Health-related Behaviors Research Articles

Ultra-processed food consumption and risk of cardiovascular mortality in Australia: preliminary results from prospective observational study

Abstract Background/Introduction A large proportion of the Australian population emigrated from countries where traditional dietary patterns are protective of cardiovascular health. Yet, recent evidence suggests that 42% of a modern Australian diet's total energy intake is comprised of ultra-processed foods. This is concerning as previous meta-analyses and umbrella reviews based on population studies have found an association between ultra-processed food consumption and adverse health outcomes, including cardiovascular disease and mortality. However, this has yet to be explored in an Australian population. Purpose To determine the association between ultra-processed food consumption and the risk of cardiovascular mortality in an Australian cohort. Methods Prospective data from the Melbourne Collaborative Cohort Study (MCCS; n = 38054) were analysed. UPF consumption at baseline (1990 to 1994) was assessed in accordance with the NOVA food classification system using data from a 121-item food frequency questionnaire. Energy-adjusted ultra-processed food consumption was then categorised into quartiles. Cardiovascular mortality was obtained through data linkage with national and local registries up to 2015 and 2019, respectively. This was done using the International Classification of Diseases (ICD) codes (390-459 and I00-I99). Unadjusted and adjusted multivariate logistic regression models were fitted to estimate associations between ultra-processed food consumption (exposure) and cardiovascular mortality (outcome). Results A total of 4,242 incident cardiovascular deaths occurred (2,272 for males and 1,970 for females) during the follow-up period. After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, higher UPF consumption was associated with a higher risk of cardiovascular mortality (aOR high (quartile 4) vs. low (quartile 1) category = 1.26, 95%CIs 1.14 to 1.39, ptrend < 0.001). Conclusion(s) In this large prospective cohort of Australian adults, higher ultra-processed food consumption was associated with an increased risk of cardiovascular mortality. These findings support previous research and guidelines recommending the reduction of ultra-processed food consumption as part of a heart-healthy diet.

Digital Health Literacy Enhancement Strategies Across Diverse Groups: A Scoping Review

Abstract Background The COVID-19 pandemic has accelerated the use of digital health technologies. Digital health literacy (DHL) is essential for effectively understanding and applying electronic health information. However, unequal access and use of these technologies require interventions to improve DHL for fair healthcare access. Objectives This scoping review aimed to identify strategies to enhance DHL in patients and the general population. Methods The review used the Joanna Briggs Institute Scoping Review Methodology and PRISMA-ScR guidelines. Eligibility criteria included a wide population, interventions aimed at improving DHL, with no restrictions on outcomes. The search strategy included electronic databases (MEDLINE, PsycINFO, Web of Science), and AI-based software, AS Review, was used for screening. Results The review found 5149 articles, 44 met the eligibility criteria. Studies focused on different demographic groups and health conditions. Most interventions were in North America and Europe. The study designs varied. Interventions via mobile apps, online platforms, and in-person sessions aimed at various conditions yielded positive results, including increases in DHL, self-management skills, and health-related behaviors. These interventions involved either independent interventions that focused on DHL or integrated interventions that were part of another intervention that aimed at a health outcome and had an element of DHL enhancement. Conclusions The review highlights the importance of DHL in informed decision-making and navigating digital health environments. While many interventions had positive outcomes, methodological limitations challenge the findings, emphasizing the need for more rigorous study designs. Future research should address sustainability, scalability, and the impact of DHL on health disparities, considering cultural sensitivity when developing interventions. Key messages • Scoping review identifies strategies to enhance Digital Health Literacy (DHL), crucial for effective use of health technology. • Despite positive outcomes, methodological limitations exist. Future research should focus on sustainability and scalability.

1.L. Scientific session: Public Health data in support of healthy ageing policies

Abstract As Europe grapples with an ageing population, the imperative of health policies that promote healthy ageing is increasingly critical. This workshop aims to explore the significant role of public health data in shaping and supporting such policies. By integrating insights from administrative records to sophisticated research infrastructures, we will highlight the multifaceted uses of data in public health, particularly in the realms of non-communicable diseases and health-related behaviours in older populations. The session will open by examining how administrative records have been utilised within Lombardy’s regional health system to understand the epidemiology and access to care for people living with dementia. The discussion will then cover the advantages and challenges associated with integrating health data from diverse sources, emphasising the importance of quality, privacy, and the potential for real-time surveillance and response systems in healthcare. Following this, the focus will shift to the determinants of good health among older adults, presenting findings from a comprehensive cross-sectional study that identifies key factors contributing to what can be termed as “superhero” health status: seniors who maintain excellent physical and mental health. This analysis will delve into socioeconomic, behavioural, and environmental factors that influence health outcomes in the elderly, providing evidence-based recommendations for public health interventions and highlighting the potentialities of ad hoc surveys in examining health outcomes during emergencies. Thirdly, the workshop will also address the impact of significant life transitions on health behaviours, specifically the transition to retirement and its effects on alcohol consumption. Leveraging longitudinal data from a pan-European multidisciplinary research infrastructure, it will be demonstrated how retirement affects daily habits and lifestyles, including changes in alcohol consumption patterns. This segment will explore the implications of these findings for public health planning and policy formulation. In conclusion, there will be a discussion about healthcare system policies that support healthy ageing and the global impact of ageing on economics and health economics. These discussions will draw from the presented data sources and studies to suggest ways in which public health policies can be designed to reduce disparities and improve overall health outcomes among the elderly. This workshop is designed to provide a comprehensive overview of how data-driven insights can inform effective public health strategies and interventions to support an ageing society. By exploring various aspects of health data application, from individual behaviour to systemic policy adjustments, the session aims to highlight the critical role of data in promoting sustainable health and well-being in older adults, especially in the context of increasing life expectancy and prolonged retirement periods. Key messages • Harnessing data from diverse sources is crucial for understanding and enhancing healthy ageing processes. • Utilising longitudinal studies and robust data to design informed public health policies is essential for effective ageing interventions.

Exploring Climate Health Risks and Adaptations among Vulnerable Populations in Israel’s Negev Desert

Abstract Background Climate change represents the paramount challenge to global health, disproportionately impacting particular vulnerable individuals and communities. By identifying and elucidating disparities in health-related climate risks among these groups, we can facilitate the development of appropriate and equitable climate adaptation strategies. This research identified climate-related risks, health perceptions and needs, and behaviors among Jewish and Bedouin populations in the Negev Desert, a region highly susceptible to climate change, located at the intersection of geographical and social marginality. Methods Ten focus groups (n = 69) among vulnerable Jewish and Bedouin residents were conducted and systematically analyzed to identify disparities in health-related climate risks and behaviors. Vulnerabilities were defined based on income, age, health status, living environment, and outdoor activities. Results The findings highlight both shared and distinct difficulties and barriers vulnerable Jewish and Bedouin Negev residents face in the context of climate-related health risks. Key themes that emerged address: a) the direct and indirect impacts of climate-related events on health and well-being; b) the exacerbation of climate-related health risks by existing vulnerabilities and systemic barriers; c) the pivotal role of community resources in coping strategies; and d) lack of trust in the state and its institutions which underpin climate-related experiences. Conclusions The complexity of coping with climate change encompasses individual, community, and national/institutional levels. Vulnerable populations’ experiences with climate change are impacted by factors such as poverty, social marginality, violence, and barriers to accessing healthcare and other services, and is not a standalone phenomenon. Therefore, climate change adaptation and mitigation cannot be distinguished from other challenges impacting the health and well-being of populations. Key messages • Climate adaptation efforts must integrate with broader social and health strategies to effectively support vulnerable groups. • Community resources and trust in institutions are crucial for vulnerable populations facing climate change impacts.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Forecasting cognitive functioning: an artificial intelligence approach with Dynamic Bayesian Networks

Abstract Background Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. We examined multifactorial trajectories of risk factors, and their associations with SCD using an artificial intelligence approach to build a score that forecasts later SCD. Methods Five repeated surveys (2000-2022) of the Helsinki Health Study (n = 8960, 79% women, aged 40-60 at Phase 1) were used to build dynamic Bayesian networks (DBN) for estimating the odds of SCD. A score-based approach was implemented for learning DBN using the quotient normalized maximum likelihood criterion. The model was used to predict SCD based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure-time physical activity, body mass index, and insomnia symptoms, adjusting for sociodemographic covariates. Results Of the participants, 31-48% reported decline in memory, learning, and concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Conclusions A new online risk score tool was developed that enables individuals to inspect their own risk profiles, as well as explore potential targets for interventions and their estimated contributions to later SCD. Dynamic decision heatmap was presented as a communication tool to be used at healthcare consultations. Key messages • Potentially modifiable health-related behaviours such as physical activity can contribute to subjective cognitive decline. • Artificial intelligence can be applied to discover the complex interactions between risk factors and subjective cognitive decline, to support preventive healthcare at individual and population levels.

Exploring Spectacle Usage Patterns: A Thematic Analysis of Refractive Disorder Patients in Medan, Indonesia

Objectives: This study explores the behavioral patterns of spectacle users with refractive errors in Medan City, Indonesia, and identifies the key factors influencing the decision-making process in choosing and using glasses, contributing to SDG 3 (Good Health and Well-being) by addressing vision health. Theoretical Framework: The research is guided by the Precede-Proceed model and the Theory of Planned Behavior, which provide a framework for understanding health-related behaviors, including spectacle usage and its impact on overall well-being. Method: A qualitative methodology was employed, involving in-depth interviews with 30 Medan City residents diagnosed with refractive errors. This was supplemented by focus group discussions and consultations with eyewear experts. Data were analyzed using a descriptive-analytical approach. Results and Discussion: Key themes influencing spectacle usage behavior were identified, including needs, comfort, fashion, quality, perception, economy, and knowledge. Among these, needs, comfort, and quality emerged as the most significant factors influencing users’ choices of glasses. The findings suggest that people with refractive errors should prioritize glasses that meet health standards to ensure comfort and improve visual impairments, aligning with the goals of SDG 3 to promote health and well-being. Research Implications: Health practitioners, particularly optometrists, play a critical role in educating the community about the importance of using high-quality eyewear and addressing common misconceptions related to spectacle use, thus contributing to SDG 3 (Good Health and Well-being). Originality/Value: This study provides novel insights into the behavioral patterns of spectacle users in a specific cultural context, offering valuable information for health professionals and policymakers to improve vision care services in Medan City in support of SDG 3.

Trust in sources of information about digital health technologies: The User’s Perspective

Abstract Background Trust is key to healthcare, including all types of health information. This applies not only to the process of healthcare delivery, but also to health-related behaviors and the utilization of healthcare services. Trust in health information sources has been shown to vary by social and health characteristics. Therefore, the research question is: Are there social and health-related differences in perceptions of trust in sources of information (government agencies or physicians) about digital health technologies? Methods The analysis is based on a cross-sectional online survey (STELLAR) conducted in 2022 (N = 1,200), Participants were asked whether they perceive trust (1= fully agree- 4= not at all) in information about digital health technologies provided by government agencies (institutional trust) or physicians (interpersonal trust). For the analysis, binary logistic regressions (references: traditionalists, low education level, poor self-perceived health) were used. Results Institutional Trust. Overall, 43.9% of the participants perceived trust in this information source. Baby Boomers (OR 2.022), Generation Y (OR 2.544), and Generation Z (OR 2.566), as well as medium (OR 2.526) and high (OR 3.823) educational level, increased the odds of perceived trust; the same was found for better self-perceived health (OR 1.569). Interpersonal Trust. In general, 94.8 % of the participants expressed trust physicians. Belonging to Generation Z decreased the chance (OR 0.097) and a better subjective health status increased the chance (OR 4.250) of perceiving trust. Education did not emerge as a significant determinant. Conclusions The study confirmed that interpersonal and institutional trust varies by social and health characteristics. There seems to be a need to strengthen efforts to explain the process of trust building in different population groups., e.g. to find explanations for why educational level was only relevant for institutional trust but not for interpersonal trust. Key messages • Trust in sources of information about digital health technologies differ by generation, educational level, and subjective health status. • Given the existing differences in perceptions of trust, it is worthwhile to explore the unknown mechanisms of the trust-building process among different population groups.

Knowledge, Attitude and Practice of Nurses and Midwives towards Hepatitis B Infection and Control Measures in Alban Gaded Hospital, Khartoum, Sudan

Purpose: Infection with the hepatitis B virus (HBV) causes severe morbidity and death, burdening world health. Nurses and midwives, among other healthcare professionals, are more likely to contract the illness. Few studies have looked at the knowledge, attitude, and practices (KAP) of healthcare professionals in Sudan with regard to HBV infection, despite the fact that diverse components of KAP have an impact on health-related behaviors. This study's objective was to assess the knowledge, attitude, and practice (KAP) level of nurses and midwives concerning HBV viral infection in, Khartoum, Sudan.  Methods: In the Sudanese state of Khartoum, a public hospital (Alban Gaded Hospital) underwent a cross-sectional descriptive hospital-based study. To assess KAP's understanding of nurses and midwives about HBV infection. Self-administered questionnaires were used and approved by the supervisor for distribution to the population chosen for the study. The data was handed over to the Medical Director whom personally ensured the questionnaires were signed and filled by the Healthcare workers (HCWs) of the chosen criteria at the field. A member of group (23:B) took care of the supervision aside with the medical director, and made sure the data was collected as needed. The data at hand were subjected to statistical analysis using SPSS version 24.0 (Statistical Package for Social Sciences).  Results: 95 samples out of 99 were collected. According to participants’ knowledge: 67.95% have good knowledge about HBV, while 32.05% lack basic knowledge about it. The participants’ attitude towards HBV is above average showing 60.3% safe attitude. Lastly, the study shows excellent practice of the participants’ behavior towards HBV safety measures with a score of 92.3% safe practice. From the hospital, a total of 95 out of 99 nurses and midwives took part in the study. Two thirds of the respondents practiced safety, and the majority of respondents had a positive attitude about HBV preventative measures. More than half of the respondents (58.2%) had an average level of understanding. A minor but serious score of (12.6%) was noticed of the individuals, dealing with patients without wearing gloves. More over half of the nurses and midwives were not vaccinated against HBV; more than 50% of participants had incorrect ideas regarding the symptoms and route of HBV infection and all 95 participants voted (NO) for ever being infected by HBV.  Conclusion: In Alban Gaded hospital, the majority of the nurses and midwives were aware of HBV infection. But a sizeable majority of the participants lacked the necessary understanding of early immunization after birth. The study found a probability of high risk infection due to exposure under the poor level of HBV vaccine coverage rate. Moreover a clear point of limitation was noticed in Table 4 third question, where it asks whether you are or ever was infected by HBV. All the participants denied, showing a sense of partiality. Further occupational exposure prevention measures, training programs on HBV infection, including post-exposure prophylaxis, and increasing the vaccination rate of all HCWS are also strongly encouraged.

Impersonal Sex and Pornography: Potential Confounding, Moderation, and Implications for Public Health

ABSTRACT Following the recent exhortations of health communication scholars to continue the study of pornography and its potential impact on health-related behaviors, the present study investigated associations between the frequency of pornography use and six indicators of impersonal sex among a national probability sample of US adults. Impersonal sex has been linked to a variety of important public health outcomes, including STD risk and sexual aggression perpetration. In this study, pornography use was positively correlated with the likelihood of engaging in group sex, having sex with a casual partner, having sex without emotional intimacy, experiencing heightened sexual pleasure during non-relational sex, relational infidelity, and perceiving the receipt of sexual pleasure from others as the best thing about sex. No evidence emerged that these associations were spuriously due to high sex drive individuals being both more likely to consume pornography and engage in impersonal sex. But several were conditional on age. Most importantly, countering the conventional wisdom that sexual media are most likely to affect the sexual behavior of young audiences, the strength of the positive association between pornography use and the likelihood of engaging in group sex and casual dyadic sex was larger among older adults and weaker among younger adults.

Exploring the Association Between Oral Health Literacy and Oral Health-Related Quality of Life Among Young Women in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-Sectional Study.

One approach for improving oral health is focusing on oral health literacy (OHL). In this study, we aimed to investigate the association between OHL and oral health-related quality of life (OHRQoL) and to identify relevant OHL intervention targets that can be used to improve oral health. We performed a cross-sectional questionnaire study among 1889 10th grade female students in the Eastern Province of the Kingdom of Saudi Arabia (KSA). We then assessed OHL using the Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). OHRQoL was assessed using the 14-item oral health impact profile (OHIP-14). Information on socio-demographics and oral health-related behaviours (e.g., toothbrushing, sugary diet consumption and dental attendance) was also collected. The relationship between OHL and OHRQoL was investigated using binary logistic regression adjusted for sociodemographic information and oral health-related behaviours. In both the adjusted and unadjusted models, poor OHL was significantly associated with OHRQoL problems (odds ration [OR] = 2.90, p < 0.001). Having any OHL problem was significantly associated with having an OHRQoL problem (p < 0.001). The ORs were highest for the domains of financial barriers (OR = 2.49, p < 0.001) and receptivity (OR = 2.16, p < 0.001). Interventions targeted at individuals with low OHL are crucial to improving OHRQoL in the population. The most relevant interventions concern (a) dedicating time and attention to oral health and (b) financial barriers.

Impact of oral health literacy on oral health behaviors and outcomes among the older adults: a scoping review

BackgroundOral Health Literacy (OHL), defined as an ability to obtain, understand, and apply information related to oral health, plays a crucial role in promoting effective oral health outcomes and behaviors. Given the pressing need to enhance oral health among older adults, this scoping review aims to summarize the impact of OHL on oral health behaviors and outcomes in this population.MethodsThe authors performed an electronic search up through July 22, 2024. Among the 2,226 articles identified, the authors included studies in which the investigators evaluated the association between OHL and oral health behaviors or outcomes restricted to individuals aged 60 years and older. Thematic analysis was used to develop the domain for oral health behaviors or outcomes.ResultsAmong the 10 studies analyzed, significant correlations were identified between OHL and various oral health indicators, including periodontitis, the number of remaining teeth, dental prosthesis use, oral hygiene, oral health-related quality of life among men, as well as dissatisfaction with oral health (p < 0.05). However, the results were conflicting across the studies, indicating variability in the strength and nature of these associations. Additionally, OHL was shown to significantly influence oral health-related behaviors, especially the tooth brushing frequency (p < 0.05).ConclusionsThis review highlights a scarcity of studies addressing OHL in older populations, suggesting that OHL has been deprioritized in efforts to improve oral health for this vulnerable group. Key gaps include the need for age-appropriate OHL assessment tools, stronger evidence linking OHL to specific oral health behaviors and outcomes, and the integration of OHL into broader health initiatives and research in older group. These areas are critical to advancing our understanding and improving oral health outcomes among older adults.

Content Analysis of Brief Telephonic Conversation with Parents of Children with Cleft Lip and Palate During Sustained Anticipatory Guidance Sessions.

Cleft lip and palate (CLP) represents complex congenital anomalies that necessitate a comprehensive approach to care, involving multiple healthcare disciplines. The primary aim of the study is to explore the content of periodic telephone support calls between parents/caregivers of children with CLP and pediatric dentist during sustained anticipatory guidance. The qualitative analysis was conducted with the available telephonic recordings that was obtained from the STOP database. 40 recordings of 8 children were used for this study. The recorded interviews were translated and transcribed verbatim and analysed using the thematic content analysis method. The four major themes that were addressed by the dentist were the general health of the baby, oral health and development, surgery-related concerns and emotional support. It was also observed that the parents demonstrated a positive shift in oral health related behaviour significantly improving their child's oral hygiene practices. The telephonic support calls offer valuable insights into the concerns and topics the parents of children with CLP are eager to discuss. These calls not only address general concerns, receiving emotional support from the professionals, demonstrate the health related behavior shift that takes place during SAG and reassures parents of their support.

Oral hygiene predicts lower life satisfaction and subjective health: experience of post-Soviet countries

Oral diseases are among the most common non-communicable diseases around the globe and become a public health challenge that considerably impact general health and well-being in all ages across the lifespan. Oral health is an integral part of general health, where poor oral health and other lifestyle-related chronic diseases have a common risk factor background. The underlying causes of oral health inequalities are often complex and related to country-specific historical, economic, cultural, social, or political factors. For more than a decade, data from the Health Behavior in School-aged Children (HBSC) survey showed that tooth brushing rates are very low in post-Soviet countries. The general aim of our study was to focus on a more detailed profile of schoolchildren from post-Soviet countries, who have poor habits of teeth brushing, in terms of their family, social support, physical activity, nutrition, and other health-related behaviors. Data for this study was extrapolated from the Health Behavior in School-aged Children study, a World Health Organization collaborative cross-national study, conducted every 4 years since 1983/1984. For this study, the post-Soviet countries from Eastern Europe and Central Asia were selected: Armenia, Azerbaijan, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Moldova, Tajikistan, Ukraine, and Uzbekistan. Data from all countries (some exceptions for Kyrgyzstan, Tajikistan, and Uzbekistan) were collected within 2017–2018 HBSC study, following international research protocol. The sample consisted of 44,760 schoolchildren, aged 11, 13, and 15 years from 12 countries. Irregular tooth brushing is more common among boys, elder adolescents, and schoolchildren from less affluent families. Low own health measures, low life satisfaction, low physical activity, and low FAS relate to poorer adolescent dental hygiene in post-Soviet countries. Adolescents characterized by irregular tooth brushing were more likely to assess their health as fair or poor rather than excellent or good (OR = 1.22), and also had greater odds of reporting low life satisfaction (OR = 1.36). Individual mental health complaints—feeling low, being irritable, being nervous, and having sleep difficulties—were assessed as a possible outcome of irregular tooth brushing. However, irregular tooth brushing was not associated with poorer mental health outcomes (p > 0.05). Conclusions: Oral hygiene in post-Soviet countries is still a major public health challenge and have to be addressed properly.What is Known:• Oral health strongly affects the overall health of children and adolescents in the future.• Oral diseases often share common determinants and risk factors with other chronic diseases.• The underlying causes of oral health inequalities are often complex and related to country-specific historical, economic, cultural, social, or political factors.What is New:• Irregular tooth brushing was more common among adolescents with low life satisfaction and poor or fair health as well as in less affluent families.• Irregular tooth brushing was not found to be associated with poorer mental health among post-Soviet countries adolescents.

The PHEM-B toolbox of methods for incorporating the influences on Behaviour into Public Health Economic Models

BackgroundIt is challenging to predict long-term outcomes of interventions without understanding how they work. Health economic models of public health interventions often do not incorporate the many determinants of individual and population behaviours that influence long term effectiveness. The aim of this paper is to draw on psychology, sociology, behavioural economics, complexity science and health economics to: (a) develop a toolbox of methods for incorporating the influences on behaviour into public health economic models (PHEM-B); and (b) set out a research agenda for health economic modellers and behavioural/ social scientists to further advance methods to better inform public health policy decisions.MethodsA core multidisciplinary group developed a preliminary toolbox from a published review of the literature and tested this conceptually using a case study of a diabetes prevention simulation. The core group was augmented by a much wider group that covered a broader range of multidisciplinary expertise. We used a consensus method to gain agreement of the PHEM-B toolbox. This included a one-day workshop and subsequent reviews of the toolbox.ResultsThe PHEM-B toolbox sets out 12 methods which can be used in different combinations to incorporate influences on behaviours into public health economic models: collaborations between modellers and behavioural scientists, literature reviewing, application of the Behaviour Change Intervention Ontology, systems mapping, agent-based modelling, differential equation modelling, social network analysis, geographical information systems, discrete event simulation, theory-informed statistical and econometric analyses, expert elicitation, and qualitative research/process tracing. For each method, we provide a description with key references, an expert consensus on the circumstances when they could be used, and the resources required.ConclusionsThis is the first attempt to rigorously and coherently propose methods to incorporate the influences on behaviour into health economic models of public health interventions. It may not always be feasible or necessary to model the influences on behaviour explicitly, but it is essential to develop an understanding of the key influences. Changing behaviour and maintaining that behaviour change could have different influences; thus, there could be benefits in modelling these separately. Future research is needed to develop, collaboratively with behavioural scientists, a suite of more robust health economic models of health-related behaviours, reported transparently, including coding, which would allow model reuse and adaptation.

‘The coronavirus is a formidable foe’: children’s multimodal articulations of SARS-CoV-2 virus and COVID-19 pandemic experiences in China

Objective This study explored children’s post-pandemic articulations regarding the coronavirus along with their lived experiences during the COVID-19 pandemic. Design A qualitative survey featuring drawings, comments, questions and follow-up interviews was employed to gather data from 108 infected children aged 13 to 14 from two middle schools in China. This multimodal approach allowed for a rich capture of the children’s articulations of their pandemic experiences. Results Children’s multimodal articulations conveyed not only the biological features of, but also their emotional reactions to the coronavirus. The pandemic had disrupted children’s lives, making online learning, sleep and screen engagement dominant in their daily routines, while also compounding children’s unhappiness primarily due to restrictions on social interactions. Children associated the coronavirus with biological, medical, psychological and social aspects. Increased sanitisation and hygiene habits featured their pre‐to-post pandemic changes. Furthermore, children exhibited an awareness regarding preventive measures and transmission modes, albeit with certain biases or gaps. Their misunderstandings about recuperative strategies merit clarification. Conclusion The COVID-19 pandemic has had profound and multifaceted impacts on children’s emotional well-being, daily routines, social interactions, education, and health-related behaviors. Children’s multimodal articulations revealed a spectrum of adverse effects caused by the pandemic, calling for targeted health interventions to mitigate these negative effects while also equipping children with resilience and coping skills for navigating future health crises. Incorporating children’s perspectives and experiences into future pandemic preparedness and health promotion strategies is essential for addressing their vulnerabilities and ensuring their overall well-being during public health crises.

Mass Media Exposure Moderates the Association of Education and Wealth with Enrollment in Health Insurance Among Older Adults Aged 60 Years and Older in India

ABSTRACT Mass media exposure (MME) plays an important role in changing health-related behavior or decision-making. This study aimed to examine the association of MME with enrollment in health insurance and its moderating effect on the associations of education and wealth with enrollment in health insurance among older adults in India. The data of 29,935 older adults aged 60 years and older from the first wave (baseline) of the Longitudinal Ageing Study in India (LASI-2017/18) were utilized. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and Fairlie decomposition were used. The findings revealed that 18.3% of older adults had MME and enrollment in health insurance in India. Older adults with MME were 1.42 times more likely to be enrolled in health insurance than those with no MME, and years of schooling increased the probability of enrolling in health insurance compared to those who did not have formal schooling. With increasing monthly per capita expenditure (MPCE), the probability of enrolling in health insurance is lower than the poorest. Further, MME moderates the effects of education and MPCE on enrollment in health insurance and increases the likelihood of enrollment in health insurance. The study’s findings imply strategic communication plans to encourage health insurance enrollment in India should take into account the usage of these communication channels.

Substance Use and Adverse Mental Health Disparities Between Heterosexual and Sexual Minority Service Members in the U.S. Military.

Nationally representative studies have shown that lesbian, gay, and bisexual adults have higher levels of substance use than heterosexual adults. In the military, substance use is often associated with adverse mental health outcomes and is often comorbid with other mental health conditions and adverse or harmful behaviors. Few military studies to date have comprehensively examined the relationship between sexual orientation, mental health, and substance use. Data from the 2018 Health-Related Behaviors Survey (n = 17,166) were used. Univariate and multivariable logistic regression models were used to examine the association between sexual orientation and substance use. Regression models were also used to examine whether measures of mental health moderate the relationship between sexual orientation and substance use. Compared to heterosexual individuals, lesbian and gay individuals were more likely to engage in illicit drug use (adjusted odds ratio = 3.27; 95% CI, 1.45 to 7.36). Bisexual individuals were more likely to binge drink (adjusted odds ratio = 1.37; 95% CI, 1.08 to 1.74). Individuals with moderate or serious psychological distress were more likely to report binge drinking or smoking tobacco. Individuals with serious psychological distress were more likely to use illicit drugs. None of the interactions tested in this study were statistically significant. Substance use in the military was more likely among sexual minority individuals compared to heterosexual individuals. These findings reflect the patterns of substance use seen in the general population. Increased levels of psychological distress were associated with both the lesbian, gay, and bisexual population in this study and self-reported substance use behaviors. Further investigation of health disparities by sexual orientation may inform more efficacious treatment and prevention programs.

Green Behaviour Engagement Towards the Achievement of Sustainable Health: A Systematic Review and Bibliometric Analysis

Background The short-term actions generated by the proposed SDGs by the United Nations promote sustainability and raise the probability of finding the best global crisis solution. This research builds on previous studies that demonstrate the interconnectedness and reciprocal support of Goals 3 and 12 in their pursuit of societal transformation by altering production and consumption patterns. Focus of the Article This study set out to fill a knowledge need by examining the current state of the literature on the topic of how SDGs interact with one another. The paper primarily addressed SDGs 3 and 12. Research Question (a) How could green behaviour promote sustainable health, and what is the present status of research in this field across nations, research communities, academic journals, and professional organizations? (b) How, with research topic as the key domain, can we make progress towards Sustainable Development Goals 3 and 12 through the social marketing?. Importance to the Social Marketing Field The purpose of this paper is to provide a plan for bringing about societal transformation by means of sustained, short-term efforts in the realms of production and consumption, undertaken with the backing of the nation’s stakeholders. Doing so makes long-term success in altering health-related behaviours (prevention, protection, and persistence in the face of health hazards) more likely. Despite their best efforts to enhance the well-being of societies through social transformation, the authors believe that social marketers may be steering communities in an unsustainable direction. Method Thus, a systematic review and bibliometric analysis were conducted to ascertain the breadth of the research underlying the title by analyzing 135 Scopus publications from 74 journals from 2011–2022 and graphically presented and tabulated the trends, important authors, nations, research papers, and keyword co-occurrences. Biblioshiny, a Bibliometrix R-tool used for the purpose of scientific mapping. In addition, the alignment of study of keywords by taking social marketing discipline into account was justified through systematic review. Results Research on the interplay between SDGs and other factors is required, as 27% of the data remains unexplained. Short-term sustainable behaviours that may enhance health outcomes are combined in this study to better inform policymakers and marketers about consumers’ long-term commitment to sustainable green consumption. Recommendations for Research According to the study’s results, government agencies should create social marketing initiatives to influence the public’s behaviour and promote the health and well-being benefits associated with sustainable production and consumption. Additionally, they should provide incentives to businesses to expand their range of sustainable commodities. Businesses have a shared responsibility to develop, communicate and supply customers with the advantages of sustainable offerings, and enhance the demand for these products through a green marketing approach while reducing their prices. The ecosystem as a whole will reap the benefits of everyone’s efforts, as well as the health and happiness that comes with it. Limitations From 2011 through 2022, the Scopus database’s articles and review papers were used in the study. Additional knowledge in this area might be gained from a comparison of databases like Web of Science, Dimensions, Google Scholar, etc. The study had no geographic focus. Therefore, future research should assess this field’s national and regional potential.

Associations between multimorbidity patterns and sarcopenia transitions in Chinese older adults.

Previous studies have shown that chronic diseases are strongly linked to the development of sarcopenia. Few studies have assessed the relationship between multimorbidity patterns and sarcopenia. This study aimed to investigate the impact of multimorbidity patterns on sarcopenia transitions in Chinese older adults. A total of 3842 older adults (aged 66.7 ± 6.2 years) with complete data at baseline and at least one follow-up record (2 years) were included from the China Health and Retirement Longitudinal Study. Multimorbidity patterns were identified using latent class analysis. Sarcopenia was determined by the Asian Working Group for Sarcopenia 2019 criteria. Multistage Markov modeling was used to explore the association of multimorbidity patterns with sarcopenia transitions after controlling for covariates in demographic features, health status and health-related behaviours. Four multimorbidity patterns were identified at baseline: respiratory (17.73%), osteoarthritis-hypertension (22.23%), digestive-osteoarthritis (26.78) and cardiometabolic (33.27%). Participants with non-sarcopenia had 1-year transition probability of developing possible sarcopenia (10.1%) or sarcopenia (5.4%). Compared with the group without chronic diseases, the presence of cardiometabolic pattern increased the risk of progression from non-sarcopenia to possible sarcopenia (HR 1.43, 95% CI 1.05-2.95). The presence of the osteoarthritis-hypertension pattern (HR 1.55, 95% CI 1.00-2.41) and the digestive-osteoarthritis pattern (HR 1.78, 95% CI 1.20-2.66) were associated with the transition toward sarcopenia from non-sarcopenia. Sarcopenia is a dynamic condition in older adults. To address sarcopenia in older adults, tailored interventions should be targeted at populations with different multimorbidity patterns. Geriatr Gerontol Int 2024; ••: ••-••.