Health behaviour

Health promotion is often viewed as based in experience; theory is seemingly at a more abstract level. The reasons for this are many. This paper explores some theoretical perspectives which are relevant to health promotion. In particular, it considers a collective approach to the making of theory and what the components of a health behaviour and health promotion theory might include.

Survey respondents and non-respondents differ in their demographic and socio-economic position. Many of the health behaviours are also known to be associated with socio-economic differences. We aimed to investigate how much of the excess mortality of survey non-respondents can be explained by the socio-economic differences between respondents and non-respondents. Questionnairebased adult health behaviour surveys have been conducted in Finland annually since 1978. Data from the 1978 to 2002 surveys, including non-respondents, were linked with mortality data from the Finnish National Cause of Death statistics and with demographic and socio-economic register data (marital status, education and household income) obtained from Statistics Finland. The mortality follow-up lasted until 2006, in which period there were 12,762 deaths (7,994 in men and 4,768 in women) during the follow-up. Total and cause-specific mortality were higher among nonrespondents in both men and women. Adjusting results for marital status, educational level and average household income decreased the excess total and cause-specific mortality of non-respondents in both men and women. Of the total excess mortality of non-respondents, 41% in men and 20% in women can be accounted for demographic and socio-economic factors. A part of the excess mortality among non-respondents can be accounted for their demographic and socio-economic characteristics. Based on these results we can assume that non-respondents tend to have more severe health problems, acute illnesses and unhealthy behaviours, such as smoking and excess alcohol use. These can be reasons for persons not taking part in population surveys.

Numerous studies are currently addressing the issue of contextual effects on health and disease outcomes. The majority of these studies fall short of providing a theoretical basis with which to explain what context is and how it affects individual disease outcomes. We propose a theoretical model, entitled collective lifestyles, which brings together three concepts from practice theory: social structure, social practices and agency. We do so in an attempt to move away from both behavioural and structural-functionalist explanations of the differential distribution of disease outcomes among areas by including a contextualisation of health behaviours that considers their meaning. We test the framework using the empirical example of smoking and pre-adolescents in 32 communities across Qu! e ebec, Canada. Social structure is operationalised as characteristics and resources; characteristics are the socio-economic aggregate characteristics of individuals culled from the 1996 Canadian Census, and resources are what regulates and transforms smoking practices. Information about social practices was collected in focus groups with pre-adolescents from four of the participating communities. Using zero-order and partial correlations we find that a portrait of communities emerges. Where there is a high proportion of more socio-economically advantaged people, resources tend to be more smoking discouraging, with the opposite being true for disadvantaged communities. Upon analysis of the focus group material, however, we find that the social practices in communities do not necessarily reflect the ''objectified'' measures of social structure. We suggest that a different conceptualisation of accessibility and lifestyle in contextual studies may enable us to improve our grasp on how differential rates of disease come about in local areas. r

This report examines hygiene behaviour and associated factors among 13-15 year old in-school adolescents in nine African countries. The total sample included 25,760 school children aged 13-15 years from nationally representative samples from nine African countries. We examined the prevalence of and relationship between tooth brushing, hand washing before eating, hand washing after toileting, hand washing with soap and a range of psychosocial factors such as socio-demographic characteristics, health behaviour, mental health or well-being and protective factors. Overall, sub-optimal hygiene behaviour was reported, the proportions of school children reporting optimal (>once a day) tooth brushing (77.3%) was higher than the proportions reported for washing their hands regularly before meals (62.2%), after toileting (58.4%) and washing their hands with soap (35.0%). In multivariate analysis higher education, health-enhancing behaviours such as daily fruits or vegetable consumption, and protective factors such as caregiver supervision were associated with tooth brushing, hand washing before meals, hand washing after toileting and washing of hands with soap. The cross-national data on hygiene behaviour from nine African countries found sub-optimal hygiene behaviour. Various determinants of optimal hygiene behaviour were identified that can guide programmes to improve hygiene behaviour of this adolescent population.

Objective To assess the relation between being bullied or being a bully at school, depression, and severe suicidal ideation. Design A school based survey of health, health behaviour, and behaviour in school which included questions about bullying and the Beck depression inventory, which includes items asking about suicidal ideation. Setting Secondary schools in two regions of Finland. Participants 16 410 adolescents aged 14-16. Results There was an increased prevalence of depression and severe suicidal ideation among both those who were bullied and those who were bullies. Depression was equally likely to occur among those who were bullied and those who were bullies. It was most common among those students who were both bullied by others and who were also bullies themselves. When symptoms of depression were controlled for, suicidal ideation occurred most often among adolescents who were bullies. Conclusion Adolescents who are being bullied and those who are bullies are at an increased risk of depression and suicide. The need for psychiatric intervention should be considered not only for victims of bullying but also for bullies.

We study the contribution of health-related behaviors to the health education gradient by distinguishing between short-run and long-run mediating effects: while in the former only behaviors in the immediate past are taken into account, in the latter we consider the entire history of behaviors. We use an empirical approach that addresses the endogeneity of education and behaviors in the health production function. Focusing on self-reported poor health, we find that education has a protective effect for European males and females aged 50+. We also find that the mediating effects of health behaviors -measured by smoking, drinking, exercising and the body mass index -account in the short-run for 17% to 31% and in the long-run for 23% to 45% of the entire effect of education on health, depending on gender.

Fatigue complaints are frequent and important problems affecting people's quality of life and creating puzzles for the General Practitioners they consult. Little is known about what actions people undertake to deal with fatigue, and even less about their success. As revealed by multivariate analyses health-related action patterns can classify people as being particularly successful or unsuccessful in dealing with their complaints of chronic fatigue. This study suggests that a few actions applied in combination and in a concentrated manner constitute the basis for a successful action pattern. The number, type and predictive power of the relevant actions vary depending on the persons in question: having chronic diseases or not and being under 44 or over 44 years old. hepatitis or chronic renal failure [7-9]. However, 0738-3991 / 99 / $ -see front matter

The paper reviews the theoretical concepts included in a range of social cognitive models which have identified psychological antecedents of individual motivation and behaviour. Areas of comspondence are noted and core constructs (derived primarily h m the theory of planned behaviour and social cognitive theory) are identified. Tbe role of intention formation, self-efficacy beliefs, attitudes, normative beliefs and self-representations are highlighted and it is argued that these constructs provide a useful framework for modelling the psychological prerequisites of health behaviour. Acknowledging that intentions do not translate into action automatically, recent advances in our understanding of the ways in which prior planning and rehearsal can enhance individual control of action and facilitate the routinisation of behaviour are considered. The importance of engaging in preparatory behaviours for the achievement of many health goals is discussed and the processes by which goals are prioritised, including their links to self-representations, are explored. The implications of social cognitive and self-regulatory theories for the cognitive assessment of individual readiness for action and for intervention design in health-related settings are highlighted.

The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning the importance of behaviours for health, and health knowledge, using a standardized protocol suitable for translation and administration in different countries of Europe. An inventory was developed from previous literature for the assessment of substance use, positive health practices, diet and eating habits, driving behaviour and preventive health care, beliefs concerning the importance of 25 activities for health, and knowledge about the influence of seven factors (including smoking, alcohol and diet) on major diseases. The first phase of the study involved administration of the inventory to approximately 200 male and 200 female university students aged 18-30 in 20 European countries. This report concerns data collected from 419 students in the U.K., together with analyses of short-term response stability.

Obstetric documentation processes may influence the clinical, behavioural, and psychological outcomes of pregnancy, although recent alterations to integrate obstetric documentation with pregnancy handheld records have been unsuccessful. Woman-held records as a companion to usual obstetric documentation have the potential to improve pregnancy-related health behaviours with a demonstrated association with maternal and infant health outcomes, and recommendations for their format and content are provided.

Empirical articles published between 1997 and 2001 from 4 health psychology journals that tested or applied 1 or more social cognition models (theory of reasoned action, theory of planned behavior, health belief model, and protection motivation theory; N ϭ 47) were scrutinized for their pragmatic and conceptual basis. In terms of their pragmatic basis, these 4 models were useful for guiding research. The analysis of their conceptual basis was less positive. First, these models do not enable the generation of hypotheses because their constructs are unspecific; they therefore cannot be tested. Second, they focus on analytic truths rather than synthetic ones, and the conclusions resulting from their application are often true by definition rather than by observation. Finally, they may create and change both cognitions and behavior rather than describe them.

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...

Implicit attitudes, evaluations that can occur without effort, quickly and without conscious intent, have been shown to predict self-reported diets and objectively measured food choices within the laboratory. We present two studies which extend the literature by demonstrating ...

Many have commented on the potential of community pharmacy as a health promotion setting, due to accessibility, high level of use, and the respect afforded to pharmacists. Community pharmacy could be a setting through which to address risk and protective health behaviours relevant to Australia's National Health Priority Areas. However, apart from some studies on smoking cessation, there is scant evidence on its involvement in other healthy behaviours. This paper discusses how to increase research and interventions on healthy behaviours in community pharmacy. This includes placing community pharmacy's role within a broader health promotion context, expanding community expectations of pharmacists, and addressing barriers to performing a health promotion role. J Pharm Pract Res 2007; 37: 42-4.

This article examines determinants of self-perceived health. Factors associated with very good/excellent rather than good health are compared with those associated with fair/poor rather than good health. The data are from the household cross-sectional and longitudinal components of the first three cycles (1994/95, 1996/97 and 1998/99) of Statistics Canada's National Population Health Survey (NPHS). Cross-tabulations from the 1998/99 NPHS cross-sectional file were used to estimate the prevalence of very good/excellent and fair/poor health by sex and age group. Based on the longitudinal file, predictors of health perceptions in 1998/99 were studied in a multivariate model using generalized logistic regression. While physical conditions were strongly related to health perceptions, some lifestyle, socio-economic and psychosocial factors were also statistically significant. Heavy smoking, irregular exercise and overweight were associated with fair/poor health ratings. Unhealthy chang...

‘Community participation’ and ‘bottom up planning’ have become fashionable themes in international health circles. However, in the absence of sociocultural perspective these themes remain largely rhetoric. In this paper, a deprofessionalization of social science is advocated in the service of participatory research as a first step towards community involvement in primary health care. Deprofessionalization is suggested as an adjunct to, not a replacement for in-depth professional social science research. An exploratory community diagnosis of health project conducted in rural south India is described. During the project, lay researchers received rudimentary social science field training and collected data on health behaviour deemed important to health planners as well as the health concerns of the community. Illustrative data, generated by the project is presented on the rural poors' utilization of government health facilities, their attitudes towards Primary Health Centre staff, and their ideas about how a proposed community health worker scheme could best serve them.

Socioeconomic inequalities in adolescent health have been little studied until recently, partly due to the lack of appropriate and agreed upon measures for this age group. The difficulties of measuring adolescent socioeconomic status (SES) are both conceptual and methodological. Conceptually, it is unclear whether parental SES should be used as a proxy, and if so, which aspect of SES is most relevant. Methodologically, parental SES information is difficult to obtain from adolescents resulting in high levels of missing data. These issues led to the development of a new measure, the Family Affluence Scale (FAS), in the context of an international study on adolescent health, the Health Behaviour in School-Aged Children (HBSC) Study. The paper reviews the evolution of the measure over the past 10 years and its utility in examining and explaining health related inequalities at national and cross-national levels in over 30 countries in Europe and North America. We present an overview of HBSC papers published to date that examine FAS-related socioeconomic inequalities in health and health behaviour, using data from the HBSC study. Findings suggest consistent inequalities in self-reported health, psychosomatic symptoms, physical activity and aspects of eating habits at both the individual and country level. FAS has recently been adopted, and in some cases adapted, by other research and policy related studies and this work is also reviewed. Finally, ongoing FAS validation work is described together with ideas for future development of the measure.

An observation one can make when reviewing the literature on physical activity is that health-enhancing exercise habits tend to wear off as soon as individuals enter adolescence. Therefore, exercise habits should be promoted and preserved early in life. This article focuses on the formation of physical exercise habits. First, the literature on motivational determinants of habitual exercise and related behaviours is discussed, and the concept of habit is further explored. Based on this literature, a theoretical model of exercise habit formation is proposed. More specifically, expanding on the idea that habits are the result of automated cognitive processes, it is argued that physical exercise habits are capable of being automatically activated by the situational features that normally precede these behaviours. These habits may enhance health as a result of consistent performance over a long period of time. Subsequently, obstacles to the formation of exercise habits are discussed and interventions that may anticipate these obstacles are presented. Finally, implications for theory and practice are briefly discussed.

This paper describes the conceptual model that underlies the International Tobacco Control Policy Evaluation Project (ITC Project), whose mission is to measure the psychosocial and behavioural impact of key policies of the Framework Convention on Tobacco Control (FCTC) among adult smokers, and in some countries, among adult non‐smokers and among youth. The evaluation framework utilises multiple country controls, a longitudinal design, and a pre‐specified, theory‐driven conceptual model to test hypotheses about the anticipated effects of specific policies. The ITC Project consists of parallel prospective cohort surveys of representative samples of adult smokers currently in nine countries (inhabited by over 45% of the world's smokers), with other countries being added in the future. Collectively, the ITC Surveys constitute the first‐ever international cohort study of tobacco use. The conceptual model of the ITC Project draws on the psychosocial and health communication literature and assumes that tobacco control policies influence tobacco related behaviours through a causal chain of psychological events, with some variables more closely related to the policy itself (policy‐specific variables) and other variables that are more downstream from the policy, which have been identified by health behaviour and social psychological theories as being important causal precursors of behaviour (psychosocial mediators). We discuss the objectives of the ITC Project and its potential for building the evidence base for the FCTC.

Men in the United States suer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these dierences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these dierences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signi®ers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context in¯uence the kind of masculinity that men construct and contribute to dierential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.

We introduce a conceptual framework with social relations as the main concept and the structure and the function of social relations as subconcepts. The structure of social relations covers aspects of formal relations and social network. The function of social relations covers social support, social anchorage and relational strain. We use this conceptual framework to describe social relations in the Danish population, with questionnaire data from the Danish Longitudinal Health Behaviour Study including a random sample of each of the age groups 25-, 50-, 60and 70-year olds, N = 2,011. The postal questionnaires were answered by a random sample in each of the age groups. The results show marked age and gender dierences in both the structure and the function of social relations. The social network, measured as weekly contacts, weakens with age and so does instrumental support. Emotional support is unrelated to this decline in contact frequency and appears to be at the same level for younger and older individuals. Relational strain, measured as con¯icts, declines with age for all kinds of social relations. The weakening of the social network with age does not seem to aect the level of emotional support and in turn seems to be partly compensated for by a simultaneous decline in relational strain. #

In 2005 the Commission for Africa noted that ‘Tackling HIV and AIDS requires a holistic response that recognises the wider cultural and social context’ (p. 197). Cultural factors that range from beliefs and values regarding courtship, sexual networking, contraceptive use, perspectives on sexual orientation, explanatory models for disease and misfortune and norms for gender and marital relations have all been shown to be factors in the various ways that HIV/AIDS has impacted on African societies (UNESCO, 2002). Increasingly the centrality of culture is being recognised as important to HIV/AIDS prevention, treatment, care and support. With culture having both positive and negative influences on health behaviour, international donors and policy makers are beginning to acknowledge the need for cultural approaches to the AIDS crisis (Nguyen et al., 2008).

This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14-16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents. r

Attitudes towards healthy eating were explored according to dietary, lifestyle and socio-demographic correlates in a random sample of 1256 Irish adults. Data were obtained from an Irish cross-sectional survey (1997)(1998)(1999). A self-administered questionnaire was used to obtain attitudinal information. Food consumption was estimated using a 7-d food diary. A majority of the sample had a positive attitude or motivation towards their healthy eating behaviour. Those who perceived their own eating habits to be healthy were more likely to comply with current dietary guidelines than those who did not. Females, increasing age, higher social class, tertiary education, nonsmokers, lower body-weights and increased recreational activity were associated with a lower odds ratio (OR) for having a negative attitude towards their healthy eating behaviour. An increased intake (g/d) of breakfast cereals, vegetables, fruit and poultry dishes were associated with decreased OR for negative attitudes towards their healthy eating behaviour, while an increased intake of high-calorie beverages (g/d) was associated with an increased OR. It can be concluded that attitudes or motivation towards eating healthily was related to measured dietary and lifestyle behaviour in this sample. Future research is warranted to devise appropriate methods of instituting attitude change towards dietary behaviour in certain subgroups of the population. r

Knowledge about prevalence and patterns of accidents among university students is scarce. The aims of the present health survey were to assess the general prevalence of accidents among university students, to describe the specific kinds of accidents, and to analyse associated factors. A multicentre cross-sectional health survey was conducted at 12 universities and 4 universities of applied sciences in North Rhine-Westphalia (NRW), Germany. The response rate was 88%. The self-administered questionnaire covered multiple areas of health, behaviours and a specific module for accidents. In total, 252 (8.8%) out of 2855 students (aged 17-26 years) had experienced an accident in the context of their studies. Contusions, compressions and strains constituted more than 50% of all kinds of injuries, while fractures, irritations, burns or acid burns were reported less frequently. The cumulative risk of experiencing an accident was increasing linearly with the study duration, indicating an absence of a specific vulnerable period. Nearly 60% of all accidents took place during study-related sports activities, and about a quarter of all accidents occurred on the way to or from university. Only few accidents occurred on university floors, in lecture rooms or on stairways. Further studies are needed to assess more in depth the causes of accidents and the situation immediately preceding the event before making specific recommendations for prevention.

This meta-analysis explored the efficacy of the Theory of Planned Behaviour (TPB) dependent on behaviour and methodological moderators. A lack of hierarchical analysis in previous reviews risks confounding these moderators. Here moderating roles of behaviour type, length of follow-up, sample age and behavioural measure are explored hierarchically amongst prospective tests of the TPB, controlling for past behaviour where possible. Searching identified 237 prospective tests from 206 articles. Random-effects meta-analytic procedures were used to correcting correlations for sampling and measurement error. Behaviour type moderated the model; physical activity and diet behaviours were better predicted (23.9% and 21.2% variance explained, respectively) whilst risk, detection, safer sex and abstinence from drugs were poorly predicted (between 13.8 and 15.3% variance explained). Methodological moderators were also apparent: age of sample moderated relations with student samples better predicted for physical activity, and adolescent samples better predicted for abstinence behaviours. Behaviours assessed in the shorter term, and those assessed with self-reports (compared with objective measures) were also better predicted. Both behavioural and methodological characteristics moderated relations amongst model components. The results can aid selection of appropriate targets upon which to base interventions.

Readiness for change is increasingly cited as an important variable in the health behaviours literature, yet there remains a dearth of research related to this construct in mental health. This study examined the psychometric properties of the University of Rhode Island Change Assessment (URICA) scale in two samples. In Study 1 (n ¼ 252), undergraduates completed the URICA and were administered measures of hopelessness, the consequences of worry, self-esteem, anxious symptomatology, and social desirability. The reliability and validity of the URICA were generally supported, although the goodness-of-fit with the intended subscales was only moderate. The Precontemplation, Contemplation and Maintenance subscales correlated as expected with ancillary measures, but the Action subscale did not. In Study 2 (n ¼ 81), individuals with panic disorder were administered the URICA at initial assessment and following cognitive behavioural therapy. The URICA demonstrated excellent reliability, significantly predicted treatment retention and dropout, and showed modest utility for predicting treatment outcome. Confirmatory factor analysis, however, revealed an inadequate fit to the intended subscales. The implications of these findings are discussed and directions for future research highlighted. #

Reliable and valid measures of local food environments are needed to more fully understand the relationship between these environments and health and identify potential intervention points to improve access to, and the availability of, healthy foods. These measures also inform policy making, including the zoning of food outlets and food labelling/information requirements. A literature review was undertaken using health, behavioural and social sciences, nutrition and public health databases and grey literature, to determine available information on the measurement of local food environments. Included articles were those measuring aspects of food environments published from 2000 to 2010. A range of tools and methods are available to measure different components of food environments. Those focusing on community nutrition environments record the number, type and location of food outlets. The tools that focus on the consumer nutrition environment incorporate other factors, such as available food and beverage products, their price and quality, and any promotions or information to prompt consumers to make purchasing decisions. A summary and critique of these measures are provided.

Background: Suboptimal treatment adherence remains a barrier to the control of many infectious diseases, including tuberculosis and HIV/AIDS, which contribute significantly to the global disease burden. However, few of the many interventions developed to address this issue explicitly draw on theories of health behaviour. Such theories could contribute to the design of more effective interventions to promote treatment adherence and to improving assessments of the transferability of these interventions across different health issues and settings.

Background: Parents have significant influence on behaviors and perceptions surrounding eating, body image and weight in adolescents. The aim of this study was to examine the prevalence of body weight dissatisfaction, difficulty in communication with the parents and the relationship between communication with parents and adolescents' dissatisfaction with their body weight (dieting or perceived need to diet). Methods: Survey data were collected from adolescents in 24 countries and regions in Europe, Canada, and the USA who participated in the cross-sectional 2001/2002 Health Behaviour of School-Aged Children (HBSC) study. The association between communication with parents and body weight dissatisfaction was examined using binary logistic regression analysis. Results: Body weight dissatisfaction was highly prevalent and more common among girls than boys, among overweight than non-overweight, and among older adolescents than younger adolescents. Difficulty in talking to father was more common than difficulty in talking to mother in all countries and it was greater among girls than among boys and increased with age. Difficulties in talking to father were associated with weight dissatisfaction among both boys and girls in most countries. Difficulties in talking to mother were rarely associated with body weight dissatisfaction among boys while among girls this association was found in most countries. Conclusion: The findings suggest that enhanced parent communication might contribute in most countries to less body dissatisfaction in girls and better communication with the father can help avoiding body weight dissatisfaction in boys. Professionals working with adolescents and their families should help adolescents to have a healthy weight and positive body image and promote effective parent-adolescent communication.

Background: Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. Methods: Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers.

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise ...

This paper examines the results of health surveys among 544 randomly selected households (2829 people) in seven kebele (urban dwellers' associations) in Addis Ababa and Kaliti, an industrial suburb of Addis Ababa, and in four rural villages in two peasant associations. The major objective was to study illness distribution and health hehaviour among different socioeconomic and cultural groups in urban and rural communities within the context of available health resources, national health policy and planning. Results show that in spite of the rapid expansion of health services since the Ethiopian revolution serious problems of allocation and access persist. Higher illness prevalance rates were found in rural areas (23.2%), Kaliti (25.5%) and in the low socioeconomic kebele in Addis Ababa (23.9%) than in the high socioeconomic kebele (16.5%), but rural/urban and intraurban differences were greater than reported here due to underreporting. One-third of all illnesses were treated by modern services, 19.9% by self care and 26.0% by traditional medicine and transitional healers, with 21.5% of all illnesses not being treated. Utilization rates varied with type and duration of illness, socioeconomic level, age, sex and place of residence. The role of distance and other contact barriers, treatment outcome and availability of private clinics and alternative health resources in utilization is also evaluated. Coverage of the modern health services was associated with socioeconomic status and mobility of patients as well as availability of health services.

Aims-To investigate which clusters of gambling activities exist within a longitudinal study of college health, how membership in gambling clusters change over time and whether particular clusters of gambling are associated with unhealthy risk behaviour.

The study aimed at assessing the prevalence of premenstrual symptoms and of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in a population-based sample of women of the entire reproductive age range, as well as to analyse predictors of PMS and PMDD in terms of socio-demographic, health status and health behavioural factors. A set of questions on PMSbased on the premenstrual syndrome screening tool developed by Steiner et al., translated into German and piloted-was integrated into the written questionnaire of the 2007 Swiss Health Survey. Weighted prevalence rates and multivariable regression analysis for the outcome variables PMS and PMDD were calculated. A total of 3,913 women aged 15 to 54 years answered the questions on PMS symptoms, and 3,522 of them additionally answered the questions on interference of PMS with life. Ninety one percent of the participants reported at least one symptom, 10.3% had PMS and 3.1% fulfilled the criteria for PMDD. The prevalence of PMS was higher in nonmarried women, in women aged 35-44 years and in women of the Italian-speaking region of Switzerland. Both PMS and PMDD were strongly associated with poor physical health and psychological distress. Socio-cultural factors seem to determine the prevalence, perception and handling of PMS. Considering the association with poor physical health and high psychological distress, a broader underlying vulnerability in women qualifying for PMDD must be assumed and should be taken into account in clinical management as well as in future research in this field.

The aim of the study was to analyse associations of religiosity and mortality in a secular region. The sample consisted of 734 Danish, community dwelling elderly persons, living in a secular culture, and all aged 70 when primary data were collected. Secondary data consisted of a 20 year follow-up on vital status or exact age of death. The study was designed to be highly comparable to studies conducted in more religious environments in order to compare results. Three variables of religion were investigated in relation to survival: importance of affiliation, church attendance and listening to religious media. Relative hazards (RH) of dying were controlled in models including gender, education, medical and mental health, social relations, help given and received, and health behaviour. The results showed significant and positive associations between claiming religious affiliation important and survival (relative hazard of dying ¼ RH .70; 95% CI .58-.85) and church attendance and survival (RH .73; 95% CI .64-.87). Results decreased and only stayed significant regarding church attendance when controlled for covariates. Nearly all significant effects were seen in women, but not in men. The effect size of the full sample is less than in more religious environments in United States samples. Although the positive overall RHs are comparable to those of other studies, the mediating variables and pathways of effects seem dissimilar in this sample from a secular environment. Receiving and especially giving help to others are suggested as variables of explanatory value. r