Health-related Behaviors Research Articles

Psychometric evaluation of the translated arabic version of the geriatrics health behavior questionnaire (GHBQ) for geriatric nurses: a cross-sectional study

BackgroundThe Geriatrics Health Behavior Questionnaire (GHBQ) is essential for assessing health-related behaviors among older adults populations. This study focuses on the translation, cultural adaptation, and psychometric evaluation of the Arabic version of the GHBQ to ensure its relevance and accuracy for Arabic-speaking older adults individuals.MethodsThis cross-sectional study was conducted at the Cairo University Educational Hospital’s outpatient clinic. The GHBQ was translated and culturally adapted through a systematic process, including initial translation, back-translation, expert review, and pilot testing. The psychometric properties of the Arabic-translated GHBQ were evaluated using a sample of 200 older adults Arabic-speaking participants. Reliability was assessed using Cronbach’s alpha (α) and Intraclass Correlation Coefficient (ICC). Validity was evaluated through Content Validity Index (CVI), Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA).ResultsThe Arabic GHBQ demonstrated excellent reliability with Cronbach’s alpha values ranging from 0.74 to 0.87 across subscales and ICC values confirming reproducibility (ICC = 0.82). The CVI indicated strong content validity (average CVI = 0.91). EFA revealed a five-factor structure, explaining 72% of the variance, with all factor loadings exceeding 0.60. CFA supported the questionnaire’s structure with fit indices meeting recommended criteria: χ²/df = 2.05, NFI = 0.92, TLI = 0.94, GFI = 0.90, SRMR = 0.05, AIC = 140.35, and BIC = 160.22. Criterion validity was confirmed through significant correlations with established health behavior measures (r = 0.63, p < 0.001).ConclusionsThe culturally adapted Arabic version of the GHBQ is a reliable and valid tool for assessing health behaviors in the older adults population in Egypt. This instrument can aid healthcare providers in identifying and addressing health behaviors, ultimately improving the well-being of this demographic. Future research should focus on expanding the sample and comparing the GHBQ with other similar tools used in Arabic-speaking populations.

A randomised clinical trial to arrest caries using silver diamine fluoride therapy with two postoperative instructions

ObjectiveThe objective of this study is to investigate the beneficial effect of not rinsing for 30 min in arresting early childhood caries after SDF therapy. MethodsThis randomised clinical trial recruited 3- to 4-year-old kindergarten children with active (soft) dentine caries. A questionnaire was sent to the parents to collect children's demographic data and oral health-related behaviours. A dentist conducted an oral examination and measured the caries experience using dmft index and oral hygiene using visible plaque index. After 38 % SDF therapy, the children were randomly allocated into two groups. Children in group A were instructed to rinse with water immediately, whereas children in group B were asked to refrain from rinsing, drinking, or eating for 30 min. After six months, the same examiner determined the lesion activity (active/arrest) of the SDF-treated carious tooth surface. Generalized Estimating Equations was used to compare the proportion of caries arrest (caries-arrest rate) between the two groups. ResultsThis study recruited 298 children with 1,158 decayed tooth surfaces receiving SDF therapy at baseline and evaluated 275 (92 %) children with 1,069 (92 %) SDF-treated tooth-surface at the six-month examination. The demographic background, oral hygiene and caries status of two groups were comparable at baseline (p > 0.05). The caries-arrest rate for group A and group B were 65 % (337/519) and 61 % (338/550), respectively (p = 0.28). ConclusionThis randomised clinical trial found not rinsing for 30 min after SDF therapy is not better than immediate rinsing in arresting early childhood caries. Clinical significanceTopical SDF application leaves an unpleasant taste in the mouth, which may affect the acceptance or even rejection of SDF therapy among young children. This study provides clinicians with information to make their decision on postoperative instruction after SDF therapy.

Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers

BackgroundBy addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation.MethodsContextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree.ResultsOuter setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. Innovation: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. Process: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs.ConclusionsWhile the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.

Prevalence and Predictors of Soft Drink Consumption among Adolescents in the Gulf Countries: Findings from National Surveys.

This study aimed to investigate the prevalence and predictors of soft drink consumption among adolescents in the Gulf Cooperation Council (GCC) countries using nationally representative data from the Global School-based Student Health Survey (GSHS). Cross-sectional data were collected using a self-administered questionnaire in a school survey and included 22,116 adolescents aged 12-18 years from Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates. Data were collected and analyzed using complex survey methods. The GSHS was not available for Saudi Arabia. Soft drink consumption was the main outcome variable. Multivariable logistic regression was used to examine its associations with sociodemographic characteristics, dietary behaviors, parental factors, and health-related behaviors. The prevalence of soft drink consumption three or more times per day ranged from 10.6% to 26.8% across the countries, with the highest being in Qatar. Adjusted analyses showed that girls had lower odds of SD consumption compared to boys (OR = 0.66; 95% CI: 0.57-0.77). Food insecurity, a proxy for low socioeconomic status, was associated with twice the odds of frequent consumption (OR = 2.06; 95% CI: 1.75-2.43). Parental smoking and low physical activity levels were also associated with higher soft drink intake (OR = 1.46, 95% CI: 1.13-1.88 and OR = 1.18, 95% CI: 1.08-1.28, respectively), while obesity showed a weak positive association. Daily soft drink consumption was highly prevalent among adolescents in the GCC countries. Sociodemographic, behavioral, and health-related factors were significantly associated with frequent intake. These findings highlight the need for comprehensive, multi-sectoral interventions to reduce soft drink consumption in the region.

Real Talk: Conversations on HIV with Black Heterosexual Men in Healthcare Settings.

Nearly half of heterosexually transmitted human immunodeficiency virus (HIV) infections occur among Black men in the United States. Yet Black heterosexual men (BHM) are largely ignored in HIV programming, policy implementation, and research. This study explores how masculinity, mental health, and socioeconomic factors such as income, education, and insurance (e.g., enrollment and coverage) correlate with the likelihood of BHM having important conversations surrounding HIV with their healthcare providers and family members. Conversations among social networks (e.g., peers, family, and neighbors) create an opportunity to increase comfortability while discussing HIV-related topics around condom use and testing. This study used a cross-sectional survey design and convenience sampling (N = 279) to recruit participants from a community-academic partnership involving a Federally Qualified Health Center (FQHC) in Detroit between June 1, 2020, and July 31, 2020. Descriptive statistics were used to report demographics, socioeconomic information, and sexual health-related behavior variables. Spearman's correlation test was used to report bivariate correlations between predictor and outcome variables. 49.3% of the study participants disclosed having ever talked to a healthcare provider about HIV/acquired immune deficiency syndrome (AIDS), and 40.9% disclosed having ever talked to a family member about HIV/AIDS and sexually transmitted infections (STIs). The results from this article highlight potential barriers that may inhibit BHM from engaging in conversations about HIV with their healthcare providers and family members. It is important to include BHM in future research that focuses on HIV prevention and education to support community leaders and clinicians who work to address these disparities.

Anything but Representative Democracy: Explaining Conspiracy Believers’ Support for Direct Democracy and Technocracy

Conspiracy theories gained considerable attention during the Covid-19 pandemic. Although studies have extensively explored their (mostly) negative impacts on various political and social aspects, like participation, health-related behavior, and violence, their influence on support for democracy remains relatively unexplored. The few existing studies offer conflicting findings, prompting my focus to shift from assessing generic support for democracy to examining preferences for alternative decision-making models. To address some limitations of prior research on alternative models of decision-making, I combine a trade-off item with a ranking methodology: respondents were prompted to indicate their first and second preferences for different democratic and non-democratic models over representative democracy. The study is based on data from a representative survey in Germany (July/August 2022; N = 2,536). My findings confirm that the belief in conspiracy theories is positively associated with a preference for direct democratic decision-making. However, conspiracy believers also favor expert-based decision-making over elected politicians—but direct democracy would be their primary choice. Although the evidence for a preference for autocracy over representative democracy is associated with a higher degree of uncertainty, it does suggest that conspiracy believers tend to favor “anything but” representative democracy. These findings contribute to the broader discourse on the impact of conspiracy beliefs on democratic systems.

Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors—internal locus of control, impatience, optimism bias, and aspirations—and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women’s use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers’ influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks.JEL CodesI12, D10, D91, I30.

The Influence of Adolescent health-related Behaviors on Degenerative Low Back Pain Hospitalizations and Surgeries in Adulthood: A Longitudinal Study.

Retrospective longitudinal study. This study aims to investigate the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on the development of low back pain requiring hospitalization or surgery. The baseline data were surveys gathered biennially in 1981-1997 (the Adolescent Health and Lifestyle Survey) and individually linked with outcome data, degenerative low back pain hospitalizations, and spine surgeries retrieved from the Care Register for Health Care. A total of 47 724 participants were included. Explanatory variables included physical activity, high BMI, smoking, monthly drunkenness, chronic diseases, and family SES. A logistic regression model was used to analyze the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on degenerative low back pain hospitalization, lumbar disc herniation (LDH) hospitalization and/or spine surgery. Covariates were selected using directed acyclic graphs (DAGs). A total of 5538 participants had degenerative low back pain hospitalizations, 2104 had LDH hospitalizations, and 913 had spinal surgery over an average of 27-years follow-up. High BMI (aOR 1.25, CI 1.12-1.38), smoking (aOR 1.53, CI 1.43-1.62), monthly drunkenness (aOR 1.17, CI 1.10-1.26), and chronic diseases (aOR 1.47, CI 1.35-1.61) in adolescence increased the odds of hospitalizations during follow-up. In addition, high BMI (aOR 1.37, CI 1.09-1.72), smoking (aOR 1.40, CI 1.21-1.61), and monthly drunkenness (aOR 1.19, CI 1.01-1.39) increased the odds of spine surgeries. We found that smoking, high BMI, monthly drunkenness, chronic diseases, and low family SES in adolescence increased the likelihood of degenerative low back pain hospitalizations in adulthood. In addition, high BMI, smoking, and monthly drunkenness in adolescence increased the odds of spinal surgeries.

Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol.

Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management. This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany. This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed. The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025. We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study's results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients' health behaviors. German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656. DERR1-10.2196/56487.

“I can't see the forest for the ticks, uhm, trees …”: The role of online forums in parents' vaccination trajectories

When it comes to health-related information-seeking behavior, online communities play a key role for some groups, such as parents. With a case study of online communities in a loosely organized vaccination system, that of Austria, we study how parents make use of a prominent online forum (parents.at) in their vaccination trajectories and situate this analysis in its socio-political context. Based on inductive qualitative analysis of relevant threads (n = 27), we find that parents use forums in three ways: First, the forum serves as a platform through which parents seek orientation in a loosely organized and fragmented vaccination system. Second, the forum offers space for sharing, collecting, and evaluating different forms of expertise. In doing so, parents carve out a space in which they can comfortably put lay expertise and credentialed expertise on a par, particularly in their advice to peers. Third, and on that basis, parents use the forum for deliberating on future or past vaccination-related decisions. In doing so, they frequently draw on idiosyncratic notions of individual risks and benefits. These three practices enable parents to accumulate and share what we label navigational capital. We conclude that parents resort to online spaces both out of a subjective need and, for some, as a result of a dysfunction of the national childhood vaccination program which offers little orientation for parents.

National Trends in PSA Cancer Screening With Parallel Investigation of Colorectal Cancer Screening: An Analysis of the CDC Behavioral Risk Factor Surveillance System From 2012 to 2022

Introduction/BackgroundFrom 2012 to 2022 there have been numerous revisions in the United States Preventative Task Force guidelines for prostate cancer screening, including advising against PSA testing to allowing shared-decision making for men aged 55 to 69. We sought to observe trends in PSA testing rates in relation to the changing guidelines. Conversely, colorectal cancer screening recommendations remained consistent for patients aged 50-75 and we sought to use this as a comparison to observe the effect of differing guidelines. MethodsThe Centers for Disease Control Behavioral Risk Factor Surveillance System is a national database of surveys on health-related behaviors and preventive medical services. We extracted responses from 2012 to 2022 regarding both prostate and colorectal cancer screening. Our primary variable of interest was prostate cancer screening while colorectal cancer screening served as a positive control. ResultsProstate cancer screening decreased among respondents from 70.1% in 2012 to 59.7% in 2022. However, there was a significant rebound in prostate cancer screening prevalence in 2022. In contrast, colorectal cancer screening rates steadily increased from 70.7% in 2012 to 78% in 2022. The annual percentage of men who had received prostate cancer screening was statistically different year to year. ConclusionsTrends in the rate of screening for prostate and colorectal cancer appeared to adapt to the updated recommendations. However, further investigation regarding lower income levels, minority groups, and uninsured men are essential to address the social and racial disparities seen in prostate cancer screening. Efforts to promote shared-decision making may improve effective cancer screening.

Prevalence of childhood obesity in Spain and its relation with socioeconomic status and health behaviors: Population-based cross-sectional study

ObjectivesThis study aims to assess the current state of childhood overweight and obesity in Spain, and its relationship with socioeconomic status and health-related behaviors. MethodsPopulation-based cross-sectional observational study, based on the 2017 National Health Survey in minors in Spain. This study included all children surveyed who were aged 1–14 years. Childhood obesity was estimated from the z-score of the body mass index. ResultsThe study included 4882 children aged 1–14 years (mean 7.5). The prevalence of obesity was 18.6% (95% confidence interval [CI] 18.5–18.7), while 13.5% (95% CI 13.4–13.6) were overweight. These figures represent over a million children in Spain who are obese and nearly 750,000 who are overweight. A north–south geographic gradient was apparent, with higher prevalence of unhealthy body weight in southern Spain. Factors associated with childhood obesity were low socioeconomic status, poor diet and sedentarism, among others. ConclusionsChildhood overweight in Spain is strongly associated with socioeconomic status and other factors such as diet and sedentarism. Multidisciplinary public health interventions are needed to reduce this serious health problem in children.

An investigation into social determinants of health lifestyles of Canadians: a nationwide cross-sectional study on smoking, physical activity, and alcohol consumption

BackgroundHealth lifestyles exert a substantial influence on the quality of everyday life, primarily affecting health maintenance and enhancement. While health-related practices during the COVID-19 pandemic may have positively altered the health lifestyles of Canadians to a certain degree, government reports indicate that issues related to health behaviors, such as cigarette smoking, physical inactivity, and alcohol consumption, continue to pose challenges to the health of Canadians. Social determinants of these health behaviors thus hold significant academic value in the formulation of policy guidelines.ObjectiveThe aim of this study is to scrutinize the social determinants of health with respect to social factors that have may have impacts on the health-related behaviors of Canadians. We tested health behaviors including cigarette use, alcohol consumption, and participation in physical exercise, which are integral to the promotion and improvement of individual health.MethodsTo examine the social determinants of Canadians’ health lifestyles, we utilized nationally representative data from the 2017–2018 Canadian Community Health Survey annual component. Our data analysis involved the bootstrapping method with two-level mixed-effect logistic regressions, ordered logistic regressions, and negative binomial regressions. Additionally, we conducted several robustness checks to confirm the validity of our findings.ResultsThe findings show that demographic background, socioeconomic status, social connections, and physical and mental health conditions all play a role in Canadians’ smoking, physical activity, and drinking behaviors. Noticeably, the association patterns linking to these social determinants vary across specific health lifestyles, shedding light on the complex nature of the social determinants that may influence young and middle-aged Canadians’ health lifestyles. Moreover, in the context of Canada, the health-region level demographic, socioeconomic, and working conditions are significantly linked to residents’ health lifestyles.ConclusionsInvestigating the social determinants of health lifestyles is pivotal for policymakers, providing them with the necessary insights to create effective interventions that promote healthy behaviors among specific demographic groups. It is recommended that health education and interventions at the community level targeting smoking, physical inactivity, and alcohol consumption be introduced. These interventions should be tailored to specific subgroups, considering their demographic and socioeconomic characteristics, social networks, and health status. For instance, it is imperative to focus our attention on individuals with lower educational attainment and socioeconomic status, particularly in relation to their smoking habits and physical inactivity. Conversely, interventions aimed at addressing alcohol consumption should be targeted towards individuals of a higher socioeconomic status. This nuanced approach allows for a more effective and tailored intervention strategy.

Automated Behavioral Coding to Enhance the Effectiveness of Motivational Interviewing in a Chat-Based Suicide Prevention Helpline: Secondary Analysis of a Clinical Trial.

With the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. This study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. We used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. The deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model's interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. The results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback.

Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults

Trust in physicians and hospitals has been associated with achieving public health goals, but the increasing politicization of public health policies during the COVID-19 pandemic may have adversely affected such trust. To characterize changes in US adults' trust in physicians and hospitals over the course of the COVID-19 pandemic and the association between this trust and health-related behaviors. This survey study uses data from 24 waves of a nonprobability internet survey conducted between April 1, 2020, and January 31, 2024, among 443 455 unique respondents aged 18 years or older residing in the US, with state-level representative quotas for race and ethnicity, age, and gender. Self-report of trust in physicians and hospitals; self-report of SARS-CoV-2 and influenza vaccination and booster status. Survey-weighted regression models were applied to examine associations between sociodemographic features and trust and between trust and health behaviors. The combined data included 582 634 responses across 24 survey waves, reflecting 443 455 unique respondents. The unweighted mean (SD) age was 43.3 (16.6) years; 288 186 respondents (65.0%) reported female gender; 21 957 (5.0%) identified as Asian American, 49 428 (11.1%) as Black, 38 423 (8.7%) as Hispanic, 3138 (0.7%) as Native American, 5598 (1.3%) as Pacific Islander, 315 278 (71.1%) as White, and 9633 (2.2%) as other race and ethnicity (those who selected "Other" from a checklist). Overall, the proportion of adults reporting a lot of trust for physicians and hospitals decreased from 71.5% (95% CI, 70.7%-72.2%) in April 2020 to 40.1% (95% CI, 39.4%-40.7%) in January 2024. In regression models, features associated with lower trust as of spring and summer 2023 included being 25 to 64 years of age, female gender, lower educational level, lower income, Black race, and living in a rural setting. These associations persisted even after controlling for partisanship. In turn, greater trust was associated with greater likelihood of vaccination for SARS-CoV-2 (adjusted odds ratio [OR], 4.94; 95 CI, 4.21-5.80) or influenza (adjusted OR, 5.09; 95 CI, 3.93-6.59) and receiving a SARS-CoV-2 booster (adjusted OR, 3.62; 95 CI, 2.99-4.38). This survey study of US adults suggests that trust in physicians and hospitals decreased during the COVID-19 pandemic. As lower levels of trust were associated with lesser likelihood of pursuing vaccination, restoring trust may represent a public health imperative.

Physical Activity and Sleep Lessons Learned from Disruptions at a Residential University in Thailand

Existing research shows COVID-19 pandemic restrictions led to widespread disruptions in health-related behaviors, including physical activity (PA) and sleep patterns among university students, faculty and staff. The specific impact of pandemic restrictions and the lack of crisis preparedness at educational institutions are not well documented. This cross-sectional pilot study (n=48) used a self-administered questionnaire to investigate the impact of restrictions on PA and sleep to identify the health impact, possible modifiable behaviors, and policies to target for change in future crises to improve health, academic, and work outcomes, especially for institutions with natural green spaces. It was hypothesized the restrictions reduced adults’ PA levels and negatively impacted sleep. Statistical analyses revealed significant differences (p &lt; 0.05) in the time spent doing medium- and high-intensity PA, walking, length of time to fall asleep, and hours slept before and during the pandemic. Concentration on infection prevention and spread rather than on health maintenance for those not acutely ill inadvertently discouraged using outdoor spaces for exercise while gym and sports facilities remained closed. These findings indicate the negative impact lockdown restrictions may have on general health, and how organizations can promote behaviors to maintain basic physical and sleep health.

Cardiorespiratory fitness and body mass index on metabolic syndrome in middle-aged Japanese adults under national health guidance: a cross-sectional study

ObjectivesPoor cardiorespiratory fitness (CRF) and high body mass index (BMI) increased the risk of developing metabolic Syndrome (MetS) mostly in Caucasians. However, the sex-specific combined association of CRF and BMI on MetS considering health-related behaviors has yet to be thoroughly examined in Japanese. This study aims to investigate the sex-specific independent and combined associations of CRF and BMI with MetS in middle-aged Japanese adults.Methods421 participants were included in this cross-sectional study. CRF was estimated using a submaximal cycle ergometer. CRF and BMI were respectively divided into three categories according to tertile distribution. MetS was diagnosed based on five risk factors: waist circumference, triglycerides, high-density lipoprotein cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were used to estimate independent and combined association of CRF and BMI with MetS.ResultsResults showed that 154 (57.5%) and 70 (45.8%) of men and women had MetS, respectively. Compared to men with lower CRF or higher BMI, men with middle and higher CRF or middle and lower BMI were less likely to have MetS. Compared with ‘unfit and higher BMI’ group, ‘unfit and lower BMI’, ‘fit and higher BMI’, and ‘fit and lower BMI’ groups in men showed statistically significant decreased prevalences of MetS. However, no significant associations were found in women.ConclusionsThis study found significant independent and combined associations of CRF and BMI with MetS only in men, but not in women. However, prospective studies are warranted to confirm sex-specific associations of CRF and BMI with MetS.

An analysis of protective health behavior and polypharmacy among older patients: a nationwide cohort study

BackgroundThis study analyzed the relationship between protective health behaviors and polypharmacy in individuals aged 65 years and older.MethodsWe used data from a nationwide survey (KNHANES) from 2012 to 2016 in conjunction with the health insurance claims databases. A total of 3297 adults aged 65 or older were included in the study. Polypharmacy was defined as more than 30 prescription days in 6 months with five or more different drugs. Health-related behaviors (BMI, smoking, drinking, regular walking, and living alone) were extracted for 6 months before measuring polypharmacy. We used multivariable logistic regression on polypharmacy for each protective health behavior, as well as a composite score of protective health behavior. Subgroup analysis was also conducted by age and sex.ResultsAmong protective health behaviors, BMI < 25 (OR, 0.76; 95% CI, 0.66–0.88) and never smoking (OR, 0.78; 95% CI, 0.62–0.98) were associated with a lower risk of polypharmacy. Polypharmacy was significantly associated with BMI < 25 in both sex subgroups (male: OR, 0.71; 95% CI, 0.56–0.88; female: OR, 0.81; 95% CI, 0.67–0.99) and 65–79 subgroup (OR, 0.74; 95% CI, 0.63–0.86). The association between never smoking and polypharmacy was only significant in the 65–79 subgroup (OR, 0.71; 95% CI, 0.55–0.91). Participants with five protective health behaviors had a lower risk of polypharmacy than participants with zero or one health behavior, which was only statistically significant in the subgroup analysis of participants aged 65–79 years (OR, 0.52; 95% CI, 0.29–0.94).ConclusionsThis study finds that health behaviors such as obesity and smoking are associated with a higher risk of polypharmacy. Furthermore, we confirm that a high score of protective health behaviors is associated with a lower risk of polypharmacy. Our findings indicate the need for geriatric-centered management of protective health behaviors to prevent polypharmacy.

Assessment of parents’ oral health related behaviours and its relationship with oral health status of the children aged between 6-12 years in Davangere city: a cross-sectional survey

Background: It is widely acknowledged that the behaviour of parents affects their children's health. This study aimed to evaluate the relationship between oral health behaviour of parents and oral health status of their children aged between 6-12 years. Methods: A cross-sectional survey was conducted among 420 parent-child dyads with children aged between 6-12 years. A self-designed proforma was used for recording the sociodemographic details, with a questionnaire to assess parents’ oral health-related behaviours followed by clinical examination of the children for their oral health status. The Chi-square test, spearman’s correlation test and binary logistic regression analysis were applied by considering Statistical significance at p&lt;0.05. Results: The majority of the parents reported of having good oral health-related behaviours (60.2%). When children’s oral health status was assessed, more than half of the children had low caries experience (62.5%), showed a milder form of gingivitis (96.2%) and good oral hygiene status (57.4%). No statistically significant association was found between parents’ oral health-related behaviours with the children’s oral health status. Conclusions: Parents’ oral health-related behaviours did not influence the children’s oral health status.

Differences in social adjustment during adulthood between adoptees with high and low risk for schizophrenia spectrum disorders - the Finnish adoptive family study of schizophrenia.

To investigate differences in social adjustment during adulthood between adoptees with high genetic risk (HR) and low genetic risk (LR) for schizophrenia spectrum disorders. This study is a subsample of the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 120 adoptees whose biological mothers had DSM-III-R verified schizophrenia spectrum disorders, and 142 socio-demographically matched control adoptees. The social adjustment of the adoptees was assessed using the interview-based Adult Adjustment Scale (AAS). A lower proportion of the HR adoptees (61.7%) fell into the category of good adaptation compared to LR adoptees (74.6%) (p = 0.024). In addition, the median AAS score among HR adoptees was lower compared to LR adoptees (p = 0.023). Poorer results among HR adoptees were also found regarding some individual items and the social health -domain within the AAS. The psychiatric morbidity, excluding schizophrenia spectrum disorders, was higher among HR adoptees. Psychiatric morbidity was shown to mediate the association of genetic status to total AAS, and, also to the domain of social health. According to our results, genetic susceptibility to schizophrenia is associated with weakened social adjustment during adulthood. Although our results demonstrated that psychiatric morbidity has notable effect on the association of genetic status to adult adjustment scores, the impact of other determinants, like psychosocial factors or health-related behaviour, cannot be ruled out. The comparable rearing environment provided by the adoption design in conjunction with reliable diagnostics provide new information on the relation of genetic susceptibility and social adjustment.