROM AUTHOR]

To evaluate differences in auxological parameters between transgender and cisgender adolescents. Retrospective analysis of auxological data of 269 transgender and gender diverse patients (75% assigned female at birth or AFAB, 25% assigned male at birth or AMAB) at the outpatient clinic for Pediatric Endocrinology at the Vienna General Hospital. All were treatment naïve at initial measurement. Height and weight data were compared to current World Health Organization (WHO) standards, defining a standard deviation score (SDS) of ≥ 1 ≤ 2 as overweight and > 2 as obese. In our untreated transgender population (mean age 15.7 years), 20% were overweight and 17% obese. Mean BMI was 0.64 SDS above the WHO average (p <.001). This result was more pronounced in the AFAB subgroup (+0.73 SDS, p <.001) than in the AMAB group (+0.37 SDS, p =.07). The AMAB group showed markedly higher BMI variance compared to WHO standards (p <.001) and to the AFAB group (p =.03), due to a higher relative number of underweight observations. When correcting for psychiatric diagnosis, transgender patients were still significantly overweight (p <.001). In patients for whom data both pregender-affirming hormone therapy and during gender-affirming hormone therapy was available (n = 133), BMI SDS did not change significantly over time (p =.22). We observed significantly higher rates of overweight and obesity in our adolescent transgender cohort. The reasons are likely complex and multifactorial. This makes eating and exercise behaviors central in both transgender care and future research. [ABSTRACT FROM AUTHOR]

There is little robust quantitative evidence on how community gardens impact on physical activity and other health-related behaviours. This natural experiment study aimed to examine the effects of a community garden within a Chinese neighbourhood on health-related behaviours during the COVID-19 epidemic. The study design was a repeat cross-sectional pre–post study, assessing differences between the non-epidemic period and epidemic period. Camera-based systematic observations were conducted at two locations within a community garden. A total of 180 h of video recordings were collected and coded by two researchers during a "non-epidemic" period when there were no COVID-19 restrictions (120 h) and the "epidemic" when COVID-19 restrictions were implemented (60 h). Observations of these video recordings assessed the total number of users, physical activities (Sedentary, Walking, Vigorous), social interactions (Connect), and people taking notice of the environment (Take Notice), followed by a breakdown of observed gender and age group. Data were analysed using paired t-tests and Wilcoxon signed-rank tests, comparing outcomes during the epidemic period and non-epidemic period. Results showed a significant increase in total number of users during the epidemic, particularly in females, older adults and children. Sedentary and moderate physical activities were significantly higher during the epidemic period. The increase in the total number of users of the community garden during the 2022 epidemic outbreak in Suzhou shows the importance of community gardens as a primary space for outdoor activities. This robust natural experiment study demonstrated that the community garden contributed more to physical activity, such as walking, but less to interactions between people (connecting) or people–place interactions (taking notice of the environment). More natural experiment research on community gardens like this is needed to better understand how the health and well-being benefits of community gardens can be maximized. [ABSTRACT FROM AUTHOR]

Background: A large number of deaths could be avoided by improving health behaviours. The degree to which people invest in their long-term health is influenced by how much they believe they can control their risk of death. Identifying causes of death believed to be uncontrollable, but likely to occur, may provide actionable targets for health interventions to increase control beliefs and encourage healthier behaviours. Method: We recruited a nationally representative online sample of 1500 participants in the UK. We assessed perceived control, perceived personal likelihood of death, certainty of risk estimation, and perceived knowledge for 20 causes of death. We also measured overall perceived uncontrollable mortality risk (PUMR) and perceived prevalence for each of the Office for National Statistics' categories of avoidable death. Findings: Risk of death due to cancer was considered highly likely to occur but largely beyond individual control. Cardiovascular disease was considered moderately controllable and a likely cause of death. Drugs and alcohol were perceived as risks both high in control and low in likelihood of death. However, perceptions of control over specific causes of death were found not to predict overall PUMR, with the exception of cardiovascular disease. Finally, our sample substantially overestimated the prevalence of drug and alcohol-related deaths in the UK. Conclusions: We suggest that more can be done by public health communicators to emphasise the lifestyle and behavioural changes that individuals can make to reduce their general cancer risk. More work is needed to understand the barriers to engaging with preventative behaviours and maintaining a healthy heart. Finally, we call for greater journalistic responsibility when reporting health risks to the public. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine men's body image confidence, social reflectivity, body image perceptions and external information sources influence regarding body assessments. Data were collected via a cross-sectional survey and found that men have a low motivation toward physical health behaviour changes such as food, alcohol and exercise evaluation, and have generally positive views of their bodies overall. Relationship status, rather than age, defined behavioural and attitudinal differences within the men studied here. Men in this study were largely uninfluenced by celebrities or fashion in developing their own body image perceptions; single males were more likely to turn to friends, the female population generally and societal norms when evaluating themselves. Males in relationships however, weighted their partner's opinion as the greatest influence, followed by their involvement in sport. This study offers an insight into the role of body confidence in male perspectives of the self, which is important for its intrinsic connection to motivations for health behaviours such as body weight management. This has implications for increasing the effectiveness of health-related product and service messaging, and public health messages regarding body weight management for men. [ABSTRACT FROM AUTHOR]

Our knowledge about the role of fly‐in fly‐out (FIFO) work‐related factors on the well‐being of workers across the FIFO work cycle is limited. This study examined the within‐person effects of job demand and control on psychological states and health behaviours. The study employed a daily diary design, with 23 FIFO workers in the Australian mining industry completing a daily diary survey for 28 consecutive days across on‐shift and off‐shift periods. Multilevel analyses showed FIFO workers experienced higher positive affect and enjoyed better sleep quality, but consumed more alcohol, during off‐shift days as compared to on‐shift days. Within‐person variability in daily demand (workload) was associated with higher anxious affect, whereas job control predicted lower anxious and depressed affects, higher positive affect, more alcohol consumption, and more physical activity. The within‐person effect of demand on anxious affect was moderated by job control such that those who generally had more control over their jobs had a smaller effect of demand on anxiety than those with less control. Results suggest potentially modifiable aspects of FIFO work—particularly job control—may help alleviate the impact of workload on poorer health behaviours and mood. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether eligibility for an age‐related universal (pioneer generation [PG]) subsidy incentivises dental attendance by older Singaporeans. Methods: Data were collected between 2018 and 2021 from in‐person interviews of Singaporean adults aged 60–90 years using a questionnaire and a clinical examination. The questionnaire included details of age, gender, ethnicity, education, residential status, socio‐economic status, marital status, eligibility for subsidy (community health assistance/CHAS, PG or both) and frequency of dental attendance. The clinical examination recorded number of teeth (categorized as edentulous, 1–9 teeth;10–19 teeth; ≥20 teeth). To estimate the effect of the PG subsidy on dental attendance pattern, a regression discontinuity (RD) analysis was applied using age as the assignment variable. Results: A total of 1172 participants aged 60–90 years (64.2% female) were recruited, with 498 (43%) being eligible for the PG subsidy. For those eligible for PG subsidy, there was a higher proportion of regular attenders than irregular attenders (53.6% vs. 46.4%). In age adjusted RD analysis, those eligible for the PG subsidy were 1.6 (95% CI: 1.0, 2.7) times more likely to report regular attendance than their PG non‐eligible counterparts. The association remained strong (OR 2.1; 95% CI: 1.1–3.7) even after further controlling for demographics, socioeconomic factors, number of teeth and eligibility for the CHAS subsidy. Conclusions: Being eligible for the PG subsidy substantially increased the odds of regular dental attendance. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis assessed the effectiveness of physical activity interventions on undergraduate students' mental health. Seven databases were searched and a total of 59 studies were included. Studies with a comparable control group were meta-analysed, and remaining studies were narratively synthesized. The included studies scored very low GRADE and had a high risk of bias. Meta-analyses indicated physical activity interventions are effective in reducing symptoms of anxiety (n  = 20, standardized mean difference (SMD) = −0.88, 95% CI [−1.23, −0.52]), depression (n  = 14, SMD = −0.73, 95% CI [−1.00, −0.47]) and stress (n  = 10, SMD = −0.61, 95% CI [−0.94, −0.28]); however, there was considerable heterogeneity (anxiety, I 2  = 90.29%; depression I 2  = 49.66%; stress I 2  = 86.97%). The narrative synthesis had mixed findings. Only five studies reported being informed by a behavioural change theory and only 30 reported intervention fidelity. Our review provides evidence supporting the potential of physical activity interventions in enhancing the mental health of undergraduate students. More robust intervention design and implementation are required to better understand the effectiveness of PA interventions on mental health outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: Social distancing and closing down public spaces associated with learning, leisure and physical activity limited the spread of COVID-19. These measures had an impact not only on the economy and education but also on health behaviours and the quality of life of individuals affected by the restrictions. The aim of this study was to identify the role of health behaviours in the perception of the quality of life of students during the COVID-19 pandemic. (2) Methods: This study was conducted among 796 students of the University of Warmia and Mazury in Olsztyn in the first quarter of 2022. Subgroup 1 consisted of students at the Public Health School (n = 428; 53.8%) and subgroup 2 consisted of students belonging to the Faculty of Veterinary Medicine (n = 368; 46.2%). The diagnostic survey method was applied, and an original survey questionnaire, the Health Behaviour Inventory and the Quality of Life Questionnaire (WHOQoL-Bref version) were used. (3) Results: The largest contribution to the prediction of quality of life of students in subgroup 1 was made by a positive mental attitude related to avoiding too strong emotions, which explained 19% of the result variability in the somatic domain (ßeta = 0.24; R2 = 0.21), 20% of the result variability in the psychological domain (ßeta = 0.36; R2 = 0.20), 16% of the result variability in the social domain (ßeta = 0.52; R2 = 0.17) and 17% of the result variability in the environmental domain (ßeta = 0.19; R2 = 0.19). Moreover, in subgroup 2, a predominantly positive mental attitude significantly predicted quality of life in the somatic domain, explaining 23% of the result variability (ßeta = 0.24; R2 = 0.26), while it explained 25% of the result variability in the psychological domain (ßeta = 0.47; R2 = 0.25), 16% of the result variability in the social domain (ßeta = 0.46; R2 = 0.17) and 21% of the result variability in the environmental domain (ßeta = 0.38; R2 = 0.23). (4) Conclusions: Positive correlations between health behaviours and the quality of life among the study participants were determined. Health-promoting behaviours had a beneficial impact on the respondents' quality of life during the COVID-19 pandemic. The category of health behaviours described as a positive mental attitude was an important predictor for the participants' quality of life. [ABSTRACT FROM AUTHOR]

Background Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians’ attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility and implementation of MI sessions in everyday practice are missing from the physicians’ point of view. Method The present study was conducted as a mixed methods design. Twenty paediatricians were randomized to a 2-day MI course followed by MI consultations. Data were collected through a questionnaire one year after MI training. Factors for effective training and possible barriers to successful use of MI were examined. Results Completed questionnaires were returned by 19 of 20 paediatricians. The paediatricians’ experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95% of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7% percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow. Conclusions MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and provided a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly. [ABSTRACT FROM AUTHOR]

This research examined affect and health behaviours over four weeks during consecutive COVID-19 lockdowns in the United Kingdom (UK), and the impact of expressing gratitude (EG) and visualising one's best possible self (BPS) on these outcomes compared to a control condition. Participants (N = 145) took part in a 4-week intervention during lockdown and completed an EG, BPS, or control exercise and measures of affect and health behaviours once per week for four weeks. Results showed that participants reported increased positive affect and decreased negative affect, reduced food consumption, and lower levels of moderate and vigorous exercise, but no change in alcohol consumption and walking. There were, however, no significant effects of the interventions vs. control condition on any of the outcomes; these findings were also supported by Bayes factors. This research suggests that people changed their health behaviours and affect during the COVID-19 lockdown, but that BPS and EG interventions may not be viable interventions to promote these outcomes during intense crises such as COVID-19. [ABSTRACT FROM AUTHOR]

Background: There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen's Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology. Methods: Three group discussions were conducted with a total of 23 participants: (1) young women aged 18–24 with no children; (2) women aged 35–45 with primary school aged children; and (3) men aged 35–50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food– internal factors; food– external factors; personal-state factors; cognitive factors; and sociocultural factors. Results: We found that food choice was complex, with all five determinants evident from the discussions. However, the "Social environment" sub-category of "Food-external factors", which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the "Cognitive factor" category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components. Conclusions: We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people's eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly. [ABSTRACT FROM AUTHOR]

The current paper aims to investigate the effects of pandemics and self-construal primes (i.e., collectivist/individualist) on two pandemic behaviours, namely compliance to social distancing measures (SDM) and prosociality while controlling for health anxiety. Study 1 (n = 207; M age = 39.8 years, SD age = 12.3) examined the effect of pandemic salience (PS) and self-construal on Compliance to Social Distancing Measure. Results found a significant effect of PS on compliance to SDM. Study 2 (n = 203; M age = 38.9, SD age = 11.6) examined the effects of pandemic salience (PS) and self-construal on prosociality, as measured by the Prosocial Behavioural Intentions Scale and Prosociality Scale. Results from Study 2 found a two-way interaction effect of PS and delay for helping actions, and a three-way interaction effect of PS, delay, and self-construal for caring actions and empathy. Individuals were more inclined to help others immediately after PS regardless of self-construal. They also endorsed more caring actions and empathy immediately after PS, only if they had been primed with collectivism self-construal. Findings from these studies offer important considerations in the conceptualization of community interventions during crises such as a pandemic or other community disasters. [ABSTRACT FROM AUTHOR]

Abstract Background The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. Methods Surveys on health and health behaviours were sent to representative samples of 12–18-year-old Finns in 1981–1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents’ and their parents’ socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents’ occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. Results In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. Conclusion Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes.

Abstract Background Halting and reversing the upward trend in obesity requires sustained implementation of comprehensive, evidence-based strategies at the population-level. The LiveLighter® program targets adults using a range of public education strategies, including mass media campaigns, to support healthy lifestyle changes to attain or maintain a healthy weight and reduce the risk of chronic disease. LiveLighter® has been implemented in Western Australia (WA) since 2012 and, to our knowledge, includes the longest running adult-targeted mass media campaign for healthy weight and lifestyle promotion and education globally. This evaluation assessed the impact of LiveLighter® on WA adults’ knowledge, intentions and behaviours as they relate to healthy eating and body weight from 2012 to 2019. Methods LiveLighter® mass media campaigns, which are TV-led and aired statewide, depict genuine, graphic imagery of visceral fat around internal organs to raise awareness about the link between excess body weight and chronic diseases; demonstrate how unhealthy food and drink consumption can contribute to unhealthy weight gain; and recommend healthy alternatives. Cross-sectional telephone surveys were conducted at baseline and following each campaign phase with an independent, randomly selected sample of WA adults aged 25 to 49 years (n = 501 to n = 1504 per survey) to assess their knowledge of the link between excess body weight and chronic diseases, and their intentions and behaviours related to healthy eating and weight. Multivariable logistic regression models were undertaken to assess differences in responses between baseline and each post-campaign survey. Results Compared to baseline, there were significant increases in the proportion of respondents reporting knowledge of excess body weight as a risk factor for certain cancers and type 2 diabetes, intentions to eat more fruit and vegetables and drink less sugar sweetened beverages (SSBs) in the next seven days, and the proportion of respondents who reported meeting guidelines for daily vegetable intake. Reported consumption of SSBs significantly decreased. Conclusions LiveLighter® is associated with improvements in knowledge of the health risks associated with excess body mass, increased vegetable intake and reduced SSB consumption in WA adults. These findings support the use of sustained, well-designed healthy lifestyle promotion and education programs as part of a comprehensive obesity prevention strategy.

ABSTRACTLong-term psychosocial stress is strongly associated with negative physical and mental health outcomes, as well as adverse health behaviours; however, little is known about the role that stress plays on the epigenome. One proposed mechanism by which stress affects DNA methylation is through health behaviours. We conducted an epigenome-wide association study (EWAS) of cumulative psychosocial stress (n = 2,689) from the Health and Retirement Study (mean age = 70.4 years), assessing DNA methylation (Illumina Infinium HumanMethylationEPIC Beadchip) at 789,656 CpG sites. For identified CpG sites, we conducted a formal mediation analysis to examine whether smoking, alcohol use, physical activity, and body mass index (BMI) mediate the relationship between stress and DNA methylation. Nine CpG sites were associated with psychosocial stress (all p

Background: The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. Methods: Surveys on health and health behaviours were sent to representative samples of 12–18-year-old Finns in 1981–1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents' and their parents' socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents' occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. Results: In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. Conclusion: Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to assess health behaviours and analyse selected risk factors for disease among patients diagnosed with chronic lower limb ischaemia. Material and methods: The study included 100 patients with chronic lower limb ischaemia according to the Fontaine classification in stages IIb to IV. The study used the diagnostic survey method using Juczynski's Health Behaviour Inventory and a proprietary survey questionnaire, as well as analysis of medical records. Results: In the study, 54% of the subjects had low levels of health behaviours. A statistical analysis revealed a correlation between health behaviours and certain risk factors such as the number of cigarettes smoked (p = 0.0357), hypertension (p = 0.0398), hypercholesterolaemia (p = 0.0446), age (p = 0.0015), and gender (p = 0.0021). The study group had the main risk factors for chronic ischaemic disease of the lower limbs, which include gender, age, hypertension, type 2 diabetes mellitus, smoking, lipid metabolism disorders, overweight and obesity, and history of atherosclerotic diseases. According to Fontaine's classification, diagnosed degree III ischaemia prevailed among the subjects (44%), slightly fewer subjects (33%) had degree IV, while the fewest subjects (23%) were diagnosed with degree IIb ischaemia. Conclusions: Health behaviours of patients with chronic lower limb ischaemia were at a low level overall; the lowest in the categories of health practices and proper eating habits. A burden of risk factors for chronic lower limb ischaemia was detected in the study group of patients. [ABSTRACT FROM AUTHOR]

Background: Skin aging signs affect body image satisfaction and decrease self-confidence and selfesteem. Objective(s): The present study aimed to assess factors associated with skin aging among community-dwelling adults over forty-five years. Methods: This cross-sectional study enrolled 360 individuals aged above forty-five years. Participants were recruited from various social clubs in Alexandria. Structured interviews were conducted to gather socio-demographic information, medical history, personal habits, and lifestyle factors that are possibly associated with skin aging. Skin aging was clinically evaluated using the Skin Aging Score. Results: Most participants had pigmented spots on their forehead and cheeks (87.8% and 90.8%, respectively). Fine lines (89.4%), nasolabial folds (90.6%), crow's feet (90.3%), and wrinkles under the eyes (98.3%) were prevalent among the majority with tissue slackening being marked in 77.5% of participants. Results of linear regression analysis showed that, eight variables proved to be significant predictors of skin aging among the study sample; age (B=0.16, p <0.001), being widowed (B=2.00, p= 0.01), sleeping less than 6 hours per day (B=2.35, p= 0.02), daily intake of more than one spoon of sugar (B= 1.42, p= 0.01), daily intake of less than 8 cups of water (B=2.81, p <0.001), smoking (B= 3.59, p <0.001), frequent sun exposure (B=2.00, p <0.001) and sun exposure from 12 pm to 4 pm (B= 1.82, p <0.001). Conclusion: This study highlights the importance of lifestyle factors in skin aging among individuals above forty-five years. Implementing strategies to promote healthy habits may help mitigate skin aging effects. [ABSTRACT FROM AUTHOR]

Issue Addressed: Selling alcohol to a minor is a serious offence in the New South Wales Liquor Act. However, minors report they can purchase alcohol easily. This study used an intersectoral partnership between the Central Coast Local Health District (CCLHD) Health Promotion Service, and Liquor & Gaming NSW (L&GNSW) Compliance Operations to test a site visit intervention to increase ID checks at packaged liquor outlets (PLOs). Methods: As the current legislative framework does not allow minors to attempt to purchase alcohol from PLOs, even under compliance operations, this study employed pseudo‐minors aged 18–19 years. Pseudo‐minors visited all PLOs on the Central Coast, NSW in four survey rounds, attempting to purchase alcohol without ID. If a PLO sold alcohol to the pseudo‐minor, they received a visit from a Health Promotion Officer and L&GNSW Inspector to inform them of the sale and that they are at risk of selling alcohol to a minor. Results: Site visits were an effective intervention to increase the rates of ID checking. Alcohol sales to pseudo‐minors without ID decreased from 34% in Round 1 to 7% in Round 4. Young sales staff and independent stores were less likely to check ID. Conclusions: This intervention was associated with some of the lowest rates of underage alcohol purchasing reported to date. However, it may not be sustainable in the long term. It is recommended that: future studies randomise site visits to investigate their contribution to the observed reduction, cost effectiveness of the intervention is explored and legislative change to allow controlled purchase operations for alcohol is considered. So What?: Young people under 18 years of age should not be able to purchase alcohol from liquor licence outlets, and strong laws apply if a sale is detected. However, despite these rules, young people still report they can access alcohol in this manner. Whilst our intervention of site visits with the regulatory body saw decreases in sales to our pseudo‐minors, we advocate for controlled purchase operations (similar to tobacco control) as a more sustainable and effective intervention to reduce sales to minors ‐ while this is not yet legislated for packaged liquor outlets in Australia, it is deemed best practice in other countries. [ABSTRACT FROM AUTHOR]

Objectives: This study examined how Mexican and Central American immigrants' social support was associated with three selected dental outcomes among recent immigrants, prior to the 2020 COVID‐19 pandemic. Methods: Using baseline wave data from the 2017–2022 VidaSana study about the health and social networks of Mexican and Central American immigrants living in Indiana, this study utilized logistic and ordinal logistic regression to predict lifetime fluoride use, lifetime dental restoration and flossing frequency, across levels of social support and differences between Mexican and Central American immigrants. Results: Data from 547 respondents were included in the present analysis (68% women; mean age 34.4 years [SD 11.2]; Central American 42%; Mexican 58%). Results show a high level of social support was associated with increased probability of fluoride use, dental restoration and higher flossing frequency for Mexican immigrants. However, social support for Central American immigrants was associated with a decreased likelihood of fluoride use, more infrequent flossing, and had no significant association with dental restorations experience. What would be a negative association between Central American immigrants and dental restoration was accounted for by education level and never having been to a dentist. Conclusions: While higher social support was linked to beneficial outcomes for oral health in Mexican immigrants, the opposite was found in Central Americans. These findings highlighted the complexities of social relationships among new immigrants, and potential heterogeneity within the Hispanic population, particularly regarding social and behavioural measures as they pertain to oral health. Further research is needed to identify the underlying mechanisms producing both differences in social support and oral health outcomes. [ABSTRACT FROM AUTHOR]

Background: Satisfaction with life is considered the best indicator of the quality of life of older people and is commonly used as an indicator of adaptation and successful aging. The objective of this study is to evaluate the quality of life and health among pre-seniors and seniors in Płock, Poland, focusing specifically on the interplay between life satisfaction and health outcomes. Methods: The study encompassed a total of 2040 individuals, categorized as pre-seniors and seniors. A diagnostic survey method was employed, utilizing a questionnaire that gathered sociodemographic data and incorporated two standardized psychometric scales: the Satisfaction with Life Scale (SWLS) and the Health Behaviours Inventory (HBI). Results: A majority of respondents demonstrated high levels of life satisfaction, with 1272 people (62.4%) scoring in the high range. In contrast, a smaller group, consisting of 299 respondents (14.7%), reported low satisfaction levels. Notably, men exhibited higher life satisfaction than women (p < 0.001). Additionally, a statistically significant but low correlation was found between the age of respondents and various aspects of the health behaviour index. This includes preventive behaviours (p < 0.001, r = 0.105), health practices (p < 0.001, r = 0.243), proper eating habits (p = 0.004, r = 0.063), and a positive mental attitude (p < 0.001, r = 0.098). These findings underline the complex interplay between age, life satisfaction, and health behaviours among the senior population. Conclusions: High life satisfaction and average to high levels of health behaviours were observed in our study, varying with gender and age. Individuals aged 61–75 reported the highest life satisfaction, whereas those aged 76–90 exhibited the most robust health behaviours. These results underscore the need for age- and gender-specific health policies and programs supporting sustainable aging, aligning with the Sustainable Development Goals. Further national research is essential to comprehensively explore these trends and support global well-being initiatives for aging populations. [ABSTRACT FROM AUTHOR]

Poor health behaviours in childhood, including sedentary behaviour, low physical activity levels, inadequate sleep, and unhealthy diet, are established risk factors for both chronic diseases and mental illness. Scant studies have examined the importance of such health behaviour patterns for health-related quality of life (HRQoL). This study aimed to examine the association of health behaviour patterns with HRQoL among Canadian children. Data from 2866 grade five students were collected through a provincially representative school-based survey of the 2014 Raising Healthy Eating and Active Living Kids in Alberta study. Latent class analysis was used to identify health behaviour patterns based on 11 lifestyle behaviours: sedentary behaviour (using a computer, playing video games, watching TV), physical activity (with and without a coach), sleep (bedtime on weekdays and weekends), and diet (fruit and vegetables intake, grain products, milk and alternatives, meat and alternatives). Multivariable multilevel logistic regression was applied to examine the associations of health behaviour patterns with HRQoL. Three groupings with distinct health behaviour patterns were identified: the first grouping (55%) is characterized by relatively healthy levels of sedentary behaviour, physical activity, and sleep, but a less healthy diet ("activity-focused" group). The second grouping (24%) is characterized by a relatively healthy diet, but moderately healthy levels of sedentary behaviour, physical activity, and sleep ("diet-focused" group). The third grouping (21%) is characterized by mostly unhealthy behaviours ("not health-focused" group). Students in the third and second groupings ("not health-focused" and "diet-focused") were more likely to report lower HRQoL relative to students in the first grouping ("activity-focused"). The findings suggest that health promotion strategies may be more effective when considering the patterns of health behaviours as distinct targets in the efforts to improve HRQoL. Future research should include prospective observational and intervention studies to further elucidate the relationship between health behaviour patterns and HRQoL among children. [ABSTRACT FROM AUTHOR]

• We surveyed 2,712 people in Canada following COVID-19 vaccine mandates in 2021. • Perceiving COVID-19 as less serious predicted reporting a mostly unvaccinated social circle. • Risk perception was a more powerful predictor than sociodemographic variables. • Risk perception may be a key indicator of social networks with lower intervention uptake. • Identifying high risk social circles has utility for outreach design and health system readiness. Social networks have an important impact on our health behaviours, including vaccination. People's vaccination beliefs tend to mirror those of their social network. As social networks are homogenous in many ways, we sought to determine in the context of COVID-19 which factors were most predictive of belonging to a mostly vaccinated or unvaccinated social group. We conducted a cross-sectional survey among Canadian residents in November and December 2021. Participants were asked about the vaccination status of their social networks their beliefs relating to COVID-19, and various sociodemographic factors. Respondents were split into three groups based on social network vaccination: low-, medium-, and high-risk. Chi-squared tests tested associations between factors and risk groups, and an ordinal logistic model was created to determine their direction and strength. Most respondents (81.1 %) were classified as low risk (i.e., a mostly vaccinated social network) and few respondents (3.7 %) were classified as high-risk (i.e., an unvaccinated social group). Both the chi-square test (29.2 % difference between the low- and high- risk groups [1.8 % vs. 31.0 %], p < 0.001) and the ordinal logistic model (odds ratio between the low- and high-risk groups: 14.45, p < 0.01) found that respondents' perceptions of COVID-19 as a "not at all serious" risk to Canadians was the most powerful predictor of belonging to a predominantly unvaccinated social circle. The model also found that those in mostly unvaccinated social circles also more often reported severe COVID-19 symptoms (odds ratio between the low- and high-risk groups: 2.26, p < 0.05). Perception of COVID-19 as a threat to others may signal communities with lower vaccination coverage and higher risk of severe outcomes. This may have implications for strategies to improve public outreach, messaging, and planning for downstream consequences of low intervention uptake. [ABSTRACT FROM AUTHOR]

There is uncertainty about which factors mediate the association between adverse childhood experiences (ACEs) and cardiovascular disease (CVD). This could inform secondary prevention targets. Mediation analysis of a prospective cohort study. English Longitudinal Study of Ageing (ELSA) wave 3 data (2006/7) were used to measure retrospective exposure to 12 individual ACEs and waves 2 to 4 (2004/5 to 2008/9) data to measure current exposure to potential mediators [smoking, physical activity, alcohol consumption, body mass index, depression, and C-reactive protein (CRP)]. Waves 4 to 9 ELSA data (2008/9 to 2018/19) were used to measure incident CVD. Cumulative ACE exposure was categorised into experiencing 0, 1 to 3, or ≥4 individual ACEs. Associations were tested between ACE categories, potential mediators, and incident CVD, to inform which variables were analysed in causal mediation models. The analytical cohort consisted of 4547 participants (56% women), with a mean age of 64 years (standard deviation = 9 years). At least one ACE had been experienced by 45% of the cohort, and 24% developed incident CVD over a median follow-up period of 9.7 years (interquartile range: 5.3–11.4 years). After adjusting for potential confounders, experiencing ≥4 ACEs compared with none was associated with incident CVD [odds ratio (OR): 1.55; 95% confidence interval (CI): 1.10, 2.17], and the association of one to three ACEs compared with none was non-significant (OR: 1.08; 95% CI: 0.93, 1.24). There were two statistically significant mediators of the association between ≥4 ACEs and incident CVD: CRP and depression, which accounted for 10.7% and 10.8% of the association, respectively. Inflammation and depression partially mediated the association between ACEs and CVD. Targeting these factors may reduce the future incidence of CVD. [ABSTRACT FROM AUTHOR]

Traditionally, the prevalence of health-risk behaviours is high among university students. Although these behaviours are often analysed in isolation, there is likely evidence for the co-occurrence of multiple risk behaviours. In this study, a latent class analysis (LCA) was conducted with cross-sectional data from 840 Portuguese students (55.4% female) to explore patterns of multiple risk behaviours across seven behavioural dimensions (alcohol consumption, smoking, unhealthy eating, sedentary behaviour, risky sexual practices, illicit drug use, and self-medication). Additionally, a latent class regression was performed to explore predictors (perceived well-being and sociodemographic and academic characteristics) for each behavioural pattern. A three-class model emerged with different probabilities of risk: Low-risk behaviours (51.4%), Moderate-risk behaviors (14.9%), and High-risk behaviours (33.7%). Students with better perceptions of well-being and health were likelier to be in the healthier class. Students in the low- and moderate-risk classes were more likely to be in their first year of study, not in a romantic relationship and to be full-time students. Students who had not changed residence at the beginning of their studies and were female were more likely to be in the healthiest class. This study provides essential strategies for health promotion among university students, offering crucial insights for the design of effective health promotion interventions, especially targeted at specific groups of students with similar patterns of multiple risk behaviours.

Abstract Background Genetics play an important role in risk for cardiometabolic diseases—including type 2 diabetes, cardiovascular disease and obesity. Existing research has explored the clinical utility of genetic risk tools such as polygenic risk scores—and whether interventions communicating genetic risk information using these tools can impact on individuals’ cognitive appraisals of disease risk and/or preventative health behaviours. Previous systematic reviews suggest mixed results. To expand current understanding and address knowledge gaps, we undertook an interpretive, reflexive method of evidence synthesis—questioning the theoretical basis behind current interventions that communicate genetic risk information and exploring how the effects of genetic risk tools can be fully harnessed for cardiometabolic diseases. Methods We obtained 189 records from a combination of database, website and grey literature searches—supplemented with reference chaining and expert subject knowledge within the review team. Using pre-defined critical interpretive synthesis methods, quantitative and qualitative evidence was synthesised and critiqued alongside theoretical understanding from surrounding fields of behavioural and social sciences. Findings Existing interventions communicating genetic risk information focus predominantly on the “self”, targeting individual-level cognitive appraisals, such as perceived risk and perceived behavioural control. This approach risks neglecting the role of contextual factors and upstream determinants that can reinforce individuals’ interpretations of risk. It also assumes target populations to embody an “ascetic subject of compliance”—the idea of a patient who strives to comply diligently with professional medical advice, logically and rationally adopting any recommended lifestyle changes. We developed a synthesising argument—“beyond the ascetic subject of compliance”—grounded in three major limitations of this perspective: (1) difficulty applying existing theories/models to diverse populations, (2) the role of familial variables and (3) the need for a life course perspective. Conclusions Interventions communicating genetic risk information should account for wider influences that can affect individuals’ responses to risk at different levels—including through interactions with their family systems, socio-cultural environments and wider health provision. Protocol registration PROSPERO CRD42021289269

Abstract Background Since breast cancer (BC) has the best chance of being effectively treated when it is tiny and has not spread, encouraging early disease detection remains a fundamental goal in improving prognosis. Objective To quantify the magnitude of the delay in BC presentation as well as the contributing factors related to this delay. Patients and methods Data was collected at the Breast Diseases Treatment Clinic, Shar Teaching Hospital, Sulaimani, Iraq from January 2017 to December 2021 of 429 patients. A validated questionnaire was distributed to women about their demographics, health, and general awareness of the disease. The patient delay was calculated by collecting information on when they initially began experiencing symptoms and when they saw a doctor. We also gleaned information about the tumour’s clinicopathological features from the patient’s medical records. Results The participants’ ages ranged from 24 to 85 years, with a mean of 49.6 ± 11. Most women were middle-aged (53.8%), from urban areas (80.2%), illiterate (41.7%), married (86.5%), housewives (79.0%), given birth to > 4 children (34%), practised breastfeeding (78.8%), and non-smokers (91.4%). Regarding patients’ health behaviours, there were highly significant correlations between early and late presentation (p