Examining user-AI interaction patterns in health-Information queries.

Physicians have long known that vitamin A deficiency causes pediatric blindness. However, in 1986, Johns Hopkins researchers examining the impact of vitamin A supplementation on overall child mortality in Albay, Philippines, encountered strong local opposition, forcing the study's termination. Drawing on internal documents, interviews, and archival correspondence, this article uses the Albay study's collapse as a case study to examine how Cold War‒era cultural, geopolitical, and social forces shaped the public health knowledge production process. This history offers insights into how policymakers might develop effective modern foreign aid projects, especially as funding priorities continue to evolve. (Am J Public Health. 2026;116(7):1044-1052. https://doi.org/10.2105/AJPH.2026.308447).

This study aims to examine the complex interrelationships among dietary quality, health literacy, loneliness, physical activity, mental health, and BMI (Body Mass Index) among young Chinese individuals, with particular attention to the mediating role of mental health in the pathways linking health behaviors and BMI. A cross-sectional survey was conducted with a diverse sample of Chinese university students (N = 1568) using validated instruments to measure dietary quality, health literacy, loneliness, physical activity, mental health, and BMI. Structural equation modeling (SEM) was employed to test both direct and indirect relationships among the variables. Findings revealed that higher levels of dietary quality, health literacy, and physical activity were significantly associated with better mental health, while loneliness showed a strong negative effect. Mental health was, in turn, negatively associated with BMI. Furthermore, mental health significantly mediated the effects of dietary quality, health literacy, and physical activity on BMI. These results underscore the central role of psychological well-being in converting health knowledge and behaviors into tangible physical outcomes. The study highlights the need for integrated health promotion strategies that address not only physical behaviors and informational competencies but also the emotional and social dimensions of health. Strengthening mental health support and health literacy among youth may enhance the effectiveness of dietary and physical activity interventions, contributing to the broader goals of the Healthy China 2030 initiative.

Multimodal metaphors in animated depression educational videos on Chinese social media: A critical multimodal discourse analysis.

This study evaluated the factor structure of a measure of mental health literacy (MHL) tailored to the role of helping professionals and assessed its association with help-seeking intentions among a sample of 946 child-serving professionals. Confirmatory factor analysis was used to model different factor structures of MHL for supporting youth, item response theory examined item discrimination, and structural equation modeling tested the relationship between MHL for supporting youth and help-seeking intentions. Results provided support for a higher order factor of MHL for supporting youth, with four first-order factors (i.e., mental health knowledge, attitudes/beliefs, perceived behavior control, subjective peer norms). Item discrimination varied across observed items and first-order factors. The second-order, multidimensional MHL factor was positively correlated with help-seeking intentions. These findings provide an initial step in validating a measure of MHL that accounts for the specific work roles and population characteristics unique to at-risk youth and aligns with prior definitions of MHL and the Theory of Planned Behavior. Future research should seek to replicate these findings across diverse service settings.

Advancing Pharmacy Students' Competence in Transgender Health: Multicohort Evaluation of a Gender-Affirming Therapy Curriculum.

A pan-Canadian cluster randomized trial (by classroom) was conducted to examine the effects of a combined mental health literacy and dialectical behavior therapy skills program implemented by teachers on protective factors related to social and emotional well-being, including mindfulness, emotion regulation, inclusive education, distress tolerance, mental health knowledge, reduction of stigma, and help-seeking skills. The sample of 111 classrooms drawn from three urban centers and 67 schools, which were randomly assigned to intervention or control, included 1,750 students in third- to 12th-grade classrooms. Student-reported measures of mindfulness, emotion regulation, inclusive education, distress tolerance, mental health literacy, and classroom climate were collected three times in the year (October, February, and June). Teachers recorded dosage and fidelity data, and in-class observations took place to support implementation data. Results indicated the intervention classrooms demonstrated statistically significant improvements relative to the changes in the control classrooms on six of eight dependent variables: mindfulness, emotion regulation, impulse control, strategies, beliefs about mental illness, and stigma. Effect sizes were large for mindfulness, medium for emotion regulation and stigma, and small for impulse control and beliefs about mental illness. There was no evidence that intervention effects were moderated by intervention site, school level, or student characteristics related to Indigenous heritage, gender, or whether students received English language learner services. By contrast, the mid- to postintervention effect on mindfulness differed for students receiving special education services, such that effects were greater for students receiving special education services compared to students not receiving special education services. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Naswar, a form of smokeless tobacco, has become an important public health concern in southern Iran due to its increasing use and associated health risks. Despite its growing social acceptance, limited evidence is available regarding the combined influence of individual, cognitive, and social factors on Naswar consumption. This study aimed to investigate the individual and social determinants of Naswar use among residents of Bandar Abbas, southern Iran. This cross-sectional study was conducted from June to September 2024 among 399 individuals aged 15 years and older recruited from urban healthcare centers in Bandar Abbas. Data were collected through face-to-face interviews using a validated questionnaire assessing demographic characteristics, knowledge, attitudes, social norms, behavioral intention, and Naswar use. Descriptive statistics, univariate analyses, and multivariable logistic regression were performed to identify factors associated with current Naswar consumption. The prevalence of Naswar use was 6% in the study population. Univariate analyses indicated that male gender, lower educational level, and lower socioeconomic status were associated with higher odds of use. Greater knowledge of Naswar harms, more negative attitudes toward use, and stronger anti-use social norms were associated with lower odds of consumption. In the multivariable model, higher knowledge and stronger anti-use social norms remained significant protective factors, whereas stronger behavioral intention toward Naswar use was identified as a significant risk factor. Naswar use in Bandar Abbas is influenced more by psychosocial factors than demographic characteristics alone. Prevention strategies should strengthen health knowledge, reinforce anti-use social norms, and target behavioral intentions through culturally appropriate interventions.

Comprehensive dental care includes health education strategies that highlight the importance of disease prevention and reach as many people as possible. Bacteria are central to most oral diseases, yet few studies have explored the impact of including specifics of microbial pathogenesis on oral health education. Therefore, the objectives of this study were to determine if oral hygiene instructions (OHI) provided to undergraduate students in a group-setting positively impacted oral health knowledge and beliefs, and whether integration of microbiology-focused instructions and activities further improved these oral health measures. A pre-test/post-test experimental study was conducted among undergraduate life-science students. Participants were allocated to the control group, (n=35) receiving Standard OHI (SD-OHI) and the experimental group (n=40) receiving Microbiology-focused OHI (MICRO-OHI). Each group completed questionnaires before and after the educational intervention for measurement of changes in oral health knowledge, beliefs, and behaviors. Descriptive statistics were conducted on the pre-test/post-test responses for SD-OHI and MICRO-OHI. Both groups showed improved responses on items related to oral health knowledge and beliefs and high agreement with statements on intention to adhere to routine oral hygiene practices. Microbiology-related items had significant improvement in the MICRO-OHI group compared to the SD-OHI group (p<0.05). Qualitative analysis of responses to "Why should we brush our teeth?" revealed that a higher percentage of MICRO-OHI responses added emphasis on bacteria/biofilm removal compared to SD-OHI. Both methods of group-based instruction increase health-promoting responses and the addition of microbiology-focused instructions has the potential to uniquely augment comprehensive oral healthcare strategies.

Factors associated with reproductive concerns among adolescent and young adult cancer survivors: A cross-sectional study.

ABSTRACT Schools are vital environments for cultivating lifelong health behaviors. This study evaluated the outcomes associated with a 15-week comprehensive after-school health program, Healthy Kids+, on students’ health-related knowledge, attitudes, and self-efficacy in five public elementary schools. Using a quasi-experimental pre-post design, 228 students aged 8–11 years (grades 3–6) participated in a multi-component program that integrated nutrition, physical activity, social-emotional learning, and family engagement. Data was collected using the validated After-School Student Questionnaire (ASSQ). Descriptive statistics, paired samples t-tests, and repeated-measures ANOVA evaluated pre-/post-differences. Program participation was associated with significant improvements in health knowledge (ΔM = +17.8, p < .001, d = 1.62), attitudes (ΔM = +.66, p < .001, d = 1.54), and self-efficacy (ΔM = +.72, p < .001, d = 1.53). Interaction effects among gender, grade level, and socioeconomic status were not significant, indicating that the program had an equitable impact across all student subgroups. Hierarchical linear regression confirmed that baseline attitudes (β = 0.36, p < .001) and student age (β = 0.12, p = .008) were both significant predictors of post-test attitude scores, with the model accounting for 44% of the variance (R2 = .44, p < .001). Findings support the short-term potential of multi-component programs in enhancing elementary students’ health-related cognition and motivation. The results underscore the importance of intensive educator capacity-building and family engagement to maintain high program fidelity and achieve consistent outcomes across diverse school settings.

ABSTRACT Background Physical literacy (PL) has emerged as a key component of health promotion and physical education policies worldwide, recognised for fostering lifelong physical activity and holistic child development. Defined as the motivation, confidence, physical competence, knowledge, and understanding to value and engage in physical activity for life, PL is increasingly integrated into school curricula across Europe. Poland has lacked validated tools and national data to assess PL among school-aged children. Purpose This study aimed to assess the physical literacy levels of Polish children aged 8–12 using the newly adapted Polish Assessment of Physical Literacy (PAPL), based on the internationally recognised Canadian Assessment of Physical Literacy, second edition (CAPL-2). The study also examined age and gender differences and correlations between PL domains. Methods A large, geographically diverse sample of 1,780 primary school children (51.3% boys, 48.7% girls; M = 9.83, SD = 1.34) from schools across Poland participated in the assessment. The PAPL protocol assessed four domains: Physical Competence (via CAMSA, PACER, and plank hold), Daily Behaviour (wrist-worn activity tracker-measured step counts and self-reported MVPA), Motivation and Confidence (self-report scale), and Knowledge and Understanding (multiple-choice questions). All participants had parental consent and no medical contraindications. Findings The overall PL score averaged 65.0/100. However, age-related progress was minimal – only a 5.74-point increase between ages 8 and 12 – despite regular participation in physical education (PE). Boys scored significantly higher than girls in Physical Competence and Daily Behaviour, while girls slightly outperformed boys in Knowledge and Understanding. Lower Motivation and Confidence scores were observed among older age groups. Notably, no significant correlation was found between knowledge and daily activity in children under 12, consistent with developmental theories suggesting that cognitive understanding does not automatically translate into behavioural action in younger children. Conclusions This is the first large-scale study of PL in Polish children using a validated framework. The results may suggest areas for further investigation regarding PE curricula and learning environments to enhance motivation, address gender disparities, and integrate health knowledge in meaningful ways. The PAPL tool offers a platform for national monitoring, educational interventions, and future research. Impact statement This study provides the first large-scale evidence on physical literacy among Polish children, offering a reference point for research and practice. The findings highlight the need for integrated, developmentally sensitive physical education addressing all domains of physical literacy. The results may inform curriculum development, teacher education, national monitoring, while supporting international comparisons.

This article investigates the causal impact of educational attainment on women’s empowerment in Malawi. The study utilizes nationally representative data from the Malawi Demographic and Health Survey for 2004, 2010, and 2015–16 to examine the impact of the 1994 universal primary education policy on women’s empowerment. The findings reveal that, on average, women affected by the reform have 0.56 more years of education than those unaffected. Findings also show that an additional year of schooling delays women’s age at first cohabitation by 0.38 years, increases their use of modern contraceptives by 9.3 percentage points, reduces threats of domestic violence by 5.4 percentage points, and enhances their household decision making by 5.3 percentage points. This study also provides insights into the mechanisms behind this relationship, including women’s literacy and knowledge of health, engagement in the labor market, increased exposure to health information, and the characteristics of their husbands or partners. HIGHLIGHTS Malawi’s universal primary education reform generated significant gains in women’s schooling. Each additional year of schooling improved multiple empowerment outcomes for women. Education delayed cohabitation and increased contraceptive use. Schooling reduced domestic violence and strengthened household bargaining. Investments in girls’ education promote gender equality and the development of just societies.

To explore the impact of oral care knowledge on the oral health behaviors of the older person. A convenience sampling method was used to distribute online questionnaires to older adults aged 60 and above in Nanjing. A total of 314 questionnaires were distributed, and 294 valid questionnaires were collected, with an effective response rate of 93.63%. The awareness of oral health knowledge among the older adults aged 60 and above was inadequate (11.56%), with low awareness rates regarding, and knowledge related to oral cosmetology. The results from the adjusted Poisson regression analysis showed that monthly income ( p = 0.001), education level (p = 0.006), brushing frequency (p < 0.001), toothbrush replacement (p = 0.008), mouth rinse after meals (p < 0.001), dental plaque (p < 0.001), sugar causes dental caries (p < 0.001), treatment time (p < 0.001), gum bleeding (p = 0.001), causes of bleeding (p = 0.001), the hazards of tooth loss (p < 0.001), and the three major diseases (p = 0.011) remained the main influencing factors for oral health behaviors. Oral health knowledge among the older adults in Nanjing is currently insufficient and represents a key modifiable factor influencing behavior. Targeted health promotion should prioritize populations with lower socioeconomic status and address critical knowledge gaps to improve oral health practices.

This study aimed to assess the feasibility and short-term comparative outcomes of a community-based BES rehabilitation program assisted by a digital service package for postmenopausal women with PFD, and to explore whether pelvic floor muscle strength outcomes were compatible with a prespecified exploratory margin compared with tertiary hospital care. We conducted a non-randomized controlled study involving 200 community-dwelling postmenopausal women with PFD. Participants in the intervention group received community-based BES plus a digital service package, while contemporaneous controls received standard BES care at a tertiary hospital. Follow-up lasted 1 month. Because treatment allocation was non-randomized, doubly robust estimation and multivariable regression were used to reduce measured confounding; findings should therefore be interpreted as exploratory rather than causal. The observed rate differences in improvement of Type I and Type II pelvic floor muscle strength were 0.008 and 0.054, respectively. The lower bounds of the 98.75% confidence intervals remained above the prespecified exploratory margin of - 0.20, suggesting that the observed differences were compatible with the prespecified exploratory margin in this exploratory analysis. While no significant between-group difference was found for self-perceived symptom severity, the intervention group was associated with higher self-reported adherence (β = 4.604, P < 0.001), health knowledge awareness (β = 24.419, P < 0.001), and quality of life (OR = 5.292, P = 0.023). Feasibility metrics were favorable, with a mean System Usability Scale score of 81.40. However, given the non-randomized design and the prespecified margin, these findings should be interpreted cautiously. This pragmatic, digital-assisted community-based rehabilitation program appears feasible and was associated with favorable short-term outcomes in postmenopausal women with PFD. Compared with tertiary hospital care, the integrated community-based program showed pelvic floor muscle strength outcomes that were compatible with the prespecified exploratory margin, while also being associated with higher self-reported adherence, health knowledge, and quality of life. However, because of the non-randomized design, retrospective registration, short follow-up, and potential residual confounding, these findings should be considered preliminary and hypothesis-generating rather than confirmatory evidence of non-inferiority, equivalence, or causal effects. Chinese Clinical Trial Registry (ChiCTR2400088675); Registered on 23 August 2024, retrospectively registered.

ABSTRACTBackgroundAdolescents’ sexual and reproductive health (SRH) knowledge and attitudes are critical determinants of future health behaviors and service utilization. In Nepal, despite the inclusion of comprehensive sexuality education (CSE) within the national curriculum, evidence suggests persistent gaps in SRH knowledge and unfavorable attitudes among school‐going adolescents, particularly in public school settings. This study aimed to assess the level of SRH knowledge and attitudes and factors associated with favorable SRH attitudes among adolescents.MethodsA school‐based cross‐sectional study was conducted among adolescents aged 10–19 years enrolled in Grades 8–10 in three purposively selected government schools in Tansen Municipality, Palpa District. Data were collected using a structured, self‐administered questionnaire covering SRH knowledge domains (puberty, abortion, sexually transmitted infections, and family planning) and SRH attitudes. SRH knowledge was categorized as poor, moderate, and good for respective domains. Likewise, attitude was measured using 10 Likert‐scale statements and categorized as favorable or unfavorable. Descriptive statistics summarized knowledge and attitudes, whereas binary and multivariable logistic regression analyses were used to identify factors associated with favorable SRH attitudes. Results are presented in adjusted odds ratios (AOR) and 95% confidence intervals (CI).ResultsAmong the 228 participants, moderate knowledge was most common across SRH domains, whereas good knowledge remained limited. Nearly two‐thirds (62.3%) of adolescents demonstrated unfavorable SRH attitudes. Adolescents with moderate (AOR = 4.41, 95% CI: 1.09–17.83) and good knowledge of abortion (AOR: 4.93; 95% CI: 1.35–17.95; p = 0.016) were significantly more likely to have favorable SRH attitudes compared with those with poor knowledge.ConclusionLower percentage of adolescents with good SRH knowledge and higher percentage with unfavorable attitudes highlight gaps in SRH education in government schools. CSE, including abortion‐related education, could be prioritized in government schools to uplift the SRH knowledge and attitudes.

This pilot study primarily aimed to evaluate the feasibility of conducting a cluster randomised controlled trial of the Integrated Network for Student Psychosocial Interventions, Resilience, and Education (INSPIRE) programme, including recruitment, retention, counsellor-led delivery, attendance, and completeness of outcome data. As a secondary aim, the study explored preliminary signals of change in adolescent mental health knowledge and related outcomes to inform the design of a future definitive trial. Two-centre, two-arm cluster randomised controlled pilot trial with pretest and posttest design. Adolescents aged 13-15years and their parents were recruited from public junior high schools in West Java, Indonesia. Two schools were randomly assigned to intervention or control groups using a computer-generated sequence. The eight-week INSPIRE programme, delivered by a school counsellor, included three joint sessions with parents and two home-based activities. Feasibility outcomes included recruitment, retention, intervention fidelity, attendance, and outcome data completeness. Preliminary signals of change were described at baseline and 2‑month follow-up. Recruitment achieved 74% of eligible adolescent-parent dyads (52/70). Retention was excellent, with 100% of adolescents and 96% of parents completing follow-up assessments, and outcome data were complete. Programme attendance was high (adolescents 91%; parents 79%), and the intervention was delivered as planned by a trained school counsellor, with minor scheduling adjustments for public holidays. Consistent with the primary feasibility objectives, indicators such as recruitment, retention, and delivery were favourable. As secondary findings, adolescents demonstrated preliminary signals of improvement in mental health knowledge and selected literacy domains. In contrast, parents showed gains in mental health knowledge and attitudes, with favourable trends in help-seeking attitudes observed across both groups. INSPIRE demonstrated feasibility and acceptability, with preliminary signals supporting progression to a fully powered trial. The findings support its further evaluation in a fully powered cluster-randomised trial and its integration into school health programmes involving families and counsellors. Trial registration ClinicalTrials.gov (NCT06942637).

Use of herbal and dietary supplements (HDS) is widespread among patients with chronic liver disease (CLD). Despite the potential for adverse effects (AEs) and drug interactions (ADRs), these products are often perceived as "natural," safe, and not requiring medical prescription. This study aimed to assess HDS, oligo and trace element consumption among patients with CLD, to examine sociodemographic correlates, to determine the extent to which use is overseen by general practitioners or specialists versus self-medication, and to document reasons for use and perceived benefits. Over a 6-month period, patients with CLD attending the outpatient clinic of the Internal Medicine and Hepatology Unit of the University Hospital of Palermo, along with their caregivers, were surveyed regarding their use of supplements. A self-administered questionnaire collected information on demographics, lifestyle habits, supplement use, motivations, perceived benefits, and prescription awareness. A total of 323 participants were enrolled: 220 (68.1%) were CLD patients and 103 (31.9%) were caregivers. Overall, 110 (34%) subjects, 39 patients and 71 caregivers, reported using at least one supplement. Consumption was slightly more frequent among caregivers than patients (37.9% vs 32.3% p = ns). Among users, HDS were the predominant products (87/110; 79.1%), followed by oligo and trace elements (36/110; 33.0%); 21/110 (19.1%) reported combined use. The most common reasons for supplement use were anxiety and sleep disorders (each 15/110; 13.6%), osteoporosis/osteoarthrosis (15/110; 13,6%), dyslipidemia (12/110; 10.9%), and dyspepsia (11/110; 10.0%). Compared with caregivers, patients more frequently used supplements for anemia (7.3%), anxiety (13.6%), and steatotic liver disease (7.3%). Perceived benefit was reported by 70.9% of users, whereas AEs and ADRs were uncommon (3.6%). Supplement consumption for liver steatosis was more common among males than females (14.3% vs 2.9%; p = 0.034). Osteoporosis-related supplement use showed a significant positive correlation with age (p = 0.019). Consumption of HDS, oligo and trace elements is common among CLD patients, and it increases with age. Their use appears driven by perceived health knowledge and a desire for well-being. Further studies are needed to enhance health education and prevent inappropriate or excessive use of these products.

Aims To explore teachers' perspectives on incorporating oral health education within schools, since its statutory introduction in the National Curriculum in England in 2020.Methods An online survey including open and closed questions was designed and distributed via postal invitations to selected schools in North West England, and via social media between September 2024 and January 2025. Quantitative data were analysed descriptively, while directed content analysis was used for free-text responses.Results Fifty-four responses were received. Oral health education was reported as inconsistent with different methods and frequencies of delivery reported; 21% (n = 11) teachers taught the topic less than once a year. Challenges included lack of curriculum time (44%, n = 23), and resources to help deliver (27%, n = 14) or plan the teaching (19%, n = 10). Most teachers (93%, n = 50) expressed confidence in their oral health knowledge, but free-text responses highlighted that teachers valued dental professionals' involvement with schools, and parental engagement to reinforce oral health at home.Conclusions Oral health education in schools remains inconsistent despite statutory requirements. Sustainable resources and multi-agency partnerships can help embed oral health promotion within a whole-school framework.

ABSTRACT African Americans experience disparities in mental disease burden and mental health outcomes, yet they are less likely to engage in formal treatment than non-Hispanic whites and prefer help from clergy and informal supports instead. However, clergy often feel ill-equipped to address the mental health problems brought to them by congregants. This study applies social action theory (SAT) to the development and piloting of the Christ-Centered Mental Health Training Program, a novel faith-based mental health program focusing on group, congregation, and community-level change, by increasing mental health awareness and reducing stigma among African American pastors and their staffs to equip them to promote the positive mental health of their congregations. The community engagement and social innovation (CESI) model guided program development. A pilot study was conducted with eleven English-speaking African American congregation leaders to identify whether training curriculum objectives were met. Pre- and posttest surveys evaluated general mental health knowledge, knowledge of mental health in the Bible, ability to identify signs and symptoms of mental illness, and skills to refer to professional help, revealing self-reported gains across all objectives. Implications for future research suggest the need for further development and evaluation of church-based mental health promotion interventions for African Americans.