Health behaviour

To examine how thinness is associated with indicators of socio-economic disadvantage, health-related behaviours, and health indicators including mortality. DESIGN: Independent risk factor surveys carried out in four geographic areas in Finland in 1982, 1987, 1992, and 1997, with mortality follow-up to the end of the year 2001. SUBJECTS: A total of 13 389 men and 14 770 women aged 25-64 y at baseline, and 2077 deaths during the follow-up when subjects who have died during the first 5 y were excluded. METHODS: A self-administrative questionnaire data on socio-economic status, health behaviour, and perceived health, together with measured height, weight, and metabolic indicators using standardised protocol. Mortality data by Statistics Finland were linked to the baseline surveys. RESULTS: Thin men (BMIr20 kg/m 2 ) were the socio-economically disadvantaged group engaged in adverse health behaviours. They also reported poorer perceived health despite having better metabolic indicators. Thin women reported more adverse behaviours than other women and had better metabolic profile than their obese counterparts. Thin subjects had higher mortality, but results become nonsignificant among men when first 5 y of follow-up were excluded, and nonsignificant among women when health behaviours were adjusted for. CONCLUSION: Thinness is associated with good metabolic profile but increased mortality, explained partly by underlying diseases or adverse behaviours. Thinness in men is associated with socio-economic disadvantage.

Objectives: Research has suggested that higher mastery is associated with lower cardiovascular disease (CVD) risk. This pilot study investigated how a range of psychosocial factors, including mastery, relate to CVD risk factors among Aboriginal people living in rural south-eastern Australia. Methods: Psychosocial and behavioural measures were obtained via questionnaire as part of developing a cardiovascular risk screening program (The Heart Health Project). Relationships between mastery, social support and other risk-factors were examined. Results: Higher mastery was associated with a greater likelihood of having quit smoking (p=0.007), higher partner support (p=0.013) and higher total cholesterol levels (p=0.004). Conclusions: Results were consistent with previous studies but suggested that for this population, the relationship between mastery and CVD risk may more complex than expected. Results indicated that mastery may have some utility as a point for intervention to improve health and wellbeing, however further research into these associations and their cultural salience for Aboriginal people is warranted.

The study was to test the theory of planned behaviour in predicting women's intention about weight gain prevention. Methodology: A correlation study design with multiple regression and path analysis was used. The sample of the study was 270 healthy women between the ages of 21-45 who were married, and able to respond to a questionnaire. The participants were recruited from regions of four primary health care centers in Malatya, Turkey. The women were visited, interviewed and the questionnaire was filled in their homes. The data of the study were analysed through frequency distribution, multiple regression, path and correlation analyses. Results: Path analysis confirmed the direct and indirect relationships of the theory of planned behaviour in predicting women's intention about weight gain prevention. Regression analysis computed the model path coefficients ranging from ß .612 to .940. Overall, the Theory of Planned Behaviour explained 77.48% of the variance. Conclusions: A woman's attitude towards weight gain prevention and referent motivation needs further explanation prior to the development of women's intention about weight gain prevention.

In this study, it was hypothesised that dentists with a high burnout risk would experience more health complaints and show more unhealthy behaviour when compared with dentists with a low burnout risk. With a response rate of 75%, a representative group of 709 actively practising dentists responded to a questionnaire containing the Dutch version of the Maslach Burnout Inventory (MBI‐NL), a health complaints measure (VOEG), and items on health behaviour. Results showed that dentists with a high burnout risk reported health complaints to a greater extent than dentists with a low burnout risk. They also reported more unhealthy behaviour in some aspects (physical exercise/sporting, increase in alcohol consumption, unhealthy diet), but not in others. It also appeared that one out of ten dentists reported having poor general health, and that three out of ten reported to have poor physical condition. In general, dentists' self‐reports appeared favourable in comparison with the Dutch pop...

Issue addressedPeople in rural areas have poorer oral health than their urban counterparts due to a range of factors. Local governments (LGs) have a key role in addressing health issues that impact on local communities.MethodsPublicly available oral health profile (OHP) data and Municipal Public Health and Wellbeing Plans (MPHWPs) (2017‐2021) were downloaded from Dental Health Services Victoria and LG websites for 48 Victorian local government areas (LGAs) containing predominately rural areas. OHP data were collated to provide an overview of the oral health status of the communities and a content analysis of the MPHWPs undertaken.ResultsDespite poor oral health in rural Victorian LGAs, oral health was not often in MPHWPs. Twenty of the MPHWPs had some mention of oral health but only four included specific actions or strategies that would be used to improve oral health. None of the plans contained any specific targets for action or details of evaluations that might be used to assess ...

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. Nurseries, health centres and dental clinics in 17 countries. 2822 children aged 3 to 4 years and their parents. Dental examination of children and questionnaire to parents. Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception...

The use of medical services and the utilisation rate in screening programmes in relation to social class: results of a representative inquiry in Bavaria Objectives: This article aims to analyse utilisation of medical services and screening programmes in relation to social class. Methods: 2 051 adults in Bavaria were interviewed using computer-assisted telephone interview (CATI) in 1999/2000. Social class was established from the income-adjusted Winkler social category index. Data were standardised by age and sex. If social class differences were found, separate analyses for education and income effects were conducted. Results: Higher education was found to be associated with visits to specialist and vaccinations. The purchase of over-thecounter medication was related to higher education and family income. Frequency of HIV-tests was higher in higher social classes but not related to higher education or better financial situation. Utilisation rates for screening programmes for various types of cancer were similar in all social classes. The results show that social class differences in health behaviour in Bavaria prevail. Positive health behaviour is often associated with higher education. Compared to earlier findings social class effects on the utilisation of cancer screening appears less pronounced. Preventive measures seem to have reached all social classes to a similar degree.

BackgroundHealth behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to the health and well-being of chronically ill people. With China's ageing population and increased prevalence of people with chronic diseases, the improvement of unhealthy behaviours in this population has become crucial. Although recent studies have highlighted the importance of social participation for health and quality of life (QoL) among older people, no study to date has included social participation along with more traditional health behaviours. Therefore, this study aimed to identify associations of multiple health behaviours (social participation, physical activity, maintenance of a healthy diet and not smoking) with health and QoL outcomes (including cognitive and physical function) among chronically ill older adults in China. Methods For this nationally representative cross-sectional study, wave 1 data from the World Health Organization’s Study o...

Background Adolescent mental health problems are on the rise globally, including in Sweden. One indicator of this trend is increased psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the time trends in PSS; however, the evidence base is scarce. The aim of this study was to investigate associations between time trends in PSS and lifestyle factors. The study was based on data collected from a nationally representative sample of 9,196 fifteen-year-old boys and girls in Sweden using the Health Behavior in School-aged Children (HBSC) symptom checklist. The sample comprised nearly equal proportions of girls (50.5%) and boys. The lifestyle factors examined in this study included PA, regular breakfast intake, consumption of fruits, vegetables, sweets, or soft drinks, smoking, and alcohol drunkenness. We used data from 2002 to 2018 and stratified by family affluence scale (FAS) to demonstrate how the associations varied among the FAS groups. We fitted separate regression models for the high-and low-FAS groups, where interaction terms between the year of survey and each lifestyle factor were used to estimate the level and direction of associations between the factors and trends in PSS. There was a generally increasing trend in PSS mean scores from 2.26 in 2002 to 2.49 in 2018 (p <.001). The changes in each survey year compared to the average mean scores during the preceding years were significant in all years except 2010. Regular breakfast intake, daily fruit and vegetable consumption, and higher PA were associated with lower PSS mean scores, while smoking and drunkenness had opposite associations with PSS. The only significant interaction between survey year and the lifestyle factors was observed regarding drunkenness in the high FAS group, suggesting that the association between trends in PSS and the experience of getting drunk at least twice got stronger over time (B = 0.057; CI:0.016, 0.097; p <.01). The results indicate increasing trends in PSS among young people in Sweden from 2002 to 2018, with a significant increase observed among adolescents in the high FAS group who reported getting drunk on at least two occasions.

The purpose of the present study was to investigate possible associations between college students' attitudes, risk-taking behaviour related to noisy activities, and hearing problems such as threshold shifts or self-experienced hearing symptoms. The sample included 258 students aged between 17 and 21 enrolled at the University of Pennsylvania, USA. A questionnaire measuring attitudes towards noise, use of hearing protection, and selfreported hearing symptoms was distributed among the students. After completing the questionnaire a hearing screening, including pure-tone audiometry and tympanometry, was conducted. The result revealed that 26% had thresholds poorer than the screening level of 20 dBHL. Attitudes were significantly related to self-experienced hearing symptoms, but not to threshold shifts. Attitudes and noise sensitivity was, significantly related to use of hearing protection. Hearing protection use was found in activities such as using firearms, mowing lawns, and when using noisy tools but was less reported for concerts and discotheques. It can be concluded that the young adults in this study expose themselves to hearing risks, since the use of hearing protection is in general very low.

To assess youth health behaviours and related quality of life in urban Tunisia, we conducted a cross-sectional survey of a representative sample of 699 secondary-school students. The overweight rate was 20.7%. Most of the sample had an insufficient level of physical activity and were unfamiliar with the recommended frequency of moderate physical activity. Norm-based scores of psychological state were about average, slightly better for boys than girls. Girls perceived themselves to be more stressed than boys. Of all students, 35% declared having smoked a cigarette and 14% having drunk alcohol at least once in their lives. The main sources of health education were mass media (59%) and medical staff (36%).

Diabetic patients&#39; lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients&#39; daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice. Change in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients&#39; daily lives one year later). At diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On a...

Eating in response to negative emotions (emotional eating, EE) may predispose an individual to obesity. Yet, it is not well known how EE in children is associated with body mass index (BMI) and health behaviours (i.e., diet, physical activity, sleep, and TV-viewing). In the present study, we examined these associations in a cross-sectional sample of 5426 (54% girls) 9-11year-old children from 12 countries and five continents. EE, food consumption, and TV-viewing were measured using self-administered questionnaires, and physical activity and nocturnal sleep duration were measured with accelerometers. BMI was calculated using measured weights and heights. EE factor scores were computed using confirmatory factor analysis, and dietary patterns were identified using principal components analysis. The associations of EE with health behaviours and BMI z-scores were analyzed using multilevel models including age, gender, and household income as covariates. EE was positively and consistently (across 12 study sites) associated with an unhealthy dietary pattern (β = 0.29, SE = 0.02, p < 0.0001), suggesting that the association is not restricted to Western countries. Positive associations between EE and physical activity and TV viewing were not consistent across sites. Results tended to be similar in boys and girls. EE was unrelated to BMI in this sample, but prospective studies are needed to determine whether higher EE in children predicts the development of undesirable dietary patterns and obesity over time.

Background Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor. Methods/Design A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health...

After the fall of the Berlin Wall in 1989 the former communist countries of central and eastern Europe underwent substantial social and economic changes that had a major impact on health. The situation of the former German Democratic Republic was unique in that its existing institutions were replaced rapidly and it was quickly integrated economically with the West. This study describes recent trends in morbidity and mortality from infectious diseases in East and West Germany before and after unification using routine data from 1980 onwards. Substantial differences in morbidity and mortality resulting from infectious diseases were observed between East and West Germany. These seem to be the complex result of societal and health system differences in both parts of Germany before unification, differing population dynamics and health behaviours, and an increasing westernisation in the eastern part of Germany during recent years.

A unique aspect of exercise is that people may choose to engage in to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). We examined how the impact of gain-vs. loss-framed messages depends on the type of outcome emphasized. Drawing from regulatory focus theory , we predicted that gain-framed messages would "fit" with intrinsic outcomes and loss-framed messages would "fit" with extrinsic outcomes, but the effect of such fit on physical activity would depend on participants" need for cognition (NC). We tested these hypotheses with a sample of 176 sedentary young adults who read an exercise message with randomly-assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Participants provided daily reports of exercise over the following week. The predicted interaction between frame, outcome, and NC was found (p = .001), such that a "fit" message promoted somewhat, but not significantly, greater exercise for those with high NC, but a "non-fit" message promoted significantly greater exercise for those with low NC. Furthermore, differences in physical activity were partially mediated by attitudes towards exercise. Findings shed light on how the outcomes and motivations associated with physical activity shape people"s behavioral responses to framed health communications.

A unique aspect of exercise is that people may choose to engage in to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). We examined how the impact of gain-vs. loss-framed messages depends on the type of outcome emphasized. Drawing from regulatory focus theory , we predicted that gain-framed messages would "fit" with intrinsic outcomes and loss-framed messages would "fit" with extrinsic outcomes, but the effect of such fit on physical activity would depend on participants" need for cognition (NC). We tested these hypotheses with a sample of 176 sedentary young adults who read an exercise message with randomly-assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Participants provided daily reports of exercise over the following week. The predicted interaction between frame, outcome, and NC was found (p = .001), such that a "fit" message promoted somewhat, but not significantly, greater exercise for those with high NC, but a "non-fit" message promoted significantly greater exercise for those with low NC. Furthermore, differences in physical activity were partially mediated by attitudes towards exercise. Findings shed light on how the outcomes and motivations associated with physical activity shape people"s behavioral responses to framed health communications.

The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinically effective 'Heart Manual'. The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory. It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care. Methods/design: In a two-group cluster randomized controlled trial, GP practices are allocated by computer minimisation to an intervention group or a six-month deferred intervention group. We aim to recruit 250 participants from 50 practices across central England. Eligibility criteria are adults able to undertake the programme with type 2 diabetes, not taking insulin, with HbA1c over 8% (first 12 months) and following an agreed protocol change over 7% (months 13 to 18). Following randomisation, intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants. Deferred intervention nurses receive the training following six-month follow-up. Primary outcome is HbA1c with total and HDL cholesterol; blood pressure, body mass index; self-efficacy and quality of life as additional outcomes. Primary analysis is between-group HbA1c differences at 6 months powered to give 80% power to detect a difference in HbA1c of 0.6%. A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes, and a qualitative study is running alongside. Discussion: This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes. The trial will increase our understanding of intervention transferability between conditions, those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes.

Objectives-To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status. Methods-This cross-sectional analysis of 608 women aged 35-74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones. Results-Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an ageadjusted difference of -329 bp (95% CI -110 to -548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of -472 bp, 95% CI -786 to -158 for 20+ vs 1-5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels. Conclusions-Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL.

Background: This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). Results: Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p=0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful. Conclusions: This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.

Introduction Mental disorders constitute an increasingly important public health problem in the general population. Therefore, investigation of the determinants and state of mental health of those who will be treating patients, that is, future medical doctors, is justified. The paper gives an account of a mental health survey of medical students at a university in Hungary. Methods A representative sample of year I-V students (N = 100) filled an anonymous standardized self-administered questionnaire that included demographic and socioeconomic items, mental well-being characterized by a sense of coherence (SOC) and psychological distress, as well as health behaviour. SOC was measured by the 13-item Antonovsky questionnaire and psychological distress was measured by the 12-item general health questionnaire (GHQ). Models for estimating mental well-being in relation to various determinants were built by backward stepwise regression. Results Almost one-fifth of the students scored above the strict threshold on the GHQ indicating notable psychological distress. SOC showed significant positive correlation with perceived health and significant negative correlation with psychological distress. SOC and psychological distress were determined by different sets of explanatory variables in the regression models. Psychological distress and the use of sedative without medical prescription are inversely related to SOC; whereas social support and female gender show positive correlation to SOC according to our estimation. SOC, as expected, was a strong explanatory variable for psychological distress, forecasting an improvement in the GHQ score. Conclusion Psychological distress was significantly greater in our sample of Hungarian medical students than in the same age group of the general population. Psychological distress is strongly related to SOC and can be estimated by our proposed models. Both SOC and psychological distress can be used to characterize the mental health of future medical doctors, the improvement of which needs attention even during their training.

Emergency Health Services (EHS), encompassing hospital-based Emergency Departments (ED) and pre-hospital ambulance services, are a significant and high profile component of Australia&#x27;s health care system and congestion of these, evidenced by ...

Objective: To investigate physical activity during leisure time and commuting among persons aged 15-69 years in the urban population of Tianjin, China, and to assess its associations with demographic and health-related characteristics. Methods: In 1996 a cross-sectional survey of 2002 males and 1974 females provided information on physical activity during leisure time and commuting and on demographics and health behaviours. Findings: No leisure-time physical activity was engaged in by 67% of females and 61% of males. However, only 4% of females and 9% of males reported an absence of physical activity during commuting. The mean duration of leisure-time physical activity for the whole population was about 10 min per day. The average commuting time on foot or by bicycle was about 30 min. Leisure-time physical activity was more frequent among highly educated people, people with high incomes, white-collar workers, married people, non-smokers, or people commuting on foot or by bicycle than among other people. Persons with low incomes, male blue-collar workers and married people were more likely than others to engage in 30 min or more per day of physical activity on foot or by bicycle when commuting. Conclusion: People in Tianjin engaged in a high level of physical activity when commuting and a low level of leisure-time physical activity.

The purpose of this study was to compare residents of an area (Tel-Aviv), which was severely afflicted by SCUD missiles during the Persian Gulf War (high risk region), to residents of a low-risk region (Jerusalem) in terms of: (a) changes in physical health, in use of medical or psychological services, and in health behaviours during the period of the war compared to the preceding month; (b) levels of psychological distress (somatization and anxiety) during the war; (c) characteristics of persons at highest risk for psychological distress. Respondents were randomly chosen and interviewed by telephone (N= 545 in Tel-Aviv, N= 406 in Jerusalem). The respondents in both regions reported significant yet similar deterioration in physical health status, and an increase in detrimental health behaviours during the Gulf War. Tel-Aviv residents had significantly higher levels of psychological distress as compared to residents of Jerusalem: in somatization 18 vs 12% respectively (OR=2.44, CI = 1.39-4.28), in anxiety 34 vs 26% respectively (OR= 1.62, CI= 1.1-2.42). In addition to place of residence, age, ethnicity, religiosity and self-assessed health were identified as characteristics of persons at greater risk for psychological distress,

Blood pressure control: Significant decreases in both diastolic and systolic blood pressure (BP) were observed in both groups. The intervention was associated with a significantly greater reduction in mean systolic BP in comparison to usual care (p=0.022). The mean reduction in BP in the Pharmacist Care Group (PCG) was 10 mmHg. Subgroup analysis of participants who were nonadherent at baseline showed a decrease in systolic BP in the PCG group of the order of 13 mmHg, which was significantly greater than the drop in the Usual Care Group (UCG) (p=0.01). PCG participants whose BP was above target at baseline showed a decrease in systolic BP of the order of 16 mmHg, which was significantly greater than the drop in the UCG (p=0.01). PCG participants nonadherent at baseline and above target BP showed a decrease in systolic BP in the order of 20mmHg, which was significantly greater than in the UCG (p=0.003). The literature indicates that this degree of change in systolic BP could be associated with reduced cardiovascular risk if it were able to be sustained. The proportion of participants judged to be adherent by the Morisky score increased in both groups from baseline to six months, but there was no significant difference in adherence rates between the groups. In both groups, some individuals achieved improved adherence and others became nonadherent over the course of the trial. Similarly, while significant improvements in adherence occurred in the PCG on a number of measures of adherence, no significant differences between the groups were demonstrated. It cannot be concluded that the intervention resulted in improved adherence in comparison to usual care. Subgroup analysis of participants nonadherent at baseline showed a significant improvement for the PCG over the UCG in the TABS adherence score (p=0.046). Subgroup analysis of participants nonadherent and above target BP at baseline showed a significant improvement for the PCG over the UCG in the MedsIndex score (p=0.046). The intervention was evaluated as highly cost-effective. Willingness to pay: Consumers indicated that, on average, they would be willing to pay $20 per month for the intervention, if provided as a community pharmacy service. The intervention was successfully implemented in the community pharmacy setting. Stakeholders were largely satisfied with the service. To implement the service: -Pharmacists require appropriate and accredited training to deliver the service; -Pharmacies will be expected to have the space to conduct private consultations; -Pharmacists require appropriate remuneration to provide the service; -MedeMineCVD is a useful tool to identify potential participants and to assist pharmacists with administrative tasks; however it may need to be altered to be suitable for service provision rather than research and preferably be integrated into the dispensing software. Considering the highly effective reduction in systolic BP in subgroup analyses, screening for eligibility using Morisky scale and/or control of blood pressure relative to target, after identification by MedeMineCVD, may be useful strategies with which to better target potential recipients of the service. However, these need to be tested in large RCTs before wider implementation through community pharmacies. The amount of data collection should be reduced in implementation to streamline delivery. For implementation of the service, pharmacists should record a patient's BP, adherence issues, risk factors and pharmacist plan of management. Demographic information, quality of life and business case questions should be removed. The HAPPY trial was effective in reducing systolic BP and has potential to reduce risk of CVD by helping patients achieve their target BP. For potential future implementation of the HAPPY service, the main emphasis should be on reduction of BP rather than just improving medication adherence.

Background. Working conditions influence health, but previous studies on the associations between work-related factors and health behaviours are scarce. The aim of this study was to analyse whether unfavourable working conditions are associated with diet, physical activity, alcohol consumption, and smoking. Methods. The data derive from postal questionnaires collected in 2000 -2001 from 40-to 60-year-old employees of the City of Helsinki (n = 6243, response rate: 68%). Logistic regression analysis was used to examine health behaviours as outcomes. Job demands and job control, physically and mentally strenuous work, work fatigue, working overtime and satisfaction with work -home interface were independent variables, adjusted for age, education, occupational social class and marital status. Results. Most of the examined associations between working conditions and health behaviours were not statistically significant. Among women, mentally strenuous work and high job control were associated with a healthy diet. Work fatigue was associated with physical inactivity, whereas physically strenuous work and satisfaction with work -home interface were more often reported by physically active women. Work fatigue was associated with high drinking among men. Low job strain was reported by nonsmoking women, whereas working overtime was associated with nonsmoking among men. Conclusions. Working conditions were only weakly associated with health behaviours, and the associations varied for different health behaviours.

The aim of this study was to examine the association between mental health and recommended food habits among employed middle-aged women and men. A mail survey including data on mental health and intake of food items was collected from 40 to 60-year-old women ðn ¼ 4991Þ and men ðn ¼ 1252Þ; employed by the City of Helsinki. The participants' current mental health status was assessed by the General Health Questionnaire 12-item version and categorised into 'poor' (score 3 -12) and 'normal' mental health (score 0 -2). Multivariable logistic regression analyses were conducted using this categorisation as an independent variable to predict recommended food habits among women and men. All analyses first adjusted for age and lifetime mental diagnosis, secondly socio-economic status variables, and thirdly health behaviours. Women having poor mental health were less likely than their healthier counterparts to report consuming fresh vegetables, fresh fruits, low-fat milk and low-fat cheese on a daily basis, and cereals or porridge at least five times a week. Men having poor mental health reported consuming less frequently fresh fruits and dark bread. Except for cereals and dark bread, these results remained statistically significant in the fully adjusted model. The results suggest that poor mental health is associated with unhealthy food habits.

The objective of this study was to investigate regional gradient of a synthetic cardiovascular burden (CVRB) in Croatia. Analysis was based on a multistage stratified sample representative of general adult population in six regions of Croatia (Croatian Adult Health Survey). Synthetic CVRB was defined by incidents (heart attack, stroke), blood pressure, overweight/obesity (BMI, waist circumference), and risky behaviours (smoking, physical inactivity, high alcohol consumption, inadequate nutrition). Total CVRB in Croatia was 44.7% for men and 50.3% for women. Combining both high and moderate CVRB, men were found to be under more risk than women (72.8% vs. 61.7%, respectively). The result showed an east-north-west gradient in continental Croatia, with high CVRB in Eastern (40.2%) and Central region (44.3%), City of Zagreb (45.7%) and Northern region (53.1%). Mountainous region had the lowest prevalence of respondents with high CVRB (39.2%). Coastal region with the prevalence of 46.3% o...

Background: Self-rated health and the factors that influence it have never been described in Singapore before. This paper presents a descriptive study of self-rated health in a nationally representative cross-sectional survey of 6236 persons. As part of the National Health Surveillance Survey 2001, 6236 subjects aged 18 years and above were interviewed in the homes of participants by trained interviewers. The subjects were asked "In general, how would you rate your health today?", and given 5 possible responses. These were then categorized as "Good" (very good and good) and "Poor" (moderate, bad and very bad) self-rated health. The association of socio-economic and health behaviour risk factors with good self-rated health was studied using univariate and multivariate logistic regression analysis. Results: Univariate analyses suggest that gender, ethnicity, marital status, education, household income, age, self-reported doctor-diagnosed illnesses, alcohol intake, exercise and BMI are all associated with poor self-rated health. In multivariate regression analyses, gender, ethnicity, household income, age, self-reported illness and current smoking and BMI were associated with poor self-rated health. There are gender differences in the association of various factors such as household income, smoking and BMI to self-rated health. Socioeconomic factors and health behaviours are significantly associated with selfrated health, and gender differences are striking. We discuss why these factors may impact selfrated health and why gender differences may have been observed, propose directions for further research and comment on the public policy implications of our findings.

Many medical decisions are made on a probability estimate. Models of risk benefit calculations in health behaviour rarely articulate how people perceive and appraise such probability. Cognitive processes may mediate the processing of probability expressions and may be important to understand the meaning or the range of meanings that probability statements portray to patients. Past studies have indicated that verbal expressions of probability are vague and subject to individual interpretation. On the theoretical level when subjects are asked to translate a set of verbal probability expressions, ranging from high to low, into their equivalent numerical expressions subjects usually produce a continuum of numerical equivalents also ranging from high to low. In practice clinicians frequently communicate information about uncertainty to the patients by verbal probability estimates. This study explored the effect of the order of presentation of the verbal expressions on the numerical probabilities produced by a group of medical students (n = 87) in relation to medical probabilities. The results showed that the order of presentation (descending vs. random) of the verbal probability expressions was found to have a significant effect on three of the seven numerical probabilities produced by the subjects. The order effect is discussed to together with implications for clinical practice.

Objectives. This study investigated differences in behavioural health protective and risk factors in US Latino and non-Latino White adolescents as well as differences among Latinos with different levels of acculturation using a bicultural acculturation model. The bicultural model is consistent with current understanding of cultural change processes; however it has infrequently been applied to understand adolescent health outcomes. The outcomes included risk and health behaviours as well as mental health factors consistent with Jessor's framework for describing adolescents' health status. Design. Participants included 1119 students randomly selected from all middle schools of a Northern California district. Respondents completed project staff administered self-reports surveys in their schools that included assessments of health behaviours, mental health, and socio-cultural variables-including acculturation level. . Latinos were at higher risk than non-Latino Whites in the following areas: academic orientation, physical activity, and sunscreen use. Boys and those of lower social class were more likely to report use of various substances and violence. Among Latinos, those in the marginalised acculturation group-those with less attachments and adaptations to Latino and other cultures, showed less desirable mental health outcomes than the bicultural group. These results extend prior research by assessing the health needs of early adolescent youth. The study found important differences within Latinos using a bicultural acculturation model. The use of a bicultural acculturation model, or cultural orientation approach more generally, may have especial utility for addressing health issues wherever minority populations interact with a dominant society.

People with long‐term, severe mental health problems are at higher risk of premature death linked to lifestyle. They are more likely to smoke, to be overweight, and to take little or no exercise. Their physical health needs also tend notoriously to be neglected by the health services. Diane Crone and colleagues conducted a comparative survey of the health behaviours and lifestyles of mental health service users in one city in the south west, and found much cause for concern.

Objective-To evaluate the associations between social class as defined by occupation, health be- haviour, and mortality from all causes and coronary heart disease among middle aged men and women in eastern Finland. Design-Prospective observational study of two independent, random population samples examined in 1972 and 1977. Setting-North Karelia and Kuopio, Finland. Subjects-8967 men and 9694 women aged 30-64 years at the beginning of the follow up study. The subjects were followed up for mortality up till 1987 by using the National Death Registry. Measurements and main results--Altogether 1429 men and 620 women died during the follow up, 603 men and 164 women of coronary heart disease. Among both sexes, compared with white collar workers unskilled blue collar workers had more adverse risk factors and also higher mortality due to coronary heart disease, other cardiovascular diseases, cancer, violent causes, and all other causes. Among men the age adjusted relative risk for all cause mortality in unskilled blue collar workers v white collar workers was reduced from 1-86 (95!o confidence interval 1 55 to 2.22) to 1-47 (1.23 to 1.77) when adjusted for smoking, serum cholesterol concentration, hypertension, body mass index, and physical activity in leisure time. Among women the corresponding reduction in hazard ratio was from 149 (1 15 to 1.92) to 1*39 (1.07 to 181). The respective hazard ratios for coronary heart disease were 1-54 (1.16 to 2.02) and 1-22 (0.92 to 1.61) among men and 1-74 (1.05 to 2.90) and 1-66 (0.99 to 2.79) among women. Conclusions-Unfavourable cardiovascular risk factors and high mortality are concentrated among lower social classes in Finland. Among men about half of the excess coronary and all cause mortality among unskilled blue collar workers was associated with their unfavourable risk factor profile. The association was smaller in women.

Gender differences in lifestyle-related mortality and morbidity suggest a need to investigate gender-specificity of health behaviour change process and factors influencing it. We tested whether changes in self-efficacy beliefs and planning, as well as the level of social support predict change in exercise. Finnish men and women, aged 50-65 years, at an increased risk for type 2 diabetes were recruited from health care centres to participate in the Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. Psychosocial factors were measured with questionnaires and exercise with 7-day physical activity diaries at baseline and at 3 months. At baseline, no gender differences were found in self-efficacy and planning, but men reported receiving more social support than women. At 3 months, women reported having formed more action plans for changing their exercise routines than men. Among women, increase in selfefficacy and planning predicted increase in exercise. Among men, changes in planning played a less significant role. The more salient role of planning for women than for men, and the fact that women receive less social support, may reflect life circumstances allowing less spontaneous lifestyle decisions and a lower acceptance of lifestyle changes by their social environment.

Denison, O'Reilly, Schmid, conducted a meta-analysis that focuses solely on Voluntary HIV counselling and testing (VCT) efficacy data from different VCT settings (health facility, stand alone, community-based, home) in developing countries. Overall, the pooled data from seven studies identified showed a moderate effect of VCT on unprotected sex [OR 1.69; 95%CI 1.25-2.31] and inconclusive evidence, based only on three studies, regarding the effect of VCT on recipients' number of sex partners. Effect size estimates showed the largest effects seen among HIV positive individuals or discordant couples. The significant effect on unprotected sex has been confirmed in previous studies conducted among HIV-infected persons or discordant couples (

Objectives: The cortisol awakening rise (CAR) is defined as cortisol secretory activity in the first 45-60 min immediately post-awakening. It has been suggested that psychological factors may disrupt the normal awakening rise. Recent research has shown that psychological stress may influence the magnitude of the CAR, however the findings have been mixed. This study examined the impact of stress on the CAR and the diurnal mean in a sample of middle-aged women. Method: One hundred and eighteen healthy female participants who reported experiencing high or low stress were recruited. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) and at 3, 6, 9 and 12 h on two consecutive days. A number of metabolic and inflammatory biomarkers were also assessed together with measures of mood disturbance and health behaviour. Results: The magnitude of the CAR, assessed by the area under the response curve (AURC) estimate, was significantly lower in the high stress group compared to the low stress group indicating that participants who experienced high stress secreted lower levels of cortisol. The effect was largely accounted for by differences 30 min after waking. The diurnal mean was also lower for the high stress group. Although participants in the high stress group had a slightly worse inflammatory profile, only low-density lipoprotein levels were found to be significantly higher, compared to the low stress group. Lifestyle indicators and mood were also found to be significantly poorer in the high stress group. Conclusions: The results suggest that psychological stress may be associated with a smaller cortisol awakening rise, a lower diurnal mean, poor lifestyle choices and high levels of psychological distress. These findings may have broader implications for future health risk and for an individual's ability to cope with imminent daily stressors and demands.

This study aims to investigate the self-regulated strategy of early childhood teachers in online learning during the Covid-19 pandemic. A quantitative survey approach was used as a method in this study. The data collection involved 100 early childhood teachers in Indonesia with a focus on the analysis of six dimensions of selfregulated strategy (1) goal setting, (2) environment structuring, (3) task strategies, (4) time management, (5) help-seeking, and (6) self-evaluation. The results of this study indicated that the level of self-regulated of early childhood teachers in a digital environment is good with an average value of 82.025%. In addition, the research findings also confirmed that the Covid-19 pandemic has not dampened the enthusiasm of early childhood teachers to adaptive in the digital learning environment. The main contribution of this study is to provide an understanding of the importance of self-regulated strategy for early childhood teachers in a digital environment. The results of this study can be useful for the Indonesian early childhood directorate as a basis for policy making and evaluating the improvement of the competence of early childhood teachers in Indonesia. Abstrak: Penelitian ini bertujuan untuk mengetahui strategi self-regulated guru PAUD dalam pembelajaran online di masa pandemi Covid-19. Pendekatan survei kuantitatif digunakan sebagai metode dalam penelitian ini. Pengumpulan data melibatkan 100 guru PAUD di Indonesia dengan fokus pada analisis enam dimensi strategi self-regulated, yakni (1) penetapan tujuan, (2) penataan lingkungan, (3) strategi tugas, (4) manajemen waktu, (5) bantuan, dan (6) evaluasi diri. Hasil penelitian ini menunjukkan bahwa tingkat self-regulated guru PAUD di lingkungan digital sudah baik dengan nilai rata-rata 82,025%. Selain itu, temuan penelitian juga menegaskan bahwa pandemi Covid-19 tidak menyurutkan semangat guru PAUD untuk beradaptasi di lingkungan pembelajaran digital. Kontribusi utama dari penelitian ini adalah untuk memberikan pemahaman tentang pentingnya strategi self-regulated bagi guru PAUD di lingkungan digital. Hasil penelitian ini dapat bermanfaat bagi Direktorat PAUD Indonesia sebagai dasar pengambilan kebijakan dan evaluasi peningkatan kompetensi guru PAUD di Indonesia.

Implementation intentions , planning in advance the situation in which one will act, have been proposed to be an effective self-regulatory technique for changing health behaviour. Encouraging people to receive text message reminders of their implementation intentions should enhance their strength and, thus, it was predicted that this combined approach would be particularly effective in increasing exercise. Participants (N=155) were randomly allocated to one of five conditions (implementation intentions and SMS, implementation intention, SMS, or one of two control groups) then completed self-report measures of exercise behaviour and motivation. Four weeks later, they responded to similar items. Results suggested that the combined intervention increased exercise frequency significantly more than the other strategies including the implementation intention group. It is proposed, therefore, that implementation intention effects can be enhanced via plan reminders.

Little is known of Malaysian older people's participation in physical activities, and the purpose of this pilot study is to explore their participation and the barriers. A self-administered questionnaire was given to 80 eligible respondents at the Kuala Lumpur Health Clinic of which 70 responded. Thirty-six (51.4%) were males and 34 (48.6%) were females. There were 26 (37.1%) Malays, 20 (28.6%) Chinese, 18 (25.7%) Indians and 6 (8.6%) of other ethnic groups. Forty (57.1%) took part in some form of physical activities and the remaining 30 (42.9%) reported no participation at all. The Chinese participated actively in physical activities (90%), followed by Indians (66.7%) and Malays (30.8%). The five common activities were walking (60%), tai chi (20%), gardening (12.5%), stretching (2.5%) and cycling (5.0%). Identified barriers to physical activities were lack of time (26.7%), having health problems (26.7%), was already fit (26.7%), no companion to exercise with (13.3%) and no exercise knowledge (6.7%). These findings indicated that emphasis should be given to the females and the Malay ethnic group when planning physical activity education for the older people as they were identified to be the least active groups.

Background: Based on a large national survey on the health of adolescents, this paper focuses on the socio-demographic and lifestyle correlates of sport practice among Swiss adolescents. The SMASH2002 database includes 7428 vocational apprentices and high school students between the ages of 16 and 20 who answered a self-administered anonymous questionnaire containing 565 items targeting perceived health, health attitudes and behaviour. Weekly episodes of extracurricular sport activity were measured by a four-category scale, and the sample was dichotomised between active (≥two episodes of sport/week) and inactive (<two episodes of sport/week) respondents. Thirty percent of female respondents and 40.2% of male respondents reported engaging in sport activity at least two to three times a week; another 9.7% of the female and 19.4% of the male respondents reported participating in least one sport activity each day (p<0.01). The percentage of active respondents was higher among students than among vocational apprentices (p<.01), and the rates of sport activity decreased more sharply over time among the apprentices than among the students (p<0.01). Most active adolescents reported having a better feeling of well-being than their inactive peers [among male students: odds ratio (OR): 3.13; 95% confidence interval (95%CI): 1.28-7.70]. The percentage of active females who reported being on a diet was high, and female apprentices exhibited higher involvement in dieting than their inactive peers (OR: 1.68; 95%CI: 1.32-2.14). Relative to the inactive male respondents, the proportion of active male respondents smoking was lower; however, a lower proportion of the latter group did not report drunkenness, and the percentage of those who reported lifetime cannabis consumption was higher among active than inactive students (females, OR:1.57; 95%CI:1.09-2.25; males, OR:1.80; 95%CI: 20-2.69). Conclusion: Organised sport activities should be better tailored to the work schedules of apprentices. Practitioners should be aware of the potential for problematic behaviour in the area of dieting and substance use among a subset of sport-oriented adolescents.

The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinically effective 'Heart Manual'. The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory. It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care. Methods/design: In a two-group cluster randomized controlled trial, GP practices are allocated by computer minimisation to an intervention group or a six-month deferred intervention group. We aim to recruit 250 participants from 50 practices across central England. Eligibility criteria are adults able to undertake the programme with type 2 diabetes, not taking insulin, with HbA1c over 8% (first 12 months) and following an agreed protocol change over 7% (months 13 to 18). Following randomisation, intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants. Deferred intervention nurses receive the training following six-month follow-up. Primary outcome is HbA1c with total and HDL cholesterol; blood pressure, body mass index; self-efficacy and quality of life as additional outcomes. Primary analysis is between-group HbA1c differences at 6 months powered to give 80% power to detect a difference in HbA1c of 0.6%. A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes, and a qualitative study is running alongside. Discussion: This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes. The trial will increase our understanding of intervention transferability between conditions, those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes.

This study focuses on life experiences and social representations related to gender in the context of health among young French lay people aged from 18 to 21 years ( N = 47). Qualitative analysis of the discursive content of nine focus groups illuminated the lay thinking underlying gender issues in the health context. Broadly speaking, group composition (i.e. unisex, mixed) had an impact on participants&#39; discourse construction. Through their discourses, participants came to &#39;naturalise&#39; the health issues and practices of each sex/gender through the biological specificities of men and women. In addition, discourse content underscores a differentiated &#39;imperative of health&#39;.

The psychosocial factors involved in successful physical activity engagement are not fully understood. Research suggests that specific personality traits (e.g., extraversion, conscientiousness, and neuroticism) influence physical activity behaviour. There is also evidence that social cognitive constructs (e.g. self-efficacy, self-regulation, outcome expectations, social support, and perceived barriers) can significantly explain and predict physical activity behaviour. The current study aimed to investigate the influence of personality and social cognitive constructs on physical activity over a two-week period. The study employed a prospective design in which ninety-four participants provided two-weeks of pedometer data and completed daily diary measures of non-ambulatory physical activity. In addition, all participants completed self-report measures of the Big Five personality traits and social cognitive constructs. Multiple regression analyses revealed that social cognitive constructs significantly explained 35.6% of the variance in physical activity, with goal setting emerging as a key predictor. Although personality did not have an effect on physical activity overall, subsequent analyses found significant differences in neuroticism between activity groups, and personality significantly interacted with social cognitive constructs to influence behaviour. The findings suggest a key role for goal setting, barrier self-efficacy, conscientiousness, and neuroticism in explaining physical activity behaviour.

The aim of the present study was to (i) develop a material affluence scale (MAS) for measuring adolescent SES in health inequality research in developing countries, (ii) compare the association of the MAS with the parental SES measures (parental occupation and education), and (iii) evaluate the association of parental SES and MAS with key health and health behaviour indicators. We used schoolbased cross-sectional survey conducted in thirty districts within three administrative regions in southern Ghana (a West African country) among adolescents ages 12-18year old (N=1,195) as an example. Principal Component Analysis (PCA) was used as the main statistical technique. MAS categorised adolescents into material affluence groups (MAS scores for the poorest, poor, average, affluent and most affluent were-1.679, -0.355, 0.354, 0.725 and 1.022 from the first principal component quintile respectively), it has adequate internal coherence (α=0.622) and moderately correlates with parental SES (r=0.39, p<0.001). MAS and parental SES showed similar pattern of strength and direction of association with selected health and health behaviour indicators. MAS presents a viable alternative method for measuring adolescent's SES in health inequality research in developing countries and could be useful as well in western countries.

Child mortality in Africa is a pressing issue, particularly due to diarrhea and respiratory tract infections. These diseases are often transmitted through improper handwashing practices. This research aimed to identify the factors that influence handwashing habits and assess the availability of adequate facilities and water sources in primary schools in the Karongi district. A mixed-method approach was used to collect data from 583 students through structured questionnaires and 120 teachers through semi-structured interviews. Additionally, interviews with parents and community members were conducted to gain broader insights into community hygiene practices and support systems. Quantitative analysis using SPSS showed that promoting handwashing among school children reduces illness and absenteeism. Over two-thirds (67.2%) of students reported receiving effective support from their teachers, and another two-thirds (66.7%) stated that they wash their hands with soap and water. Moreover, close to another two-thirds (64%) of students acknowledged the importance of hygiene in disease prevention, and nearly two-thirds (60.9%) were aware of the health risks associated with poor hygiene. Qualitative findings revealed that while primary schools have sufficient hygiene facilities, there are challenges such as water shortages, inadequate hygiene resources, a limited number of washing stations, and water supply shortages. The study concludes that it is crucial to promote handwashing through educational campaigns to reduce disease transmission and improve the health outcomes of school children in Rwanda. Additionally, it emphasizes the need to address resource challenges in primary schools.