Changes In Risk Behaviors Research Articles

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services.

PurposeDisparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen.MethodsIn-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data.ResultsFour themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence.ConclusionsPrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.

Effect of heterogeneous risk perception on information diffusion, behavior change, and disease transmission

Motivated by the importance of individual differences in risk perception and behavior change in people's responses to infectious disease outbreaks (particularly the ongoing COVID-19 pandemic), we propose a heterogeneous disease-behavior-information transmission model, in which people's risk of getting infected is influenced by information diffusion, behavior change, and disease transmission. We use both a mean-field approximation and Monte Carlo simulations to analyze the dynamics of the model. Information diffusion influences behavior change by allowing people to be aware of the disease and adopt self-protection and subsequently affects disease transmission by changing the actual infection rate. Results show that (a) awareness plays a central role in epidemic prevention, (b) a reasonable fraction of overreacting nodes are needed in epidemic prevention (c) the basic reproduction number R_{0} has different effects on epidemic outbreak for cases with and without asymptomatic infection, and (d) social influence on behavior change can remarkably decrease the epidemic outbreak size. This research indicates that the media and opinion leaders should not understate the transmissibility and severity of diseases to ensure that people become aware of the disease and adopt self-protection to protect themselves and the whole population.

What Does it Mean to be At-risk of Developing Type 2 Diabetes? Family Matters

Family history of type 2 diabetesis likely to impact individual perception of risk and subsequent behavior change. The purpose of this study was to explore health care provider and at-risk individual perceptions of family history risk status in the context of the self-regulatory model of illness through qualitative interviews. Participants discussed cause, consequences, and control of risk. Health care providers described various aspects of risk perception, while at-risk individuals predominantly discussed cause. In relation to type 2 diabetes risk and family history, providers should dispel messages of inevitability, engage in conversations concerning consequences, and provide education concerning cause.

Public Perception About Pandemic Risk

<p><em>This research motivated by the prevalence of the pandemic myth, namely that a pandemic is unavoidable and thus nothing to be worried about, and the health sector which should manage risks, and the risk of a pandemic, is not a development problem. This will lead to a poor understanding of pandemic risks, minimal preparedness and inadequate prevention. Examining the reasons this myth persists can help improve risk management associated with pandemics. Perceptions of risk play an important role in shaping health-related behaviors in controlling infectious diseases. The aim of this study is to assess risk perceptions and behavioral changes in response to a pandemic. This research is a qualitative research, with descriptive analysis techniques. The results showed that most people were apathetic in responding to pandemic conditions.</em></p>

The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

BackgroundWidespread viral and serological testing for SARS-CoV-2 may present a unique opportunity to also test for HIV infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on HIV incidence and the cost-effectiveness of this strategy in six US cities.MethodsUsing a previously-calibrated dynamic HIV transmission model, we constructed three sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviours at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to scenario (2). We estimated cumulative HIV infections between 2020-2025 and incremental cost-effectiveness ratios of linked HIV testing over 20 years.ResultsIn the absence of linked, opt-out HIV testing, we estimated a total of 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviours and no service disruptions), and 9.0% increase in the worst-case scenario (no behavioural change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7,225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health care costs in each city.ConclusionsA campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce HIV incidence and reduce direct and indirect health care costs attributable to HIV.

Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

At present, there are no set guidelines establishing cumulative limits for blast exposure numbers and intensities in military personnel, in combat or training operations. The objective of the current study was to define lung injury, pathology, and associated behavioral changes from primary repeated blast lung injury under appropriate exposure conditions and combinations (i.e. blast overpressure (BOP) intensity and exposure frequency) using an advanced blast simulator. Male Sprague Dawley rats were exposed to BOP frontally and laterally at a pressure range of ~ 8.5–19 psi, for up to 30 daily exposures. The extent of lung injury was identified at 24 h following BOP by assessing the extent of surface hemorrhage/contusion, Hematoxylin and Eosin staining, and behavioral deficits with open field activity. Lung injury was mathematically modeled to define the military standard 1% lung injury threshold. Significant levels of histiocytosis and inflammation were observed in pressures ≥ 10 psi and orientation effects were observed at pressures ≥ 13 psi. Experimental data demonstrated ~ 8.5 psi is the threshold for hemorrhage/contusion, up to 30 exposures. Modeling the data predicted injury risk up to 50 exposures with intensity thresholds at 8 psi for front exposure and 6psi for side exposures, which needs to be validated further.

Fidelity of the delivery of NHS Health Checks in general practice: an observational study.

BackgroundThe NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. Failure to deliver the consultation appropriately could undermine its efficacy. To date, to the authors’ knowledge, there are no published data on the fidelity of delivery of NHS Health Checks.AimTo assess the fidelity of delivery of NHS Health Checks in general practice.Design & settingFidelity assessment of video and audio recordings of NHS Health Check consultations conducted in four GP practices across the East of England.MethodA secondary analysis of 38 NHS Health Check consultations, which were video or audio recorded as part of a pilot study of introducing discussions of cancer risk into NHS Health Checks. Using a checklist based on the NHS Health Check Best Practice Guidance, fidelity of delivery was assessed as the proportion of key elements completed during the consultations.ResultsThe mean number of elements of the NHS Health Check completed across all consultations was 14.5/18 (80.6%), with a range of 10 to 17 (55.6% to 94.4%). The mean fidelity for risk assessment, risk communication, and risk management sections was 8.7/10 (87.0%), 4.1/5 (82.0%), and 1.7/3 (56.7%), respectively. Clinically appropriate lifestyle advice was given in 34/38 consultations. Elements with the lowest fidelity were ethnicity assessment (n = 12/38; 31.6%), family history of cardiovascular disease (CVD) assessment (n = 25/38; 65.8%), AUDIT-C communication (n = 13/38; 34.2%), and dementia risk management (n = 6/38; 15.8%).ConclusionAlthough fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed.

Associations between methamphetamine use and lack of viral suppression among a cohort of HIV-positive persons who inject drugs in Hai Phong, Vietnam.

We assessed the association between methamphetamine use and lack of viral suppression among a cohort of HIV-seropositive persons who inject drugs (PWID) in Hai Phong, Vietnam. Cohort study with random effects logit modeling and mediation analysis for antiretroviral therapy (ART) adherence. PWID were recruited from October 2016 to October 2017; HIV-seropositive PWID were enrolled in a cohort to assess HIV viral loads, changes in drug use, risk behaviors, and ART adherence during 24-month follow-up. Methamphetamine use in last 30 days was divided into three categories: 0 days (no use), 1-19 days (intermediate), and 20 or more days (heavy). Bivariate and a multivariable random effects logit models were used to assess the relationship between methamphetamine use and not being virally suppressed. We also assessed self-reported ART adherence as a mediating factor. A total of 645 HIV-seropositive PWID were included at baseline; 95% male, average age 40 (SD = 6.4). At baseline, methamphetamine use in last 30 days was 64% no use, 32% intermediate use, 4% heavy use. Approximately 74% of PWID reported high/complete adherence; 76% were at viral suppression. In random effects analysis, recent methamphetamine use was associated with not being virally suppressed during follow-up (adjusted odds ratio: 1.84, 95% confidence interval: 1.06, 3.17); the effect was not explained by a mediating effect of self-reported adherence to ART. Recent methamphetamine use is associated with not being virally suppressed among PWID. The results of this study indicate the need for targeted interventions for methamphetamine use with special focus on those with HIV infection.

Perceptions of Indigenous Australians towards cardiovascular primary prevention programs

Abstract Background Indigenous Australians have disproportionately poorer health outcomes than their non-Indigenous counterparts. Preventable chronic diseases, such as cardiovascular disease, are primary factors that contribute to their lower life expectancy. Health risk behaviors such as smoking, physical inactivity, poor nutrition and obesity largely contribute to the enduring health divide. Therefore, the aim of this qualitative review was to synthesize the best available evidence on the perceptions of Indigenous Australians towards cardiovascular primary prevention programs. Methods A search using MEDLINE, CINAHL, EMBASE, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Meta-aggregation was conducted in accordance with JBI methodology. Results Eleven studies involving 249 participants were included. Three synthesized findings were developed 1) External factors can affect participants' experiences of prevention programs. Support from family motivates participation and behavioral change. Support from health professionals that is free from judgment facilitates participation; 2) The complexities of an individual's life influence Indigenous Australian's experiences and participation in prevention programs and health risk behavioral change; 3) A personal desire to change behaviors and participate in prevention programs requires development of knowledge on healthy lifestyles, creation of new social norms and overcoming internal struggles. Conclusions Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants and personal desire. Future programs need to tackle structural drivers and create a supportive environment to assist in behavior change. Key messages Social determinants affect Indigenous Australians experiences and participation in prevention programs for behaviour change. Prevention programs must create a supportive environment with the inclusion of family.

Parental-oriented educational mobile messages to aid in the control of early childhood caries in low socioeconomic children: A randomized controlled trial

ObjectivesTo evaluate the effectiveness of educational messages as an aid in the control of early childhood caries (ECC) in low socioeconomic children. MethodsA single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36–60 months, recruited in preschools from Bauru, Brazil. The participants were randomly allocated into control and intervention groups (1:1), stratified by parental eHealth literacy scores (eHEALS) and children's caries experience. Every 2 weeks, text messages were sent to parents of intervention group via WhatsApp. Visible plaque index (VPI) and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-ups, while eHEALS and dietary habits were determined at baseline and 6-month follow-up. Statistical analysis was performed to intra and intergroup comparisons through Fischer’s exact and McNemar tests, and Mann-Whitney U and Friedman tests, respectively (P < 0.05). ResultsDespite similarities between groups, intervention increased parental eHEALS scores, influencing the reports about the children’s consumption of sugar-free sweets and controlling the severity of ECC. ConclusionTherefore, mobile text messages were effective to control the severity of ECC in low socioeconomic preschoolers, improving parental eHealth literacy and changing children’s dietary patterns. Clinical significanceThese findings demonstrate that parental-oriented WhatsApp messages can contribute to oral health education of socioeconomic vulnerable parents towards risk behavior changes to control ECC.

PENGARUH PENDIDIKAN KESEHATAN TERHADAP PENGETAHUAN, SIKAP, DAN PERILAKU DALAM PENCEGAHAN HIV/AIDS PADA ANAK JALANAN BINAAN YAYASAN CIREBON PEDUL ANAK BANGSA (YCPAB) DI KOTA CIREBON TAHUN 2020

The phenomenon of social problems in Indonesia is the outbreak of children on the street. Especially in the city of Cirebon, which is known as one of the areas supplying street children in Jakarta. The occurrence of Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV / AIDS) is still a global problem. Health education is very important in changing one's behavior. Children on the street have a high enough risk factor for HIV / AIDS. Therefore, this study aims to determine the effect of health education on knowledge, attitudes, risk behaviors in HIV / AIDS prevention. Experimental research with a research design using Quasi Experiment with Pretest-posttest One Group Design on 38 street children with purposive sampling technique. Data collection using a questionnaire that was analyzed by the Cochran and McNemar tests. This study shows the frequency distribution of knowledge both before being given health education as many as 1 person (2.6%) and after being given health education as many as 35 people (92.1%), the frequency distribution of positive attitudes before being given health education as much as 2 people (55.3 %) after 36 people were given health education (9.7%), the frequency distribution of risk-free behavior before being given health education were 23 people (60.5%) and 37 people were given health education (97.4%). In addition, the results of p value 0,000 were obtained using the Cochran test calculations for knowledge, attitudes, and behavior (p?0.05). Then it was stated that there was an influence of health education on knowledge, attitudes, and behavior in the prevention of HIV / AIDS. Health education with PowerPoint media, videos, and leaflets combined with games with repeated interventions can have an influence on increasing knowledge, positive attitudes, and changing risk behaviors in preventing HIV/AIDS

Changes in condom use among males who have sex with males (MSM): Measuring the effect of HIV prevention programme in Dhaka city.

BackgroundA systematic assessment was done to examine the effect of HIV interventions among MSM in Dhaka, Bangladesh. MSM were defined as males having sex with males but did not sell sex in the last year. MSM are hidden, marginalized and stigmatized population groups not only in Bangladesh but also globally. In 2010, HIV interventions for MSM were expanded in 40 districts of Bangladesh through 65 drop-in-centres (DICs) and peer outreach workers.MethodsData from two surveys on MSM in Dhaka in 2010 (baseline) and 2013 (midline) were used to analyse the effect of ongoing HIV prevention services. Both surveys used time location sampling to randomly select MSM for risk behaviour interviews. Two outcome variables were considered; condom use in the last anal sex act and consistent condom use during anal sex in the last month. Univariate and multivariate logistic regression methods were used to determine factors associated with condom use.ResultsCondom use significantly increased at the midline than baseline (p<0.001 for both). Multivariate analysis showed that having comprehensive knowledge of HIV and participation in HIV prevention programme were positively associated with both last time and consistent condom use. MSM who had comprehensive knowledge of HIV were 1.9 times (95% CI: 1.3–2.8, p = 0.002) and 2.1 times (95% CI: 1.4–3.2, p<0.001) more likely to use condoms than those who did not have comprehensive knowledge of HIV. The likelihood of using condoms among MSM was more than double at the midline than the baseline (p<0.01 for both). However, odds of condom use was significantly lower among those who perceived themselves to be at risk or were not able to assess their own risk of HIV.ConclusionTo sustain positive changes in HIV risk behaviours, HIV prevention programmes for MSM need to be continued and strengthened.

The Impact of Pre-exposure Prophylaxis for Human Immunodeficiency Virus on Gonorrhea Prevalence.

Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in reducing the risk of HIV infection in gay and bisexual men who have sex with men (GbMSM). However, PrEP does not protect against other sexually transmitted infections (STIs). In some populations, PrEP has also led to riskier behavior such as reduced condom usage, with the result that the prevalence of bacterial STIs like gonorrhea has increased. Here, we develop a compartmental model of the transmission of HIV and gonorrhea and the impacts of PrEP, condom usage, STI testing frequency and potential changes in sexual risk behavior stemming from the introduction of PrEP in a population of GbMSM. We find that introducing PrEP causes an increase in gonorrhea prevalence for a wide range of parameter values, including at the currently recommended frequency of STI testing once every three months for individuals on PrEP. Moreover, the model predicts that a higher STI testing frequency alone is not enough to prevent a rise in gonorrhea prevalence, unless the testing frequency is increased to impractical levels. However, testing every 2 months in combination with a 10-25 % reduction in risky behavior by individuals on PrEP would maintain gonorrhea prevalence at pre-PrEP levels. The results emphasize that programs making PrEP more available should be accompanied by efforts to support condom usage and frequent STI testing, in order to avoid an increase in the prevalence of gonorrhea and other bacterial STIs.

Theory of reasoned action and antismoking social marketing

There is a range of behavior change models used in social marketing. The past studies suggest thattheories can serve as valuable frameworks for the design and evaluation of health interventions. Thisarticle aims to provide a revision of theoretical models used in social marketing and health promotion,specifically Theory of Reasoned Action, and test this theory on health risk behavior change. Smokingbehavior among youth was selected as a specific context for this study due to importance of the healthof youth for the economic and social development of Kazakhstan and opportunity to prevent or reducesmoking behaviors and subsequently mitigate negative consequences of smoking among youth. A deductiveapproach was undertaken and quantitative survey method was applied. The total sample aftercleaning for incomplete data consisted of 2307 respondents. The study found that the Theory of ReasonedAction successfully predicted cigarette smoking behavior among youth. The TRA could providesolid explanations of intention to uptake cigarette use. The results indicated that attitude toward cigarettesmoking and subjective norm directly influenced intention to use cigarettes. These findings mightusefully be integrated in an intervention program aimed at reducing or preventing smoking initiation,especially among youth. Social marketing health intervention programs are recommended to be directedat the attitude and subjective norms by targeting underlying beliefs.

COVID-19 Confinement and Health Risk Behaviors in Spain.

The World Health Organization (WHO) has declared a world pandemic due to COVID-19. In response, most affected countries have enacted measures involving compulsory confinement and restrictions on free movement, which likely influence citizens' lifestyles. This study investigates changes in health risk behaviors (HRBs) with duration of confinement. An online cross-sectional survey served to collect data about the Spanish adult population regarding health behaviors during the first 3 weeks of confinement. A large sample of participants (N = 2,741) (51.8% women; mean age 34.2 years [SD 13.0]) from all Spanish regions completed the survey. Binomial logistic regressions adjusted for socioeconomic characteristics (i.e., gender, age, civil status, education, and occupation), body mass index (BMI), previous HRBs, and confinement context (i.e., solitude and exposure to COVID-19) were conducted to investigate associations between the number of weeks confined and a set of six HRBs (physical activity, alcohol consumption, fresh fruit and vegetable consumption, smoking, screen exposure, and sleep hours). When adjusted, we observed significantly lower odds of experiencing a higher number of HRBs than before confinement overall in a time-dependent fashion: OR 0.63; 95% CI: 0.49–0.81 for the second and OR 0.47; 95% CI: 0.36–0.61 for the third week of confinement. These results were equally consistent in all age and gender subgroup analyses. The present study indicates that changes toward a higher number of HRBs than before confinement, as well as the prevalence of each HRB except screen exposure, decreased during the first 3 weeks of COVID-19 confinement, and thus the Spanish adult population may have adapted to the new situational context by gradually improving their health behaviors.

Impact of male circumcision on risk of HIV infection in men in a changing epidemic context - systematic review and meta-analysis.

IntroductionWHO/UNAIDS recommended Voluntary Medical Male Circumcision in 2007 based on systematic review of observational studies prior to 1999 and three randomized controlled trials (RCTs). To inform updated WHO guidance, we conducted a systematic review and meta‐analysis of impact of circumcision on the risk of HIV infection among heterosexual men.MethodsStudies in PubMed of HIV incidence and changes in prevalence in heterosexual men by circumcision status were identified. Pooled incidence rate ratios were computed using fixed‐ and random‐effects meta‐analysis and risk of bias was assessed using the ROBINS‐I tool.Results and DiscussionIn three RCTs, the pooled incidence ratio was 0.41 (95% CI 0.30 to 0.56), with risk difference 10 (8 to 12) fewer infections per 1000 person‐years (py). Pooled incidence ratios were 0.34 (0.24 to 0.49) in two post‐RCT follow‐up studies, 0.29 (0.19 to 0.43) in men at high HIV risk (five cohorts), 0.48 (0.33 to 0.70) in four community‐based cohorts before circumcision scale‐up, and 0.56 (0.49 to 0.64) (7 [6 to 8] fewer per 1000 py) in six community‐based cohorts during circumcision and antiretroviral treatment scale‐up. Heterogeneity between studies was low except in men at high HIV risk. We estimated 520,000 (425,000 to 605,000) fewer infections occurred in men by end of 2018 from 22.7 million circumcisions performed since 2008 and increasing by 155,000 (125,000 to 180,000) annually if epidemic conditions remain similar. After exclusion of studies with high risk of bias and those conducted outside Africa, pooled incidence ratios were similar. There was no evidence of confounding nor changes in risk behaviour following circumcision. In post‐hoc exploratory analyses we observed a trend of decreasing effectiveness of circumcision in cohorts with lower HIV incidence. ConclusionsEfficacy of medical male circumcision on HIV incidence from randomized controlled trials was supported by effectiveness from observational studies in populations with diverse HIV risk and changing epidemic contexts. Voluntary Medical Male Circumcision remains an important evidence‐based intervention for control of generalized HIV epidemics.

Momentary Physical Activity Co-Occurs with Healthy and Unhealthy Dietary Intake in African American College Freshmen.

Background: Research investigating interrelations between physical activity and dietary intake has primarily used retrospective, summary-based measures of behavior subject to increased recall bias. This study used ecological momentary assessment (EMA) methods with accelerometry to determine within-day, momentary associations between physical activity and dietary intake behaviors in African American college freshmen. Methods: Participants (N = 50) completed a dietary EMA protocol that assessed food/fluids consumed over the past 2 h at five random times per day and wore an activPAL accelerometer for 7 days to measure physical activity. Physical activity was operationalized as step counts in the 2 h prior to the EMA prompt (matching the EMA recall window). Results: On occasions when participants took more steps than was typical for them in the 2 h prior to the EMA prompt, they were more likely to consume sugar-sweetened beverages (OR = 1.37, p < 0.001), water (OR = 1.28, p < 0.001), fruit (OR = 1.44, p < 0.001), vegetables (OR = 1.19, p = 0.02), and fried fast food (OR = 1.21, p = 0.04) over that same time. Conclusion: Momentary physical activity co-occurred with momentary consumption of both healthy and unhealthy dietary intake. These behavioral interrelations suggest potential implications for obesity risk and multiple health behavior change interventions in young adult African Americans.

WITHDRAWN: Self-Reported Changes in Risk Behaviours of Cardiovascular Diseases among School Adolescents in Nepal: Application of an Integrated Experiential Learning Approach

WITHDRAWN: Self-Reported Changes in Risk Behaviours of Cardiovascular Diseases among School Adolescents in Nepal: Application of an Integrated Experiential Learning Approach

Self-Reported Changes in Risk Behaviours of Cardiovascular Diseases among School Adolescents in Nepal: Application of an Integrated Experiential Learning Approach.

Cardiovascular diseases (CVDs) account for the largest proportion of all deaths in Nepal (30%). Studies report that CVDs often begin with modifiable lifestyle risk behaviours established during adolescence which manifest later. This study aimed to measure changes in the five mortality-associated CVD risk behaviours (i.e., consumption of tobacco, alcohol, and junk food, physical inactivity, and stress among school adolescents) using an integrative intervention with the experiential learning approach. The study was carried out for 24 weeks (25 credit hours) among 4,225 students from grades 8 to 10 in community schools in seven provinces in Nepal. Pre- and post-intervention in-class self-reported surveys were conducted for assessing change in the students’ aggregate risk behaviours. These percent changes were assessed through bivariate analysis. Key-informant interviews of teachers were conducted to assess their perceptions of the effectiveness of the intervention. At 24 weeks, the percentages of students reporting consumption of cigarettes and smokeless tobacco declined by 25% and 28% respectively, consumption of alcohol declined by 29%, consumption of instant noodles by 11%, and consumption of coke by 43%. The proportion of students reporting ‘going to school by foot every day’ increased by 11%, and those ‘exercising until they sweat’ increased by 29%. The percentage of students who reported feeling that their ‘life has been running as desired’ increased by 16%. Key-informant interviews of the teachers revealed that the intervention had contributed to improved motivation, knowledge, and attitude among students towards mitigating the risk behaviours. These interviews also recommended continuation of the intervention. The sample in this study has shown positive changes in school adolescents’ self-reported aggregate CVD risk behaviours using the experiential learning approach. However, further research should be conducted to explore the sustainability and scaling of these learning modules through the existing non-communicable disease (NCD) school curriculum activities in Nepal.

Beyond weight loss: Impact of a weight management programme for mid-older Australians in private health insurance.

Weight-loss maintenance and lifestyle behaviour necessary to manage weight are undisputedly challenging. We evaluated a secondary prevention weight-loss maintenance programme for participants (n = 490) with weight-related chronic disease in the Australian private health insurance setting. This study investigated the impact of the maintenance programme on anthropometric and lifestyle risk behaviour changes after 6 and 12 months, and trends in weight-loss maintenance after 1 year. Using a pre- and post-test design, data were analysed with generalized linear mixed models for repeated measures to determine the effect of the programme on weight loss and lifestyle behaviour outcomes. After initially losing a clinically significant amount of weight (mean 9.1 kg), maintenance-programme participants maintained clinically significant weight loss (mean 7.6 kg) at 12 months. Rates of discontinuation in the programme were high (47% at 6 months and 73% at 12 months). Weight-loss maintenance was achieved by 76% of participants at 3 months and 62% at 6 months, stabilizing at 55% and 56% at 9 and 12 months, respectively. Greater initial weight loss was associated with weight-loss maintenance at 12 months. Participants <55 years demonstrated consistent weight-loss maintenance over this time but the odds for successful weight-loss maintenance for those ≥55 years continued to decrease over time. At maintenance-baseline, 68.3% of participants had sufficient physical activity for health; 61.4% and 19.8% met recommended fruit and vegetable consumption, respectively. All lifestyle risk behaviours were maintained at 12 months. A programme extending support strategies for maintaining weight-related behaviour shows promise to successfully support these changes over 12 months. There is a potentially important opportunity for targeted intervention at 6 to 9 months.