Health Behavior

Background: Evidence of associations between neighborhood built environments and transport-related physical activity (PA) is accumulating, but few studies have investigated associations with leisure-time PA. oBjective: We investigated associations of five objectively measured characteristics of the neighborhood built environment-destination access, street connectivity, dwelling density, land-use mix and streetscape quality-with residents' self-reported PA (transport, leisure, and walking) and accelerometer-derived measures of PA. Methods: Using a multicity stratified cluster sampling design, we conducted a cross-sectional survey of 2,033 adults who lived in 48 New Zealand neighborhoods. Multilevel regression modeling, which was adjusted for individual-level (sociodemographic and neighborhood preference) and neighborhood-level (deprivation) confounders, was used to estimate associations of built environment with PA. results: We found that 1-SD increases in destination access, street connectivity, and dwelling density were associated with any versus no self-reported transport, leisure, or walking PA, with increased odds ranging from 21% [street connectivity with leisure PA, 95% confidence interval (CI): 0%, 47%] to 44% (destination accessibility with walking, 95% CI: 17%, 79%). Among participants who self-reported some PA, a 1-SD increase in street connectivity was associated with a 13% increase in leisure PA (95% CI: 0, 28%). SD increases in destination access, street connectivity, and dwelling density were each associated with 7% increases in accelerometer counts. conclusions: Associations of neighborhood destination access, street connectivity, and dwelling density with self-reported and objectively measured PA were moderately strong, indicating the potential to increase PA through changes in neighborhood characteristics.

Objective: To assess small business adoption and need for a worksite wellness program in a longitudinal study of health risks, productivity, workers' compensation rates, and claims costs. Methods: Health risk assessment data from 6507 employees in 260 companies were examined. Employer and employee data are reported as frequencies, with means and standard deviations reported when applicable. Results: Of the 260 companies enrolled in the health risk management program, 71% continued more than 1 year, with 97% reporting that worker wellness improves worker safety. Of 6507 participating employees, 34.3% were overweight and 25.6% obese. Approximately one in five participants reported depression. Potentially modifiable conditions affecting 15% or more of enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension. Conclusions: Small businesses are a suitable target for the introduction of health promotion programs. A s the health of the nation declines and the costs of medical care rise, interest in health and wellness promotion in the workplace has increased. 1 Because the average working American spends roughly one third of his or her time at work, 2 the workplace is a logical location for promoting healthy behaviors to large numbers of individuals. To that end, the Healthy People 2020 objectives for educational and community-based programs 3 included both increasing the number of worksites that offer health promotion programs and increasing the number of employees who participate in these programs.

Academic research aims to contribute objective, evidence-based knowledge. However, in an increasingly competitive scholarly environment, exaggerated or "hyped" claims have become prevalent in research publications and associated press releases. This paper examines the scope and causes of hype in academic writing using quantitative data from empirical studies. The paper explores how hype affects scientific communication, public trust, and research integrity, and offers data-informed strategies to mitigate its impact.

Cervical cancer poses a significant burden on women worldwide, with particularly devastating impacts in developing nations, despite the availability of established prevention methods. This study aims to determine the socio-demographic and behavioral determinants of cervical cancer screening among adult women in the United States. This study is a cross-sectional study, and it employed the use and analysis of the 2022 behavioral risk factor surveillance system data. Descriptive statistics for all the variables were obtained, and chi-square test was used to determine statistical significance of observed differences in cross tabulated variables. Statistical significance level was taken at p-value < 0.05 and confidence interval at 95%. Bivariate and multivariate analysis was done to ascertain any statistical significant between socio-demographic variables and uptake rate of cervical screening. Among the 204,540 respondents, about 60% had previously undergone cervical cancer screening and the determinants of cervical cancer screening include age, single marital status, education, race, health insurance status, general health, veteran status, smoking, alcohol use, and income. In conclusion, the screening rate for cervical cancer found by this study is still low for a developed nation like the United States and sociodemographic factors associated with screening rate were age, single marital status, education, race, health insurance status, general health, veteran status, smoking, alcohol use, and income. It is therefore recommended that targeted interventions, policy initiatives, and community engagement be instituted to increase screening uptake among citizens of the United States.

Introduction: Waste management through community mobilization to reduce breeding places at household level could be an effective and sustainable dengue vector control strategy in areas where vector breeding takes place in small discarded water containers. The objective of this study was to assess the validity of this assumption. Methods: An intervention study was conducted from February 2009 to February 2010 in the populous Gampaha District of Sri Lanka. Eight neighborhoods (clusters) with roughly 200 houses each were selected randomly from high and low dengue endemic areas; 4 of them were allocated to the intervention arm (2 in the high and 2 in the low endemicity areas) and in the same way 4 clusters to the control arm. A baseline household survey was conducted and entomological and sociological surveys were carried out simultaneously at baseline, at 3 months, at 9 months and at 15 months after the start of the intervention. The intervention programme in the treatment clusters consisted of building partnerships of local stakeholders, waste management at household level, the promotion of composting biodegradable household waste, raising awareness on the importance of solid waste management in dengue control and improving garbage collection with the assistance of local government authorities. Results: The intervention and control clusters were very similar and there were no significant differences in pupal and larval indices of Aedes mosquitoes. The establishment of partnerships among local authorities was well accepted and sustainable; the involvement of communities and households was successful. Waste management with the elimination of the most productive water container types (bowls, tins, bottles) led to a significant reduction of pupal indices as a proxy for adult vector densities. The coordination of local authorities along with increased household responsibility for targeted vector interventions (in our case solid waste management due to the type of preferred vector breeding places) is vital for effective and sustained dengue control.

Background: Dengue is highly endemic in Chennai city, South India, in spite of continuous vector control efforts. This intervention study was aimed at establishing the efficacy as well as the favouring and limiting factors relating to a community-based environmental intervention package to control the dengue vector Aedes aegypti. Methods: A cluster randomized controlled trial was designed to measure the outcome of a new vector control package and process analysis; different data collection tools were used to determine the performance. Ten randomly selected intervention clusters (neighbourhoods with 100 houses each) were paired with ten control clusters on the basis of ecological/entomological indices and sociological parameters collected during baseline studies. In the intervention clusters, Aedes control was carried out using a community-based environmental management approach like provision of water container covers through community actors, clean-up campaigns, and dissemination of dengue information through schoolchildren. The main outcome measure was reduction in pupal indices (pupae per person index), used as a proxy measure of adult vectors, in the intervention clusters compared to the control clusters. Results: At baseline, almost half the respondents did not know that dengue is serious but preventable, or that it is transmitted by mosquitoes. The stakeholder analysis showed that dengue vector control is carried out by vertically structured programmes of national, state, and local administrative bodies through fogging and larval control with temephos, without any involvement of community-based organizations, and that vector control efforts were conducted in an isolated and irregular way. The most productive container types for Aedes pupae were cement tanks, drums, and discarded containers. All ten intervention clusters with a total of 1000 houses and 4639 inhabitants received the intervention while the ten control clusters with a total of 1000 houses and 4439 inhabitants received only the routine government services and some of the information education and communication project materials. The follow-up studies showed that there was a substantial increase in dengue understanding in the intervention group with only minor knowledge changes in the control group. Community involvement and the partnership among stakeholders (particularly women's self-help groups) worked well. After 10 months of intervention, the pupae per person index was significantly reduced to 0.004 pupae per person from 1.075 (P50.020) in the intervention clusters compared to control clusters. There were also significant reductions in the Stegomyia indices: the house index was reduced to 4.2%, the container index to 1.05%, and the Breteau index to 4.3 from the baseline values of 19.6, 8.91, and 30.8 in the intervention arm. Conclusion: A community-based approach together with other stakeholders that promoted interventions to prevent dengue vector breeding led to a substantial reduction in dengue vector density.

Objectives: To build up and analyse the feasibility, process, and effectiveness of a partnership-driven ecosystem management intervention in reducing dengue vector breeding and constructing sustainable partnerships among multiple stakeholders. Methods: A community-based intervention study was conducted from May 2009 to January 2010 in Yangon city. Six high-risk and six low-risk clusters were randomized and allocated as intervention and routine service areas, respectively. For each cluster, 100 households were covered. Bi-monthly entomological evaluations (i.e. larval and pupal surveys) and household acceptability surveys at the end of 6-month intervention period were conducted, supplemented by qualitative evaluations. Intervention description: The strategies included eco-friendly multi-stakeholder partner groups (Thingaha) and ward-based volunteers, informed decision-making of householders, followed by integrated vector management approach. Findings: Pupae per person index (PPI) decreased at the last evaluation by 5.7% (0.35-0.33) in high-risk clusters. But in low-risk clusters, PPI remarkably decreased by 63.6% (0.33-0.12). In routine service area, PPI also decreased due to availability of Temephos after Cyclone Nargis. As for total number of pupae in all containers, when compared to evaluation 1, there was a reduction of 18.6% in evaluation 2 and 44.1% in evaluation 3 in intervention area. However, in routine service area, more reduction was observed. All intervention tools were found as acceptable, being feasible to implement by multi-stakeholder partner groups. Conclusions: The efficacy of community-controlled partnership-driven interventions was found to be superior to the vertical approach in terms of sustainability and community empowerment.

Background and Objectives: Dengue is an important public health problem in Yogyakarta city, Indonesia. The aim of this study was to build an innovative community-centered dengue-ecosystem management intervention in the city and to assess the process and results. Methods: For describing the baseline situation, entomological surveys and household surveys were carried out in six randomly selected neighborhoods in Yogyakarta city, documents were analyzed and different stakeholders involved in dengue control and environmental management were interviewed. Then a community-centered dengue-ecosystem management intervention was built up in two of the neighborhoods (Demangan and Giwangan) whereas two neighborhoods served as controls with no intervention (Tahunan and Bener). Six months after the intervention follow up surveys (household interviews and entomological) were conducted as well as focus group discussions and key informant interviews. FIindings: The intervention results included: better community knowledge, attitude and practices in dengue prevention; increased household and community participation; improved partnership including a variety of stakeholders with prospects for sustainability; vector control efforts refocused on environmental and health issues; increased community ownership of dengue vector management including broader community development activities such as solid waste management and recycling. The community-centred approach needs a lot of effort at the beginning but has better prospects for sustainability than the vertical ''top-down'' approach.

Because quitting smoking is clearly linked to preventing health problems such as lung cancer, research on health message framing based on prospect theory suggests that gain-framed messages (i.e., emphasizing the benefits of quitting smoking) would be more persuasive in promoting cessation than loss-framed messages (i.e., emphasizing the costs of continuing to smoke). However, because women tend to anticipate greater perceived risk from quitting smoking than men, this may affect how receptive they are to specific message framing interventions. Data from 249 participants (129 females, 120 males) in a clinical trial of message framing for smoking cessation with bupropion were used to examine how gender differences in perceptions of the risks associated with quitting influence the effects of framed interventions using number of days to smoking relapse as the criterion. Perceived risk of quitting scores were dichotomized using a median split for the entire sample. Women reported a higher perceived risk of cessation than men. Participants who anticipated high risks associated with quitting smoking reported fewer days to relapse. Further, females in the gain-framed condition who reported low perceived risks of cessation had a greater number of days to relapse, as opposed to females in the loss-framed condition. These findings suggest that message framing interventions for smoking cessation should consider the influence of gender and risk perceptions associated with quitting on the effectiveness of framed interventions.

Encouraging cancer survivors to discuss clinical trials with their physicians may increase enrollment in clinical trials. Health messages offer one method for encouraging such discussions. We hypothesized that matching messages to an individual's preference for detailed or non-detailed information (i.e., monitoring style) would result in more discussions. Participants (N = 538) were cancer survivors, who phoned the National Cancer Institute's Cancer Information Service (CIS). Participants were classified as higher or lower monitors and then randomized to receive detailed or non-detailed messages in the mail one and four weeks following their baseline CIS call. At 12weeks there was a significant interaction between monitoring style and message detail. Follow-up analyses were non-significant but suggested a theoretically consistent pattern in which nondetailed messages were more effective among lower-monitors. These findings imply that providing extremely detailed information may be excessive, even to individuals engaged in information seeking behavior.

Objective: To identify the factors associated with the prevalence of inadequate blood pressure control among hypertensive residents of a Quilombola community in Northeastern Brazil. Methods: A cross-sectional epidemiological study with the participation of residents of Quilombo do Barro Preto (Jequié, Bahia) aged 35 to 79 years. Blood pressure control was classified as inadequate for systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Medication adherence was assessed according to the Morisky Medication Adherence Scale. Using log-binomial regression, prevalence ratios (PR) adjusted for sex and age were estimated with 95% confidence intervals (95%CI) to compare differences between the prevalence of inadequate blood pressure control among interest groups. Comparisons between means were based on Student's t-Tests and analysis of variance. Results: Among the 300 participants, 71.7% were women, 49.3% self-identified as Black, 41.0% Brown, and 39.7% had incomplete elementary education. Systolic blood pressure was associated with age, with a higher average among people over 65 years of age, while the average diastolic blood pressure was higher among people up to 55 years of age. The prevalence of inadequate pressure control was 66.3% (95%CI 60.7; 71.7), being higher in people with type 2 diabetes (PR1.28; 95%CI 1.09; 1.51) and low adherence to medications (PR1.27; 95%CI 1.01; 1.59). Conclusions: The Quilombola population presents difficulties in controlling hypertension, with a high prevalence of uncontrolled blood pressure, especially among people with type 2 diabetes and low adherence to drug treatment.

Purpose African American women with breast cancer have higher cancer-specific and overall mortality rates. Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions. Weight loss interventions among breast cancer survivors positively affect weight, behavior, biomarkers, and psychosocial outcomes, yet few target African Americans. This article examines the effects of Moving Forward, a weight loss intervention for African American breast cancer survivors (AABCS) on weight, body composition, and behavior. Patients and Methods Early-stage (I-III) AABCS were randomly assigned to a 6-month interventionist-guided (n = 125) or self-guided (n = 121) weight loss program supporting behavioral changes to promote a 5% weight loss. Anthropometric, body composition, and behavioral data were collected at baseline, postintervention (6 months), and follow-up (12 months). Descriptive statistics and mixed models analyses assessed differen...

Whereas hedonic consumption is often labeled as impulsive, findings from self-licensing research suggest that people sometimes rely on reasons to justify hedonic consumption. Although the concept of self-licensing assumes the involvement of reasoning processes, this has not been demonstrated explicitly. Two studies investigated whether people indeed rely on reasons to allow themselves a guilty pleasure. Participants were exposed to a food temptation after which passive and active reasoning was assessed by asking participants to indicate the justifications that applied to them for indulging in that temptation (Study 1) or having them construe reasons to consume the hedonic product (Study 2). Regression analyses indicated that higher levels of temptation predicted the number of reasons employed and construed to justify consumption. By providing evidence for the involvement of reasoning processes, these findings support the assumption of self-licensing theory that temptations not only exert their influence by making us more impulsive, but can also facilitate gratification by triggering deliberative reasoning processes.

Objective. To assess the impact of a 6-week patient/provider interaction simulation on empathy and self-efficacy levels of diabetes management skills in third-year pharmacy students. Design. Pharmacy students enrolled in a diabetes elective course were paired to act as a patient with diabetes or as a provider assisting in the management of that patient during a 6-week simulation activity. After 3 weeks, students switched roles. The simulation was designed with activities to build empathy. Assessment. The Jefferson Scale of Empathy (JSE) and a self-efficacy survey were administered to assess change in empathy and confidence levels from baseline to the end of the activity. Completion of the activity resulted in significant improvement in total JSE scores. Additionally, significant improvements in overall self-efficacy scores regarding diabetes management were noted. Conclusion. The 6-week patient/provider interaction simulation improved empathy and self-efficacy levels in third-year pharmacy students.

We examined sleep-related problems in adolescents and young adults after a mild traumatic brain injury (MTBI) or orthopedic injury. We extended the analysis of data from a study of early emotional and neuropsychological sequelae in these populations (McCauley et al. 2014. J Neurotrauma. 31:914). We gave the Pittsburgh Sleep Quality Index to 77 participants with MTBI, 71 with orthopedic injury, and 43 non-injured controls. The age range was 12 to 30 years. We tested sleep quality within 96 hours of injury and at 1- and 3-month follow-up. Participants also completed measures of pain and fatigue, drug and alcohol use, and post-traumatic stress symptoms. Older participants (mean age=25 years) in the MTBI group exhibited a sharp increase in sleep-related symptoms between the baseline assessment and 1 month, and still had difficulties at 3 months. Younger participants with MTBI (mean age=15 years) and older participants with an orthopedic injury had modest increases in sleep difficulties ...

Introduction: Previous studies have reported a higher prevalence of obesity among rural Americans. However, it is not clear whether obesity-related behaviors can explain the higher level of obesity among rural adults. The purpose of this study was to examine the differences in obesity-related behaviors across rural-urban adult populations in the USA. Methods: Data were obtained from the 1999-2006 National Health and Nutrition Examination Survey, restricted to 14 039 participants aged 20 years or more. Body mass index (BMI) was calculated using measured height and weight, and individuals with BMI≥30 kg/m 2 were categorized as obese. Physical activity recommendations were used to define participants' physical activity levels: no leisure-time physical activity, less than, meeting, and exceeding the recommended levels. Sedentary behaviors were measured by hours sitting and watching TV or videos or using a computer (outside of work). Dietary intake was assessed by one-day 24 hour dietary recall. Residence was measured at the census tract level using the Rural-Urban Commuting Area Codes. Multiple logistic regression models were used to examine urban-rural differences after adjusting for sociodemographic, health, dietary, and lifestyle factors. Results: The prevalence of obesity was higher in rural than in urban residents (35.6% vs 30.4%, p<0.01), among both men (37.7% vs. 32.5%, p<0.01) and women (33.4% vs 28.2%, p<0.01). Compared to urban adults, more rural adults reported no leisure-time physical activity (38.8% vs 31.8%, p<0.01) and fewer rural adults met or exceeded physical activity recommendations (41.5% vs 47.2%, p<0.01). Rural adults had lower intake of fiber and fruits and higher intake of sweetened beverages. After adjusting for sociodemographic, health, diet, sedentary behaviors, and physical activity, the odds of being obese among rural adults were 1.19 times higher than that among urban adults (95% confidence interval: 1.06, 1.34).

Background: Previous studies demonstrated that lower outdoor temperatures increase the levels of established cardiovascular disease risk factors, such as blood pressure and lipids. Whether or not low temperatures increase novel cardiovascular disease risk factors levels is not well studied. The aim was to investigate associations of outdoor temperature with a comprehensive range of established and novel cardiovascular disease risk factors in two large Northern European studies of older adults, in whom cardiovascular disease risk is increased. Design and methods: Data came from the British Regional Heart Study (4252 men aged 60-79 years) and the Prospective Study of Pravastatin in the Elderly at Risk (5804 men and women aged 70-82 years). Associations between outdoor temperature and cardiovascular disease risk factors were quantified in each study and then pooled using a random effects model. Results: With a 5 C lower mean temperature, total cholesterol was 0.04 mmol/l (95% confidence interval (CI) 0.02-0.07) higher, low density lipoprotein cholesterol was 0.02 mmol/l (95% CI 0.01-0.05) higher and SBP was 1.12 mm Hg (95% CI 0.60-1.64) higher. Among novel cardiovascular disease risk factors, C-reactive protein was 3.3% (95% CI 1.0-5.6%) higher, interleukin-6 was 2.7% (95% CI 1.1-4.3%) higher, and vitamin D was 11.2% (95% CI 1.0-20.4%) lower. Conclusions: Lower outdoor temperature was associated with adverse effects on cholesterol, blood pressure, circulating inflammatory markers, and vitamin D in two older populations. Public health approaches to protect the elderly against low temperatures could help in reducing the levels of several cardiovascular disease risk factors.

In 1990 world leaders assembled at the World Summit for Children made a commitment to "give every child a better future" and established 27 goals for improving children's health and well being by the year 2000. Progress toward those benchmarks will be the focus of the first special session of the United Nations General Assembly devoted to children, to be held 19-21 September 2001. In preparation for this meeting, the U.S. Coalition for Child Survival asked a number of experts to write briefing papers assessing efforts to achieve the goals of the 1990 summit. This document contains papers drafted by BASICS II staff summarizing what has been learned and accomplished during the past decade in eight important areas of child survival and makes recommendations for the future. The topics covered are: 1) maintaining a high level of immunization, 2) preventing neonatal tetanus, 3) reducing deaths from diarrhea, 4) reducing deaths from acute respiratory infections, 5) reducing deaths from measles, 6) reducing malnutrition, 7) promoting children's growth, and 8) improving newborn health.

Our objective was to identify individual and school-level contextual factors related to adherence to the recommendations for physical activity in adolescents. The study used a representative sample of 15,902 students from 328 schools aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children (HSBC) survey 2006. In addition to the student questionnaire, the school management board completed a questionnaire about school-based policies related to physical activity. Adherence to the recommendations was defined as "having carried out moderate and/or vigorous physical activity for at least 60 minutes a day on five or more days during the last week". Analysis was undertaken using multilevel logistic regression models. Individual factors associated in a statistically significant way with a higher non-compliance were: being female; being older; immigrants; tobacco smoking; being overweight or obese; low consumption of fruit and vegetables; low level of satisfaction with life; not having a high level of academic achievement; and spending a lot of time studying. The family variables were: not undertaking sports activities with the family; low socioeconomic status; and a low level of satisfaction with family relationships. Compared with schools that have a low level of policies to promote physical activities, those with a high level of promotion had an odds ratio of 0.76 (CI 95%: 0.61-0.94). In summary, irrespective of personal and family factors, students from schools with better policies of promotion of physical activity showed a higher compliance with the recommendations.

The aim of this study was investigate drinking, driving, and socio-behavioral factors among university students in low and middle income and emerging economy countries. Using anonymous questionnaires, data were collected from 18476 university students, of which 15151 (82.0%) were drivers of a car or motorcycle (41.3% men and 58.7% women), with a mean age of 20.7 years (SD=2.9), from 22 countries across Africa, Asia and Americas. Overall, 17.3% reported to have been driving a car or motorcycle after having had too much to drink in the past 12 months, ranging from below 5% in Bangladesh, Indonesia and Kyrgyzstan to above 35% in China, Singapore and Thailand. In multivariate logistic regression analysis, among both men and women, earlier year of study, living in an upper middle income or high income country (OR=3.58, CI=3.00-4.27 and OR=2.95, CI=2.52-3.46), low intrinsic religiosity (OR=0.67, CI=0.54-0.83 and OR=0.34, CI=0.28-0.42), injury from motorcycle accidents (OR=4.29, CI=2.69-6....

The aim of this study was to estimate the prevalence of self-reported seatbelt use and sociodemographic, health risk behaviour and social-legal correlates among university students in 26 low-, middle-and high-income countries. Using anonymous questionnaires, data were collected from 16 770 undergraduate university students (mean age 20.9, SD=2.9) from 23 universities in 26 countries across Asia, Africa and the Americas. Results indicate that the percentage of university students reporting to be inconsistently using a seatbelt were 54.7% for all countries, 56.0% for men and 53.7% for women. In multivariate logistic regression, younger age, poorer family background, living in a low-income or lower-middle-income country, having no national seatbelt law or a law that does not apply to all occupants, poor attitudes towards seatbelt use, not always following the speed limit, having depressive symptoms, drug use, and low physical activity were associated with self-reported inconsistent seatbelt use. High selfreported inconsistent seatbelt use was found and several risk factors were identified which can be utilised in seatbelt use promotion programmes.

This study determines the differences in health risk behavior, knowledge, and health benefit beliefs between health science and non-health science university students in 17 low and middle income countries. Anonymous questionnaire data were collected in a cross-sectional survey of 13,042 undergraduate university students (4,981 health science and 8,061 non-health science students) from 17 universities in 17 countries across Asia, Africa, and the Americas. Results indicate that overall, health science students had the same mean number of health risk behaviors as non-health science university students. Regarding addictive risk behavior, fewer health science students used tobacco, were binge drinkers, or gambled once a week or more. Health science students also had a greater awareness of health behavior risks (5.5) than non-health science students (4.6). Linear regression analysis found a strong association with poor or weak health benefit beliefs and the health risk behavior index. There was no association between risk awareness and health risk behavior among health science students and an inverse association among non-health science students.

Objective: Alcohol misuse is a relevant public health issue in Thailand. The assessment of the prevalence of alcohol use among adolescents may guide policies and programmes aimed at reducing alcohol use among this age group. Method: Using data from the Thailand Global School-based Student Health Survey (GSHS) 2008, we assessed the prevalence of alcohol use and the associated factors among adolescents (n = 2758). Results: Overall, the prevalence of current alcohol use was 14.8% (21.2% males and 9.3% females). Variables positively associated with the outcome in multivariable analysis among boys were older age, other substance use (smoking and illicit drug use), sex in the past 12 months, physical fighting, injury in the past 12 months; and among girls, poverty, smoking, physical fighting and lack of parental or guardian connectedness. Conclusion: Efforts to prevent and control alcohol misuse may need to address a cluster of risk behaviours including cigarette smoking.

La búsqueda de nuevas fórmulas de gestión sanitaria capaces de dar una prestación amplia y sostenible es uno de los objetivos prioritarios de las actuales políticas de salud. Dichas fórmulas exploran cómo optimizar los vínculos entre los actores principales que participan de la salud pública, es decir, los usuarios, los profesionales, los agentes socio-políticos y los agentes empresariales. El objetivo de este artículo es dar a conocer el Análisis de Redes Sociales (ARS) como una herramienta y un método capaz de analizar, medir e interpretar esas conexiones. Conocer cómo son las relaciones entre personas, lo que se denomina redes sociales, en el campo de la salud pública está tomando cada vez más relevancia en la comunidad internacional. De hecho, países como Reino Unido, Holanda, Italia, Australia y EEUU, buscan fórmulas para aplicar estos conocimientos a sus departamentos de salud. Con el presente trabajo ponemos de manifiesto la utilidad del ARS en temas relacionados con la sostenibilidad del sistema sanitario, especialmente en cuanto a los hábitos de salud y al apoyo social, tópicos recogidos en las estrategias de salud 2020, los cuales subrayan los aspectos colaborativos en clave de red.

BACKGROUND The preschool years offer a unique window of opportunity to instill healthy life-style behaviors and promote cardiovascular health. OBJECTIVES This study sought to evaluate the effect of a 3-year multidimensional school-based intervention to improve life-style-related behaviors. METHODS We performed a cluster-randomized controlled intervention trial involving 24 public schools in Madrid, Spain, that were assigned to either the SI! Program intervention or the usual curriculum and followed for 3 years. The SI! Program aimed to instill and develop healthy behaviors in relation to diet, physical activity, and understanding how the human body and heart work. The primary outcome was change in the overall knowledge, attitudes, and habits (KAH) score (range 0 to 80). The intervention's effect on adiposity markers was also evaluated. RESULTS A total of 2,062 children from 3 to 5 years of age were randomized. After 3 years of follow-up, the overall KAH score was 4.9% higher in children in the intervention group compared with the control group (21.7 vs. 16.4; p < 0.001). A peak effect was observed at the second year (improvement 7.1% higher than in the control group; p < 0.001). Physical activity was the main driver of the change in KAH at all evaluation times. Children in the intervention group for 2 years and 1 year showed greater improvement than control subjects (5.9%; p < 0.001 and 2.9%; p ¼ 0.002, respectively). After 3 years, the intervention group showed a higher probability than the control group of reducing the triceps skinfold z-score by at least 0.1 (hazard ratio: 1.40, 95% confidence interval: 1.04 to 1.89; p ¼ 0.027). The SI! Program is an effective strategy for instilling healthy habits among preschoolers, translating into a beneficial effect on adiposity, with maximal effect when started at the earliest age and maintained over 3 years. Wider adoption may have a meaningful effect on cardiovascular health promotion. (Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial [Preschool_PSI!]; NCT01579708)

The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...

This study examines the impact of electronic waste work on the mental well-being of informal workers in Agbogbloshie and Ashaiman, Ghana two major recycling hubs notorious for hazardous and unregulated environments. While extant literature has largely focused on environmental and physical health consequences, the psychological toll of this work remains insufficiently explored. Using a mixed-methods design combining surveys (N=100) and interviews (N=5), this study assesses the prevalence of mental health conditions, determinants, and coping mechanisms among e-waste workers. Results show a high prevalence of depression, anxiety, and stress, fueled by long-term exposure to toxic substances, no use of personal protective equipment (PPE), irregular income, job insecurity, and social stigma. Coping strategies are mainly informal, such as dependence on religious beliefs, social support, and alcohol or drug use, with little use of professional mental health services. The lack of institutional safety protocols and poor access to healthcare heighten workers' vulnerabilities. The research emphasizes the synergistic interplay of socioeconomic adversity and occupational danger that compounds psychological stress. By synthesizing quantitative findings with workers' personal narratives, it provides an in-depth perspective on e-waste workers lived experience. The findings call for immediate culturally competent community-based mental health services, enhanced safety training, and stricter regulatory oversight to safeguard and advocate for the well-being of this vulnerable worker population.

Anxiety, fear, and worry are variously described as facilitators and barriers of breast cancer screening. However, several contradictions are evident in this research. A review article described the literature regarding the relations among fear, anxiety, and worry, along with emotion regulatory styles, and breast cancer screening behaviors before critiquing it in an attempt to uncover preliminary explanations for these discrepancies. Three main conclusions are drawn. First, it is suggested that researchers need to clearly define the components of cancer and the screening process that women are afraid of as each may bear a different relation to screening behavior. Second, greater care needs to be taken to employ psychometrically valid and reliable measures of fear and anxiety. Third, studies need to more systematically test findings across the minority and ethnic groups at greatest risk. A framework is presented and suggestions regarding the continued development of this promising area of research are made. (Cancer Epidemiol Biomarkers Prev 2004;13(4): 501 -510)

Background Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed &quot;Demand-Side Financing&quot; or &quot;Output-Based Aid&quot;, includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services. Methods/Design Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to addres...

Background: Cost-effective interventions to improve diet and physical activity are a public health priority. Alive! is an email-based intervention to increase physical activity, reduce saturated and trans fats and added sugars, and increase fruit and vegetable consumption. It was shown to improve these behaviors in a large randomized controlled trial. (1) To describe the components and behavioral principles underlying Alive!, and (2) to report effects of the intervention on the secondary outcomes: health-related quality of life, presenteeism, self-efficacy, and stage of change. The Alive! behavior change model is designed to elicit healthy behaviors and promote their maintenance. Behavioral strategies include assessments followed by individualized feedback, weekly goal-setting, individually tailored goals and tips, reminders, and promotion of social support. Alive! was tested among non-medical employees of Kaiser Permanente of Northern California, who were randomized to either the intervention group or the wait-list control group. After randomization, intervention group participants chose one topic to undertake for the intervention period: increasing physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. Pre-post questionnaires assessed changes in SF-8 health-related quality of life, presenteeism, self-efficacy, and stage of change. Mixed effects multiple linear regression and ordinal logistic regression models were used, with department as a random effect factor. Analyses were by intention to treat: the 30% (238/787) who did not respond to the follow-up questionnaires were assigned change scores of zero. Results: Participants were 19 to 65 years (mean 44.0 +/-10.6), and 74.3% (585/787) were female. Mean SF-8 Physical quality of life score increased significantly more in the intervention group than in the control group, 1.84 (95% CI 0.96-2.72) vs 0.72 (95% CI -0.15-1.58) respectively, P = .02. SF8 Mental score also improved significantly more in the intervention group than in the control group (P = .02). The odds ratio for improvement in self-assessed health status was 1.57 (95% CI 1.21-2.04, P < .001) for the intervention group compared to the control group. The odds ratio for having a reduction in difficulty accomplishing work tasks because of physical or emotional problems, a measure of presenteeism, was 1.47 (95% CI 1.05-2.05, P = .02) for the intervention group compared to the control group. The odds of having an improvement in self-efficacy for changing diet was 2.05 (95% CI 1.44-2.93) for the intervention vs the control group (P < .001). Greater improvement in stage of change for physical activity (P = .05), fats (P = .06), and fruits/vegetables (P = .006) was seen in the intervention group compared to the control group. Significant effects on diet and physical activity behavior change are reported elsewhere. Conclusions: Cost-effective methods that can reach large populations with science-based interventions are urgently needed. Alive! is a fully automated low-cost intervention shown to effect significant improvements in important health parameters.

Objective. To examine nonlinearity of determinants of morbidity in the United States Data Sources. A secondary analysis of data on individuals with dietary data from the Cancer Epidemiology Supplement and National Health Interview Survey (NHIS) 1987, a cross-sectional, stratified random sample of the U.S. population (n 5 22,080). Study Design. A statistical exploration using additive multiple regression models. Methods. A Morbidity Index (0-30 points), derived from 1987 National Health Interview Survey data, combines number of conditions, hospitalizations, sick days, doctor visits, and degree of disability. Behavioral (health habits) variables were added to multivariate models containing demographic terms, with Morbidity Index and Selfassessed Health outcomes (n 5 17,612). Tables and graphs compare models of morbidity with self-assessed health models, with and without behavioral terms. Graphs illustrate curvilinear relationships. Principal Findings. Morbidity and health are associated nonlinearly with age, race, education, and income, as well as alcohol, diet change, vitamin supplement use, body mass index (BMI), marital status/living arrangement, and smoking. Diet change and supplement use, education, income, race/ethnicity, and age relate differently to selfassessed health status than to morbidity. Morbidity is strongly associated with income up to about $15,000 above poverty. Additional income predicts no further reduction in morbidity. Better health is strongly related to both higher income and education. After controlling for income, black race does not predict morbidity, but remains associated with lower self-assessed health. Conclusions. Good health habits, as captured in these models, are associated with a 10-20-year delay in onset and progression of morbidity.

Pharmacy syringe sales without a prescription became legal in New York State on January 1, 2001 through the Expanded Syringe Access Demonstration Program (ESAP). At the same time, Pharmacy use among Black and Hispanic injection drug users was found to be significantly lower when compared to Whites. The purpose of this study was to assess the factors that could explain the relationship between race/ethnicity and pharmacy use. Data were combined from 2 on-going injection drug user (IDU) studies in 2 New York City neighborhoods. Social and behavioral factors independently associated with ever purchasing a nonprescription syringe in the past 6 months and examined using cross-sectional logistic regression. Of 337 IDUs, the majority were male (79%), Hispanic (73%) and had a mean age of 35 years. In bivariate analysis, IDUs who reported pharmacy use were less likely to be Black or Hispanic, older, and to have reported recent syringe exchange program (SEP) attendance compared to non-pharmac...

Patients who have been relieved of cardiac symptoms following angioplasty may not be sufficiently motivated to initiate behavior changes that can reduce risk of subsequent cardiac events. Finding an effective means to help patients modify their behavior thus presents a unique challenge. This paper describes an innovative behavioral intervention whose theoretical underpinning is net-present value economic theory. This intervention is being evaluated in a randomized controlled trial in which all patients complete a computerized baseline health assessment of 14 cardiovascular risk factors. Each patient is presented with an individualized risk-factor profile and asked to choose risk factors for modification. In the experimental group, each risk factor is presented with a corresponding numerical biologic age value that represents the relative potential to benefit from modifying each risk factor. Risk reduction for these patients is framed as the opportunity to reduce present biologic age (the net-present value), and improve current health status and quality of life. In the control group,

Children who are exposed to domestic violence (DV) may experience many short- and long-term negative effects. They are up to 3.8 times more likely to become perpetrators or victims in adulthood than are children not exposed to DV. They also are at high risk of health problems, risky health behaviors, violence, and social functioning problems. Girls who witness intimate partner violence (IPV) are more likely to experience depression, anxiety, and trauma symptoms, and boys exposed to IPV are more likely to exhibit aggression and delinquent behaviors. To prepare the practice to identify and assist children exposed to DV, physicians should undergo training, implement screening protocols, use caution when documenting findings, collaborate with local agencies, and learn about the state&#39;s reporting laws. State and local DV service programs or other community resources can provide assessment and intervention assistance. Social workers, mental health professionals, and child and DV advoc...

Silicosis is a chronic occupational disease caused by the inhalation of crystalline silica particles for prolonged periods, which produces inflammation and tissue destruction followed by remodeling of the extracellular matrix. High cytotoxicity and long pulmonary retention of crystalline forms of silica are major factors responsible for its long-term effects. Silicosis has progressive, but unpredictable development. There are no markers routinely available to measure the activity and prognosis of silico-sis, excepting radiological methods and lung function measurement; and there is no accepted treatment for this disease. The mechanisms of silica-induced disease development and progression are not well understood. Defining the mechanisms triggered by exposure to silica could facilitate early diagnosis by identifying markers of early diseases and could elucidate novel therapeutic strategies. Surface radicals on silica particles and iron-derived reactive oxygen species (ROS) are implicated in oxidative stress, considered to belong to the key events in the development of fibrosis and lung cancer 1) . After reaching the alveoli, silica particles are phagocy-

Recently accepted codes in the Current Procedural Terminology system permit licensed pediatric psychologists to deliver psychological services utilizing billing codes that focus on improving medical and physical health. They potentially allow pediatric psychologists to obtain third-party reimbursement for services within a biopsychosocial model of care without requiring a concurrent psychiatric diagnosis. These codes represent a potential major paradigm shift whereby the services of a pediatric psychologist are provided and billed within the context of physical health care. Information is provided on the history of these codes along with detailed information regarding their utilization. Future directions for implementation, teaching, and research are provided along with a strong encouragement for use of these codes by pediatric psychologists.

Recently accepted codes in the Current Procedural Terminology system permit licensed pediatric psychologists to deliver psychological services utilizing billing codes that focus on improving medical and physical health. They potentially allow pediatric psychologists to obtain third-party reimbursement for services within a biopsychosocial model of care without requiring a concurrent psychiatric diagnosis. These codes represent a potential major paradigm shift whereby the services of a pediatric psychologist are provided and billed within the context of physical health care. Information is provided on the history of these codes along with detailed information regarding their utilization. Future directions for implementation, teaching, and research are provided along with a strong encouragement for use of these codes by pediatric psychologists.

Väitekirja elektrooniline versioon ei sisalda publikatsiooneVigastussurmad on oluliselt seotud riskeeriva käitumisega, mida mõjutavad mitmed isiksuslikud (nt impulsiivsus) tegurid on suuresti pärilikud. Impulsiivne käitumine on seotud nii serotoniini- kui ka dopamiinisüsteemi toimimisega. Väitekirja peamisteks eesmärkideks oli selgitada 1) riskeeriva käitumise seoseid isiklike ja isiksuslike tegurite ning serotoniini- ja dopamiinisüsteemi markeritega ning 2) kas riskeeriva käitumise ennetamiseks läbiviidud sekkumine, mis on osutunud efektiivseks, on efektiivne ka siis kui seda viivad läbi autokoolide õpetajad. Kuna riskeeriv käitumine ning seda mõjutavad tegurid erinevad teismeliseeas ja täiskasvanuks saades, siis kasutati väitekirjas kolme erinevat valimit: kuuendate klasside õpilased (n=699), kordusmõõtmistes osalenud 15-18 aastased õpilased (n=483) ning autokoolide õpilased (n=1441). Tulemustest ilmnes, et riskide võtmine on seotud tugevamini teatud isiksuslike teguritega (nt imp...

The purpose of this article is to provide a review of research literature related to factors that influence employee participation in physical activity. Eleven published studies investigating physical activity in samples of adult employees were included in this review. Across these studies, self-efficacy, or belief in personal ability to perform this health behavior, was the best predictor of physical activity among employees. Perceived benefits of physical activity and perceived health status were also found to influence participation in physical activity. Occupational health nurses could offer self-care classes and intervention programs that assist employees in improving their perceptions of self-efficacy to perform physical activity. Additionally, occupational health nurses should continue to reinforce the benefits of physical activity in all health promotion venues.

Colaboradores A. L. B. Pavão participou da revisão bibliográfica, delineamento do estudo, análise estatística, e redação do artigo. G. L. Werneck contribuiu na supervisão, delineamento do estudo, análise estatística e redação do artigo. M. R. Campos colaborou no delineamento do estudo, análise estatística e redação do artigo. Agradecimentos A. L. B. Pavão recebeu auxílio para a realização da pesquisa mediante bolsa, concedida pelo CNPq, modalidade doutorado no país (n o 140191/20097).

Aims: University students' wellbeing and health promoting and damaging behaviours are important and comprise many parameters. The purpose of this study was to assess a range of health behaviours and lifestyle characteristics of 3,706 undergraduate students from seven universities in England, Wales and Northern Ireland. We compared differences in these parameters between males and females, and across the participating universities. Methods: A self-administered questionnaire assessed socio-demographic information (e.g., gender, age), nutrition, dietary intake and food consumption patterns, as well as the importance of healthy eating, three levels of physical activity, restful sleep, tobacco smoking, use of illicit substance (recreational drugs), frequency of binge drinking and problem drinking. The data was collected in 2007-2008. Results: While females generally reported lower use of tobacco, illicit substances and alcohol (binge drinking/problem drinking) and consumed more fruits and vegetables, male students had a higher level of physical activity, consumed less sweets and had more restful sleep. When lifestyle characteristics of students were compared between the different universities we observed some 'clustering' of the parameters under study, whereby favourable health practices would be exhibited at some universities; and conversely, the clustering of less favourable practices exhibited at other participating sites. Conclusions: We conclude that only a minority of students exhibited positive health practices above recommended levels and the level of binge drinking and problem drinking was high. This calls for increased awareness of university administrators, leaders and policy makers to the risky health habits of their students. The observed clustering effects also indicate the need for local (university-specific) health profiles as basis and guidance for relevant health promotion programmes at universities.

It is now generally accepted that vitamin D deficiency is a worldwide health problem that affects not only musculoskeletal health but also a wide range of acute and chronic diseases. However, there remains cynicism about the lack of randomized controlled trials to support the association studies regarding the nonskeletal health benefits of vitamin D. This review was obtained by searching English-language studies published up to April 1, 2013, in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials (search terms: vitamin D and supplementation) and focuses on recent challenges regarding the definition of vitamin D deficiency and how to achieve optimal serum 25-hydroxyvitamin D concentrations from dietary sources, supplements, and sun exposure. The effect of vitamin D on fetal programming epigenetics and gene regulation could potentially explain why vitamin D has been reported to have such wide-ranging health benefits throughout life. There is potentially a great upside to increasing the vitamin D status of children and adults worldwide for improving musculoskeletal health and reducing the risk of chronic illnesses, including some cancers, autoimmune diseases, infectious diseases, type 2 diabetes mellitus, neurocognitive disorders, and mortality.

It is now generally accepted that vitamin D deficiency is a worldwide health problem that affects not only musculoskeletal health but also a wide range of acute and chronic diseases. However, there remains cynicism about the lack of randomized controlled trials to support the association studies regarding the nonskeletal health benefits of vitamin D. This review was obtained by searching English-language studies published up to April 1, 2013, in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials (search terms: vitamin D and supplementation) and focuses on recent challenges regarding the definition of vitamin D deficiency and how to achieve optimal serum 25-hydroxyvitamin D concentrations from dietary sources, supplements, and sun exposure. The effect of vitamin D on fetal programming epigenetics and gene regulation could potentially explain why vitamin D has been reported to have such wide-ranging health benefits throughout life. There is potentially a great upside to increasing the vitamin D status of children and adults worldwide for improving musculoskeletal health and reducing the risk of chronic illnesses, including some cancers, autoimmune diseases, infectious diseases, type 2 diabetes mellitus, neurocognitive disorders, and mortality.

Un modo diverso di esprimere la complessità di questo tema è definirla Mediterranean Way ovvero il “modo mediterraneo di vivere”. Il 16 novembre 2024 si è celebrato il decimo anniversario del riconoscimento UNESCO quale Patrimonio culturale dell’Umanità, dichiarato con la seguente motivazione: “La Dieta Mediterranea rappresenta un insieme di competenze, conoscenze, pratiche e tradizioni che vanno dal paesaggio alla tavola, includendo le colture, la raccolta, la pesca, la conservazione, la trasformazione, la preparazione e, in particolare, il consumo di cibo. La Dieta Mediterranea è caratterizzata da un modello nutrizionale rimasto costante nel tempo e nello spazio, costituito principalmente da olio di oliva, cereali, frutta fresca o secca, e verdure, una moderata quantità di pesce, latticini e carne, e molti condimenti e spezie, il tutto accompagnato da vino o infusi, sempre in rispetto delle tradizioni di ogni comunità. Tuttavia, la Dieta Mediterranea (dal greco diaita, o stile di vita) è molto più che un semplice alimento. Essa promuove l’interazione sociale, poiché il pasto in comune è alla base dei costumi sociali e delle festività condivise da una data comunità, e ha dato luogo a un notevole corpus di conoscenze, canzoni, massime, racconti e leggende. La Dieta si fonda nel rispetto per il territorio e la biodiversità, e garantisce la conservazione e lo sviluppo delle attività tradizionali e dei mestieri collegati alla pesca e all’agricoltura nelle comunità del Mediterraneo”.

In this article, we study the psychometric properties of a short scale (TRANS-18) which was designed to detect safe behaviors (personal and vehicle-related) and psychophysiological disorders. 244 drivers participated in the study, including drivers of freight transport vehicles (regular, dangerous and special), cranes, and passenger transport (regular transport and chartered coaches), ambulances and taxis. After carrying out an exploratory factor analysis of the scale, the findings show a structure comprised of three factors related to psychophysiological disorders, and to both personal and vehicle-related safety behaviors. Furthermore, these three factors had adequate reliability and all three also showed validity with regard to burnout, fatigue and job tension. In short, this scale may be ideally suited for adequately identifying the safety behaviors and safety problems of transport drivers. Future research could use the TRANS-18 as a screening tool in combination with other instr...

To compare associations of symptom prevalence, chronic conditions, and health-related quality of life (HRQOL) between cancer survivors and non-cancer individuals using the U.S. National Health Interview Survey. Study samples comprised 604 survivors and 6,166 non-cancer individuals. Symptoms included sensation abnormality, pain, fatigue, cognitive disturbance, depression, and anxiety. Physical and mental HRQOL was measured by the Patient-Reported Outcomes Measurement Information System. Compared to non-cancer individuals, survivors had higher prevalence in sensation abnormality (OR=2.4; 95% CI=1.9 to 3.0), pain (OR=2.1; 95% CI=1.7 to 2.6), and fatigue (OR=1.4; 95% CI=1.1 to 1.8), and decremented physical HRQOL (difference=-3.7; 95% CI=-4.7 to -2.6). Prevalence of individual symptoms was significantly associated with decremented physical HRQOL (range=-5.9 [anxiety] to -8.9 [pain]) and mental HRQOL (range=-4.7 [sensation] to -8.4 [depression]). Association between cancer experience and...