Adverse Health Behaviors Research Articles

Characteristics Associated with Substance Use and Non-use Among Street Children in Delhi, India: A Community-based Cross-sectional Epidemiological Study.

Street children are vulnerable to adverse health and risk behaviors and drug use. Substance use among street children has been well documented in several countries. This study reports sociodemographic and peer, family, and stress-related factors associated with substance use and non-use in a representative sample of street children of Delhi. This cross-sectional survey was conducted through six NGOs working with street children, using Respondent Driven Sampling, in nine districts of Delhi (n = 766, 7-18 years). The multivariable model was developed by applying binary logistic regression analysis. The rate of substance use was 49%. Significant association was found between substance use in the past year and increasing age [Odds Ratio: OR (95% Confidence Interval)] [1.22(1.12,1.33)], male sex [4.34 (2.28,8.26)], lacking psychosocial support from family/relatives [3.27(1.84,5.80)], being engaged in earning from illegal sources, [3.04(1.75,5.29)], family use of substance [2.59(1.38,4.89)], presence of substance-using peers [29.86(14.38,62.01)], lack of non-drug-using peers [2.35(1.46,3.79)], and not possessing basic amenities [2.26(1.31,3.93)]. Multiple modifiable factors exist within the family and peer group, including risk and protective factors or a consequence of substance use. Some challenges in the form of difficulty in reaching out to them and poor treatment seeking by those using substances warrant intensification in both primary and secondary prevention initiatives.

Loneliness is associated with health behaviour: A Danish population study of 122.258 individuals

Abstract Background Loneliness is steadily being recognized as a public health concern due to its association with increased morbidity and mortality. Health behaviour has been proposed as a key mechanism that influences this association. The objective of the present study is to provide a comprehensive account of the relationship between loneliness and adverse health behaviour, including daily smoking, alcohol consumption, physical inactivity, unhealthy dietary habits and obesity. Methods We conducted a cross-sectional study using data from the 2017 Danish National Health Survey. Loneliness was assessed using a Danish version of the Three-Item Loneliness Scale. We analysed the association between loneliness and multiple forms of adverse health behaviour in 122.258 individuals aged 16 years and older using logistic regression models adjusting for sex, age, educational attainment, country of origin and cohabitation status. Stratified analyses was conducted to investigate potential differences by sex and age. Results Loneliness was associated with a greater risk of smoking (AOR=1.30; 95% CI: 1.21-1.40), physical inactivity (AOR=1.87; 95% CI: 1.75-1.99), unhealthy diet (AOR=1.58; 95% CI: 1.47-1.70), and obesity (AOR=1.60; 95% CI: 1.49-1.72). Conversely, loneliness was associated with a lower risk of weekly alcohol consumption (AOR=0.91; 95% CI: 0.83-0.98). Conclusions Our study provides evidence that loneliness is associated with an increased risk of adverse health behaviour, such as smoking, physical inactivity and unhealthy dietary intake, across the life span. These results suggest that adverse health behaviors may influence the association between loneliness and poor health. Longitudinal studies are needed to clarify causal relationships underlying these associations. Key messages • Loneliness is strongly associated with adverse health behaviour across the life span. • Our study supports the theory that health behaviour is a key mechanism on the relationship between loneliness and morbidity.

Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study

BackgroundThe association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors.MethodsThe study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994–2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035).ResultsDuring the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM.ConclusionThe findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.

Association of health behaviour and clinical manifestation in early multiple sclerosis in Germany – Baseline characteristics of the POWER@MS1 randomised controlled trial

BackgroundReceiving a multiple sclerosis (MS) diagnosis is a significant stressor. Therefore, highly individualised counselling is needed, especially in early MS. Modifiable risk factors (e.g. smoking and obesity) are gaining relevance in MS. Despite evidence for worse MS-related health outcomes, prevalence of adverse health behaviours, such as smoking and physical inactivity, is high across all MS stages. However, knowledge regarding health behaviours as well as their association with MS-related health outcomes among newly diagnosed PwMS in Germany is scarce. Currently, the efficacy of an interactive digital lifestyle management application intended to be used as an add-on to standard care among newly diagnosed PwMS in Germany is evaluated in an ongoing multicentre randomised controlled trial (RCT) (‘POWER@MS1’). ObjectivesTo describe baseline disease characteristics and health behaviours of the POWER@MS1 cohort and investigate associations between MS characteristics, quality of life (QOL), health behaviours and intention to optimise health behaviour habits. MethodsThis study included 234 persons with early MS from 20 study centres located across Germany who participate in the POWER@MS1 RCT. Participants were recruited by treating neurologists from different regions and health-care settings in Germany. Baseline data was obtained using paper-based questionnaires and a web-based healthy diet screener between July 2019 and end of March 2022 and analysed descriptively. ResultsIn this early MS cohort (mean disease duration 4 months), a screening tool showed severe symptoms of anxiety in 15 % of the participants. Better means for stress management appeared to be particularly relevant for the whole cohort. Moreover, 19 % were current smokers, 15 % were obese and 36 % were insufficiently physically active. On average, participants only moderately adhered to dietary guidelines for recommended intake of key food groups (e.g. vegetables, fruits and fatty marine fish). Higher EDSS scores were associated with approximately 20 % higher T2-lesion burden (rate ratio RR=1.2, p<0.001) and 13 % higher relapse rate (RR=1.13,p=0.02) per EDSS disability level. Moreover, a higher T2-lesion burden was associated with current smoking (RR=0.76, p=0.033), resulting in approximately 24 % less T2-lesions at disease onset among non-smokers. In addition, smoking was associated with unhealthier dietary habits according to lower diet scores (linear regression coefficient β=−1.27, p<0.001). Higher EDSS scores (β=0.19,p<0.001) and higher BMI (β=0.013,p=0.03) were associated with higher HAQUAMS (lower QOL). Further, lower diet scores (β=−0.044,p=0.039) were associated with lower QOL. Moreover, higher HAQUAMS (lower QOL) indicated a higher intention to optimise stress management (β=0.98,p<0.001), physical activity (β=0.74,p=0.046) and sleep behaviour (β=1.82,p<0.001). Further, higher intention to optimise stress management was accounted for by higher EDSS scores (β=0.39,p=0.004) and a higher number of T2-lesions (β=0.029,p=0.015) in this newly diagnosed MS cohort. ConclusionResults indicate a clear need for modifications of health behaviours among newly diagnosed PwMS participating in POWER@MS1. Individualised psychological and health behaviour counselling appears to be an important factor in treatment, also for similar early MS cohorts and particularly in those who demonstrate a more severe disease in clinical and MRI metrics.

Preventing and treating the adverse health conditions of androgenic-anabolic steroids: An online survey with 883 users in the United Kingdom

The use of use of androgenic-anabolic steroids (AAS) is associated with an increased risk of several health conditions. Health-related behaviours to prevent and treat these conditions include the use of needle exchange services, having blood tests to monitor one's health and seeking information and support from health professionals and other sources. This study investigates the prevalence of adverse health conditions and health behaviours in a cohort of AAS users from the United Kingdom taking part in an online survey, as well as behavioural factors impacting the likelihood of reporting a health condition in the last 12 months. The sample was composed of 883 adults (72.1 % males, 27.9 % females; Med age = 26, min = 16, max = 65). The most common health problems were dermatological (68.1 %) and neuropsychiatric (63.1 %) conditions. Although the majority of participants monitored their health with blood tests (86.4 %) and sought a General Practitioner (GP) to treat health problems (55.0 %), only a minority of LGBTQIA+ males sought a GP for information (12.8 %) or to treat health conditions (18.7 %). Participants who sought a GP for information about AAS were 74 % less likely to report a health condition in the last 12 months (OR = 0.26, 95 % CI 0.18 to 0.40, p < 0.001). These findings can be used to support research and interventions aiming to improve the access of AAS users to the health system by identifying health conditions and health-related behaviours adopted by subpopulations of AAS users.

Screen time and sleep among medical students in Germany

Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = − 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.

Preoperative optimization: Physical and cognitive pre-habilitation and management of chronic medication.

Surgery is a significant stressor for older patient. Most are at higher risk of complications due to frailty and comorbidities. This article will review the impact of surgery on the older patient, perioperative risk assessment and stratification, prehabilitation, and specific screenings and interventions. Electronic searches of PubMed were conducted to identify relevant literature using the following search terms: prehabilitation, sarcopenia, osteosarcopenia, frailty, perioperative evaluation, and polypharmacy. Using the frailty phenotype allows for the early identification of geriatric syndromes and potential targets for interventions. However, it does not inform on potential cognitive impairment, which must be assessed separately. Prehabilitation, especially using multimodal interventions, aims to increase functional capacity during the preoperative period in anticipation of the upcoming stress of surgery and the metabolic cost of recovery. It comprises aerobic and resistance training, dietary interventions, psychological interventions, and cessation of adverse health behaviors. Addressing polypharmacy is also important during the perioperative period. Several frailty assessment tools exist, and special tests only take minutes to perform such as the gait speed and chair stand test. Early identification by surgeons leads to early referral to prehabilitation, which needs about four to six weeks to improve function. The decision to enroll patients in a prehabilitation program is based on the understanding of the needs to maintain a structured and personalized intervention taking into consideration the patient's health status, the type of surgery, and the state of the disease. Perioperative evaluation and prehabilitation for older adults are evolving fields, which are generating clinical and scientific interest. This article will review relevant topics to help clinicians adapt usual perioperative care to older patients' particular needs.

Dysglycemia-Based Chronic Disease and Lifestyle Medicine: Mechanistic Interpretation Using the Allostatic Load Model

Dysglycemia-based chronic disease (DBCD) comprises insulin resistance, prediabetes, and type 2 diabetes, and their staged progression, complications, and impact contribute to one of the largest public health burdens worldwide. The clinical and economic effects of DBCD are fueled by external stressors related to modern society and lifestyles, especially in low socioeconomic strata. Chronic stressor exposure leads to chronic stress, characterized by immune-neuroendocrine activation and mobilization/depletion of metabolic resources. This complex adaptive response engaging many different signaling pathways is termed allostasis and principally regulates homeostatic mechanisms. Allostatic load is the metabolic cost of adaptation to environmental factors and can lead to numerous adverse health outcomes and behaviors. In this narrative review, the bidirectional relationship between allostatic load and unhealthy behaviors is analyzed in the context of DBCD development and progression, with a focus to reduce individual vulnerabilities.

Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients

Alcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden. To compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking. This bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020. Patients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up. The primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization. Among 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction). In this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities. ClinicalTrials.gov Identifier: NCT02247388.

Perinatal Health Outcomes Across Rural and Nonrural Counties Within a Single Health System Catchment.

Perinatal health outcomes are influenced by a variety of socioeconomic, behavioral, and economic factors that reduce access to health services. Despite these observations, rural communities continue to face barriers, including a lack of resources and the fragmentation of health services. To evaluate patterns in health outcomes, health behaviors, socioeconomic vulnerability, and sociodemographic characteristics across rural and nonrural counties within a single health system catchment area. Socioeconomic vulnerability metrics, health care access as determined by licensed provider metrics, and behavioral data were obtained from FlHealthCHARTS.gov and the County Health Rankings. County-level birth and health data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital between June 2011 and April 2017. The UFHPCA included 3 nonrural and 10 rural counties that represented more than 64,000 deliveries. Nearly 1 in 3 infants resided in a rural county, and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Maternal smoking rates (range 6.8%-24.8%) were above the statewide rate (6.2%). Except for Alachua County, breastfeeding initiation rates (range 54.9%-81.4%) and access to household computing devices (range 72.8%-86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3%-36.9%) were above the statewide rate (18.5%). Furthermore, risk ratios suggested negative health outcomes for residents of counties within the UFHPCA for each measure, except for infant mortality and maternal deaths, which lacked sample sizes to adequately test. The health burden of the UFHPCA is characterized by rural counties with increased maternal death, neonatal death, and preterm birth, as well as adverse health behaviors that included increased smoking during pregnancy and lower levels of breastfeeding relative to nonrural counties. Understanding perinatal health outcomes across a single health system has potential to not only estimate community needs but also facilitate planning of health care initiatives and interventions in rural and low-resource communities.

Experiences of Unstable Housing Among High School Students - Youth Risk Behavior Survey, United States, 2021.

Youths experiencing unstable housing face higher risks for poor physical, mental, and sexual health outcomes and increased risk for suicide compared with their peers experiencing stable housing. In addition, youths of color and sexual minority youths are disproportionately more likely to experience homelessness. For the first time, in 2021, the nationally representative Youth Risk Behavior Survey included an item assessing housing stability, or nighttime residence among students in grades 9-12 in the United States. During 2021, 2.7% of U.S. high school students experienced unstable housing. Among racial and ethnic subgroups, Native Hawaiian or other Pacific Islander youths were most likely to experience unstable housing, followed by American Indian or Alaska Native and Black youths. Sexual minority (lesbian, gay, bisexual, and questioning or other) youths were more likely to experience unstable housing compared with their heterosexual peers. Compared with students who were stably housed, students who were unstably housed were more likely to engage in risky sexual behaviors, substance use, and suicide ideation and attempts, and to experience violence. These findings highlight which adverse health risks and behaviors are elevated among youths experiencing housing insecurity. Focused public health interventions are required to address the disproportionate burden of health risks prevalent among youths who are unstably housed.

Abstract P306: Life’s Essential 8 is Associated With All-Cause and Cardiovascular Disease Mortality Among Community Dwelling Older Men and Women in the InCHIANTI Study of Aging (1998-2020)

Introduction: The population of individuals aged 65 y and older has increased steeply over the past few years. Health factors including obesity, high cholesterol, blood pressure, and blood glucose levels, as well as adverse health behaviors such as smoking, poor diet, insufficient physical activity, and low sleep quality are risk factors for chronic disease development and mortality. Because both health factors and behaviors are critical for reducing the risk of chronic disease and mortality, we examined a score assessing overall cardiovascular health (CVH) based on American Heart Association’s (AHA) Life’s Essential 8, an update of the AHA’s former Life’s Simple 7 metric. This metric may provide a tenable framework for chronic disease management and prevention. Hypothesis: We hypothesized that in a cohort of participants aged 65 y and older, higher CVH scores based on Life’s Essential 8, indicating better CVH, at baseline, is inversely associated with risk of all-cause and CVD mortality. Methods: Overall cardiovascular health was assessed using 8 health factors and behaviors, scored 0 to 100, among 928 participants (55% female) aged 65 years and older within the InCHIANTI study of aging. Vitality status was ascertained using registry information. For analysis, CVH was modeled as a 1 Standard Deviation (SD) increase in the score. Cox proportional hazards models, adjusted for age and sex, were used to examine the associations between CVH and all-cause and cardiovascular disease mortality over a median follow-up of 14.6 y. Results: A 1 SD increase in the overall CVH score was inversely associated with all-cause (hazard ratio [HR] = 0.80, 95% confidence interval [CI] = [0.738, 0.873]) and CVD mortality (HR = 0.73, 95% CI = [0.632, 0.832]). Conclusion: Among older adults, overall CVH - assessed through the lens of the AHA's Life's Essential 8 - is associated with a lower risk of all-cause and CVD mortality. This relationship lends credence to the importance of prioritizing health factors and behaviors in preventing chronic disease development and promoting healthier lives among older individuals.

Identifying Latent Patterns and Predictors of Health Behaviors and Healthcare Barriers Among LGBT Older Adults.

Heightened risk of adverse health behaviors is of major concern among lesbian, gay, bisexual, and transgender (LGBT) older adults. Yet, no previous research has investigated heterogeneity of LGBT older adults on a set of health behaviors in conjunction with healthcare barriers. We aim to identify latent classes of the behavior and barrier patterns and examine differences in physical and psychological health-related quality of life (HRQOL) by the specified latent classes while exploring predictors of the class membership. Three-step latent class analysis applying survey weights was conducted with 14 indicators of health-risk behavior, health-promoting behavior, preventive care use, and healthcare barriers from baseline data of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS, N = 2450). The best empirical and substantive fit was determined with four classes consisting of (1) healthy behaviors and minimal barriers (C1, 39%), (2) less healthy behaviors and high barriers (C2, 31%), (3) healthy behaviors and healthcare system barriers (C3, 19%), and (4) optimal health behaviors with risks of limited healthcare access (C4, 11%). Compared to C1, C2 and C3 had lower physical HRQOL and C2 also had lower psychological HRQOL. C4 did not differ in HRQOL from C1. C2 was associated with more day-to-day discrimination, lower mastery, and lower social support. Efforts to lower healthcare barriers are warranted in addition to interventions to strengthen social support and reduce marginalization. Positive relationships between LGBT older adults and healthcare need to be established via trust-building and cultural competency.

Moderation Effects of Gender on the Association between Intimate Partner Violence and Suicidal Ideation or Attempt among Adolescents: A Secondary Analysis of the 2017 YRBS

Objective Physical and sexual intimate partner violence (IPV) among adolescents leads to adverse health behaviors, particularly suicidal ideation and attempts. Studies demonstrated the link between IPV and suicidal ideation and attempts among adolescents, yet there is conflicting evidence regarding differences between adolescent males and females; research evaluating the interaction of gender and the association between IPV and suicidal ideation and attempts is limited. The present study used a nationally representative sample from the Youth Behavioral Risk Surveillance questionnaire to determine whether there is an interaction of gender on the relationship between physical IPV, sexual IPV, and suicidal ideation and suicidal attempts. Method Weighted logistic regressions were fit using Stata 15.1 and multiple imputations were used to account for missing data. Results There is a significant gender by sexual IPV interaction (AOR = 0.66, CI = 0.51–0.84, p = 0.002) such that at low levels of sexual IPV there were no differences between genders in reported suicide attempts (t[33] = 1.19, p = 0.242). However, at moderate and high instances of sexual IPV, adolescent females were significantly less likely than males to report attempting suicide in the past year (t[33] = −2.71, p = 0.011; t[33] = −3.17, p = 0.003, respectively). Conclusions The present study demonstrates the vital need for IPV and suicidal ideation and attempt screening, tailored multi-level interventions, and advocacy for adolescents. Policies are essential to increase screening among medical providers, and increase school- and community-based interventions and IPV and suicide awareness to decrease rates among adolescents. HIGHLIGHTS Female students were more likely than males to report suicidal ideation. Significant interaction between sex and sexual IPV on suicide attempts. Gender differences at medium and high levels of sexual IPV on suicide attempts.

Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study.

A growing body of evidence shows that financial incentives can effectively reinforce individuals' positive behavior change and improve compliance with health intervention programs. A critical factor in the design of incentive-based interventions is to set a proper incentive magnitude. However, it is highly challenging to determine such magnitudes as the effects of incentive magnitude depend on personal attitudes and contexts. This study aimed to illustrate loss-framed adaptive microcontingency management (L-AMCM) and the lessons learned from a feasibility study. L-AMCM discourages an individual's adverse health behaviors by deducting particular expenses from a regularly assigned budget, where expenses are adaptively estimated based on the individual's previous responses to varying expenses and contexts. We developed a mobile health intervention app for preventing prolonged sedentary lifestyles. This app delivered a behavioral mission (ie, suggesting taking an active break for a while) with an incentive bid when 50 minutes of uninterrupted sedentary behavior happened. Participants were assigned to either the fixed (ie, deducting the monotonous expense for each mission failure) or adaptive (ie, deducting varying expenses estimated by the L-AMCM for each mission failure) incentive group. The intervention lasted 3 weeks. We recruited 41 participants (n=15, 37% women; fixed incentive group: n=20, 49% of participants; adaptive incentive group: n=21, 51% of participants) whose mean age was 24.0 (SD 3.8; range 19-34) years. Mission success rates did not show statistically significant differences by group (P=.54; fixed incentive group mean 0.66, SD 0.24; adaptive incentive group mean 0.61, SD 0.22). The follow-up analysis of the adaptive incentive group revealed that the influence of incentive magnitudes on mission success was not statistically significant (P=.18; odds ratio 0.98, 95% CI 0.95-1.01). On the basis of the qualitative interviews, such results were possibly because the participants had sufficient intrinsic motivation and less sensitivity to incentive magnitudes. Although our L-AMCM did not significantly affect users' mission success rate, this study configures a pioneering work toward adaptively estimating incentives by considering user behaviors and contexts through leveraging mobile sensing and machine learning. We hope that this study inspires researchers to develop incentive-based interventions.

Sports-Related Concussions and Adverse Health Behaviors Among Middle and High School Students

Background: Concussions affect millions of youths in the United States each year, and there is concern about long-term health effects from this injury. Purpose: To examine the association between sports- or physical activity–related concussion and health risk behaviors among middle and high school students in 9 states. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from the 2019 middle school and high school Youth Risk Behavior Survey were used for this analysis. Nine states were identified that included the same question on concussion and similar questions on health risk behaviors in their 2019 Youth Risk Behavior Survey. Students were asked to self-report whether they had ≥1 sports- or physical activity–related concussions during the 12 months preceding the survey. Self-reported concussion was the primary outcome of interest. Other variables included sex, race/ethnicity, played on a sports team, were physically active 5 or more days/week, ever tried cigarette smoking, ever used an electronic vapor product, academic grades, drank alcohol, were in a physical fight, seriously considered attempting suicide, made a suicide plan, and attempted suicide. Results: Among the 9 states, 18.2% of middle school students and 14.3% of high school students self-reported ≥1 sports- or physical activity–related concussions. Among both middle school and high school students, the prevalence of ≥1 sports- or physical activity–related concussions was higher among students who played on a sports team, were physically active 5 or more days per week, had ever tried cigarette smoking, had ever used an electronic vapor product, had seriously considered attempting suicide, had made a suicide plan, and had attempted suicide compared with those who had not engaged in those behaviors. The prevalence of sports- or physical activity–related concussion was consistently higher among middle school students than high school students across sex, race/ethnicity, and adverse health behaviors. Conclusion: Middle school students with a history of concussion warrant attention as an at-risk population for concussions and adverse health behaviors. Health care providers may consider screening students for adverse health behaviors during preparticipation examinations and concussion evaluations.

Association between low health literacy and adverse health behaviors in North Carolina, 2016.

Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health. This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health. Researchers used North Carolina's 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and sleep, and irregular medical and dental check-ups. The sample was divided into four age categories (18-49, 50-64, and 65-75, and 76 and older) for statistical comparisons. Stata 15 and a user-written Stata command, - psacalc-, were used to examine the relationships by addressing omitted variable bias in OLS regressions. Findings indicate that LHL has a direct robust relationship with not exercising, inadequate sleep, irregular health and dental checkup, and health screenings across different age groups. Among women, LHL is associated with getting a Pap test in 3 years as opposed to more than 3 years. The adverse behaviors can explain the mechanisms underlying the link between LHL and adverse health outcomes. Further research on the causal relationship between LHL and adverse health behaviors using longitudinal data on a broader geographic region is warranted.

University student practices and perceptions on eating behaviours whilst living away from home

Transition to university is a vulnerable time and associated with adverse health behaviors. Purchasing and consuming healthy food is generally not a high priority due to other challenges they face. This study explored the dietary practices and perceptions which influenced eating behaviors of university students when living away from home. Forty-two university students (n 27 male) participated in 8 focus groups which identified four themes as being barriers to eating a healthier diet, namely Physical Environment, University lifestyle, self-confidence, and personal factors. Food choice is a complex behavior and these findings when applied to Maslow's hierarchy of needs suggests that basic physiological needs for food is prioritized and only when this is satisfied is making healthier food choices considered.

Feeding, television, and sleep behaviors at one year of age in a diverse sample

BackgroundHealthy lifestyle behaviors that can prevent adverse health outcomes, including obesity, are formed in early childhood. This study describes feeding, television, and sleep behaviors among one-year-old infants and examines differences by sociodemographic factors. MethodsCaregivers of one-year-olds presenting for well care at two clinics, control sites for the Greenlight Study, were queried about feeding, television time, and sleep. Adjusted associations between sociodemographic factors and behaviors were performed by modified Poisson (binary), multinomial logistic (multi-category), or linear (continuous) regression models. ResultsOf 235 one-year-olds enrolled, 81% had Medicaid, and 45% were Hispanic, 36% non-Hispanic Black, 19% non-Hispanic White. Common behaviors included 20% exclusive bottle use, 32% put to bed with bottle, mean daily juice intake of 4.1 ± 4.6 ounces, and active television time 45 ± 73 min. In adjusted analyses compared to Hispanic caregivers, non-Hispanic Black caregivers were less likely to report exclusive bottle use (odds ratio: 0.11, 95% confidence interval [CI] 0.03–0.39), reported 2.4 ounces more juice (95% CI 1.0–3.9), 124 min more passive television time (95% CI 60–188), and 37 min more active television time (95% CI 10–64). Increased caregiver education and higher income were associated with 0.4 (95% CI 0.13–0.66) and 0.3 (95% CI 0.06–0.55) more servings of fruits and vegetables per day, respectively. ConclusionIn a diverse sample of one-year-olds, caregivers reported few protective behaviors that reduce the risk for adverse health outcomes including obesity. Differences in behavior by race/ethnicity, income, and education can inform future interventions and policies. Future interventions should strive to create culturally effective messaging to address common adverse health behaviors.

Adverse childhood experiences, psychological well-being, and substance use in Pakistani university students

Adverse childhood experiences are associated with risky health behaviors and adverse health outcomes worldwide, including substance use; yet, relatively fewer studies have examined linkages between adverse childhood experiences and health behaviors and outcomes in low- and middle-income countries, including countries in sub-Saharan Africa and large portions of Asia. Furthermore, fewer studies of adverse childhood experiences have examined the pathways or processes connecting adverse childhood experiences to health behaviors and outcomes. This study addressed these gaps by investigating three competing models of associations between adverse childhood experiences, psychological well-being, and substance use in 595 Pakistani University students (40.5% female; Meanage = 21.96, Standard deviation = 2.37) using path analysis. Controlling for the effects of age, sex, and socioeconomic status, adverse childhood experiences were associated with both diminished psychological well-being and higher levels of substance use. However, psychological well-being and substance use were unrelated and neither accounted for indirect effects of adverse childhood experiences on adjustment. Suggestions for furthering research on adverse childhood experiences, particularly in low- and middle-income countries, are discussed.