Individual Health Behaviors Research Articles

Meaning of wellness in caring science based on Rodgers's evolutionary concept analysis.

Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear. To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science. Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria. Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented. Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

Health access for transgender people in Latin America: a scoping review protocol

Background Globally, trans people face barriers in living with society due to cis-heteronormative standards that impair access to healthcare. Objective: This study aims to map and analyze the literature to elucidate if access to health services and goods meets the health needs of transgender persons in Latin America. The study will describe the factors that impact health access for transgender persons in the area, the differences and similarities between the access in the region's countries, and the factors that justify them. The results will characterize the Latin American health access capacity, strengths, and difficulties in meeting the needs and rights of that group. Materials and methods: This review consists of a search in PubMed, SciELO, and LILACS databases on the health of transgender people in Latin America and, after, the selection of the controls and included articles. The selection of studies occurs in three stages, conducted in pairs of researchers: reading the title, reading the abstract, and floating the complete text, according to inclusion criteria. There is no language restriction. The pair of researchers will conduct data extraction by filling in the extraction framework information of each study. Data synthesis comprises the categorization of the data. The analysis takes place from the perspective of three factors of access to health: enabling factors, health needs, and individual health behaviors. Data analysis comprises the application of quantitative measures in the data overview and subsequent qualitative analysis of the major categories. The review will present a narrative summary of the findings. The protocol was built based on the instructions from the Joanna Briggs Institute Scoping (JBI) Reviews Manual. Reports follow the Scoping Reviews framework PRISMA-ScR. Discussion: Findings will provide subsidies to improve healthcare services for transgender persons, construct public policy in the Latin American region, and further scientific production. Protocol registration number osf.io/7rjat/

Ex-ante moral hazard and health insurance: Evidence from China's urban residence basic medical insurance scheme.

This study examines whether implementing Urban Residents Medical Insurance Scheme decreased an individual's risky lifestyle behavior before illness, termed ex-ante moral hazard. Ex-ante moral hazard is predicted by the classical economic theory suggesting that health insurance coverage reduces an individual's incentive to take preventive efforts to remain healthy. Studies have provided mixed evidence for this prediction. China's 2006 nationwide social experiment of implementing the Urban Residents Basic Medical Insurance Scheme offers an excellent opportunity for examining the effect of the transition from uninsured to insured on an individual's health behaviors. We exploit the longitudinal dimension of a representative survey data for 2007-2010 and employ the instrumental variable technique, thereby addressing the issue of self-selection into voluntary health insurance schemes. The results do not provide evidence for and contrast the prediction of the ex-ante moral hazard. Significant differences exist between insured and uninsured groups with respect to smoking, drinking habits, and being overweight. People with insurance care more about their health than people without insurance do. The main results still hold if we use alternative estimation methods and other robustness tests.

Association of COVID-19 Government-Instituted Mask Mandates With Incidence of Mask Use Among Children in Alberta, Canada

To help prevent the spread of SARS-CoV-2, government-instituted nonpharmaceutical interventions (eg, social distancing, mask use, isolating), a provincewide government-instituted mask mandate occurred on December 8, 2020, in Alberta, Canada, although some local jurisdictions implemented an earlier mask mandate. There remains a limited understanding of the association between government-implemented public health measures and individual health behaviors of children. To examine the association between government mask mandates and mask use among children in Alberta, Canada. A cohort of children from Alberta, Canada, was recruited to examine longitudinal SARS-CoV-2 serologic factors. Parents were prospectively asked about their child's mask use in public places every 3 months (5-point Likert scale: never to always) from August 14, 2020, to June 24, 2022. A multivariable logistic generalized estimating equation was used to examine government mandatory masking mandates and child mask use. Child mask use was operationalized into a single composite dichotomous outcome by grouping parents who reported their child often or always wore a mask vs those who reported their child never, rarely, or occasionally wore a mask. The primary exposure variable was the government masking mandate (began on different dates in 2020). The secondary exposure variable was government private indoor and outdoor gathering restrictions. The primary outcome was parent report of child mask use. A total of 939 children participated (467 female [49.7%]; mean [SD] age, 10.61 [1.6] years). The odds of parents' report of child mask use (often or always) was 18.3 times higher (95% CI, 5.7-58.6; P < .001; risk ratio, 1.7; 95% CI, 1.5-1.8; P < .001) with the mask mandate on compared with the mask mandate off. There was no significant change in mask use over the course of the mask mandate due to time. In contrast, each day with the mask mandate off was associated with a 1.6% decrease in mask use (odds ratio, 0.98; 95% CI, 0.98-0.99; P < .001). The results of this study suggest that government-mandated mask use and providing the public with up-to-date health information (eg, case counts) is associated with increased parent-reported child mask use, while increasing time without a mask mandate is associated with decreased mask use.

The Role of Wellness Climate in Small Business Health Promotion and Employee Wellbeing.

Wellness involves physical, emotional, behavioral, social, and spiritual dimensions. A climate for wellness exists at both the psychological and organizational levels, consisting of individual and shared perceptions of policies, structures, and managerial behavior that support or promote employee wellbeing. This study explored the associations between psychological and organizational wellness climate and the effectiveness of a team health promotion training on employees' perceived physical and mental wellbeing and substance use. Employees from 45 small businesses completed self-report measures of wellness climate, wellbeing, positive unwinding behavior, work-family conflict, job stress, drug use, and alcohol use, assessed before, and one and six months after, attending either of two types of onsite health promotion training. Team Awareness training targeted improvements in the social climate at work. Healthy Choices training targeted individual health behavior. A control group did not receive training until after the study. Businesses were randomly assigned to conditions and data were analyzed using multi-level modeling. Models that included wellness climate as a mediator fit the data significantly better than models without climate as a mediator. Team Awareness participants showed greater improvements in wellness climate and wellbeing compared to the control group. Healthy Choices participants showed no changes in climate and no mediation effects of climate. Health promotion efforts may be enhanced by including wellness climate as a target in program design at multiple levels.

Statistical Approaches for the Analysis of Combined Health-Related Factors in Association with Adult Cognitive Outcomes: A Scoping Review.

Dementia prevention is a global health priority, and there is emerging evidence to support associations between individual modifiable health behaviors and cognitive function and dementia risk. However, a key property of these behaviors is they often co-occur or cluster, highlighting the importance of examining them in combination. To identify and characterize the statistical approaches used to aggregate multiple health-related behaviors/modifiable risk factors and assess associations with cognitive outcomes in adults. Eight electronic databases were searched to identify observational studies exploring the association between two or more aggregated health-related behaviors and cognitive outcomes in adults. Sixty-two articles were included in this review. Fifty articles employed co-occurrence approaches alone to aggregate health behaviors/other modifiable risk factors, eight studies used solely clustering-based approaches, and four studies used a combination of both. Co-occurrence methods include additive index-based approaches and presenting specific health combinations, and whilst simple to construct and interpret, do not consider the underlying associations between co-occurring behaviors/risk factors. Clustering-based approaches do focus on underlying associations, and further work in this area may aid in identifying at-risk subgroups and understanding specific combinations of health-related behaviors/risk factors of particular importance in the scope of cognitive function and neurocognitive decline. A co-occurrence approach to aggregating health-related behaviors/risk factors and exploring associations with adult cognitive outcomes has been the predominant statistical approach used to date, with a lack of research employing more advanced statistical methods to explore clustering-based approaches.

The Association of Neighborhood Characteristics and Frailty in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort Study.

Childhood cancer survivors experience reduced physiologic reserve, or frailty, earlier and more frequently than peers. In other populations, frailty is impacted by one's neighborhood. This study's purpose was to evaluate associations between neighborhood characteristics and frailty in childhood cancer survivors. Participants in the St. Jude Lifetime Cohort Study with geocoded residential addresses were analyzed. Pre-frailty/Frailty was defined as having 1-2/≥3 of sarcopenia, muscle weakness, poor endurance, slow walking speed, and exhaustion from direct assessments. Neighborhood characteristics [e.g., access to exercise opportunities and healthy food, neighborhood socioeconomic status (nSES), and rurality/urbanicity] were determined using publicly available geospatial data. Nested multivariable logistic regression models identified associations between neighborhood characteristics and pre-frailty/frailty, adjusting for chronic health conditions, individual health behaviors and socio-demographics, and high-risk cancer treatment exposures. For our cohort (N = 3,806, 46.79% female, 81.40% white, mean age 33.63±9.91 years), compared with non-frail survivors (n = 2,573; 67.6%), pre-frail (n = 900; 23.6%) and frail survivors (n = 333; 8.7%) were more likely to live in neighborhoods with decreased exercise opportunities (frail OR: 1.62, 1.26-2.09), reduced healthy food access (pre-frail OR: 1.28, 1.08-1.51; frail OR: 1.36, 1.06-1.75), and lower nSES (pre-frail OR: 1.31, 1.12-1.52; frail OR: 1.64, 1.30-2.07). Participants had 8% increased odds (95% confidence interval, 2%-14%) of being pre-frail/frail if they lived in "resource poor" neighborhoods as opposed to "resource rich" neighborhoods after adjusting for other pre-frailty/frailty risk factors. The neighborhood a childhood cancer survivor resides in as an adult is associated with pre-frailty/frailty. This study provides valuable information for creating interventions using neighborhood-level factors to mitigate frailty and improve health outcomes in survivors. See related commentary by Bhandari and Armenian, p. 997.

SARS-CoV-2 seroprevalence and living conditions in Bamako (Mali): a cross-sectional multistage household survey after the first epidemic wave, 2020

ObjectivesIn low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports...

The State of Health and Intentions for Action to Advance Mental Health and Well-being for the Nursing Workforce.

The aims of this study were to explore the health of nurse leaders and assess intentions to integrate workplace mental health/wellness practices. National efforts address high rates of poor mental health and lifestyle behaviors among nurses. Few studies describe the extent to which nurse leaders in academic and clinical environments can influence a strategic mission for health/well-being among the nursing workforce. Two hundred seventeen email invitations were distributed to nurse leaders from 5 Kentucky nursing organizations to complete a 1-time 46-item online survey assessing individual health behaviors and intentions to build a culture of workplace health/well-being. Most respondents reported positive physical health (86%), positive mental health/intentions for action to change behaviors (80%), improved self-care practices (86%), integration of self-care practices in the workplace (79%), and commitment to integrate suicide prevention training (55%). Overall, nurse leaders reported positive healthy behaviors. The finding that the highest intentions were reported to integrate, sustain, and/or advance lifestyle behaviors for self-care practices as well as to integrate practices for mental health and well-being in the work environment is encouraging. Enhanced strategies and efforts are needed to prioritize workplace cultures of wellness to benefit nurses and further promote well-being among nurse leaders.

The path to good health: Shifting the dialogue and promoting social ecological thinking

The purpose of our research was to assess whether an intervention could produce changes in critical consciousness (CC) relative to participants' understanding of social influences on health and individual health behaviors. The intervention was a 4-min animation, entitled The Path to Good Health , that described how factors in our social environment influence individuals in a variety of ways and thereby our health. We used the same sampling and intervention strategies with two discrete cohorts of participants (Initial study: June 2018, n = 249; Retest study: October 2019, n = 315), who were recruited and incentivized through Amazon's Mechanical Turk platform. We measured direction and extent of change from pre-to post-intervention in four key constructs of CC (Passive Adaptation, Emotional Engagement, Cognitive Awakening, and Intentions to Act) using the 4-Factor Critical Consciousness Scale (4-FCCS), and we investigated differential effects of the intervention related to demographics of participants, including political typology. We also assessed concurrent and predictive validity of the (4-FCCS). Changes of CC subscale scores from pretest to posttest moved in the expected direction in both the Initial and Retest studies; Cohen's d effect sizes were medium to very large in both studies. Overall, findings suggest the video intervention was effective at improving CC among participants drawn from the general population. We demonstrated that it is possible to influence people's cognitive-emotional interpretations in as little as 4 min, regardless of one's political ideology, and that the (4-FCCS) is sufficiently sensitive to measure changes in CC. This study provides preliminary evidence that a brief intervention can broaden cognitive-emotional interpretations from an over-emphasis on personal responsibility for individual health to an appreciation of the impact of social ecological factors on population health.

Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15years (2002-2017).

frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. population-based cohort study. communities in England. in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

Discerning conversational context in online health communities for personalized digital behavior change solutions using Pragmatics to Reveal Intent in Social Media (PRISM) framework

BackgroundOnline health communities (OHCs) have emerged as prominent platforms for behavior modification, and the digitization of online peer interactions has afforded researchers with unique opportunities to model multilevel mechanisms that drive behavior change. Existing studies, however, have been limited by a lack of methods that allow the capture of conversational context and socio-behavioral dynamics at scale, as manifested in these digital platforms. ObjectiveWe develop, evaluate, and apply a novel methodological framework, Pragmatics to Reveal Intent in Social Media (PRISM), to facilitate granular characterization of peer interactions by combining multidimensional facets of human communication. MethodsWe developed and applied PRISM to analyze peer interactions (N = 2.23 million) in QuitNet, an OHC for tobacco cessation. First, we generated a labeled set of peer interactions (n = 2,005) through manual annotation along three dimensions: communication themes (CTs), behavior change techniques (BCTs), and speech acts (SAs). Second, we used deep learning models to apply our qualitative codes at scale. Third, we applied our validated model to perform a retrospective analysis. Finally, using social network analysis (SNA), we portrayed large-scale patterns and relationships among the aforementioned communication dimensions embedded in peer interactions in QuitNet. ResultsQualitative analysis showed that the themes of social support and behavioral progress were common. The most used BCTs were feedback and monitoring and comparison of behavior, and users most commonly expressed their intentions using SAs—expressive and emotion. With additional in-domain pre-training, bidirectional encoder representations from Transformers (BERT) outperformed other deep learning models on the classification tasks. Content-specific SNA revealed that users’ engagement or abstinence status is associated with the prevalence of various categories of BCTs and SAs, which also was evident from the visualization of network structures. ConclusionsOur study describes the interplay of multilevel characteristics of online communication and their association with individual health behaviors.

Factors Associated with Aging in Place among Community-Dwelling Older Adults in Korea: Findings from a National Survey.

Ever since baby boomers started turning 65 years old in 2020, Korea is set to become a super-aged society by 2025. This makes it the world's fastest-aging society. Aging in place (AIP) has become a policy direction to prepare for an aging society and improve older adults' quality of life. It refers to the ability of older adults to remain in their homes and communities as they age, allowing them to reside in their place of preference and access the services they require to promote their quality of life. A cross-sectional study design was employed using data sampled from the 2020 National Survey of Older Koreans. In total, 9930 older adults (aged between 65 and 99 years old) participated. The results confirmed that the intention to pursue AIP is related to personal factors (education, income, house ownership, smoking, exercise, depression), interpersonal and communal factors (unmet healthcare needs, need for home care services, family contact), and policy level factors (basic pension beneficiary, long-term care services) using an ecological model. The findings may promote individual health behaviors and help fill the gap between unmet healthcare needs and community care services that positively influence older adults' AIP.

Increased female political representation associated with lower county-level uninsured and preventable hospitalizations rates in the United States, 2013–2018

ObjectiveAlthough women comprise 50% of the population, females remain underrepresented in government. Inequitable female political representation, a form of structural sexism, may impact population health. Previous studies focused primarily on individual health behaviors and low- or middle-income countries. To date, no study has examined the association between female political representation and healthcare access and utilization, immediately policy-amenable outcomes, in the United States. Study designThis was a repeated cross-sectional study. MethodsThis study uses 2013–2018 county-level data from the County Rankings. I performed multilevel analyses to determine the relationships between state-level female representation (% female state legislators) and two outcomes—the percentage of county-level population under age 65 years without health insurance (primary outcome) and the county-level preventable hospitalization rates (secondary outcome of interest). Potential confounders included county-level and state-level characteristics such as the unemployment rate. I also examined whether associations differed by political party control of the state legislature. ResultsIn the fully adjusted model, one standard deviation difference in female political representation was associated with a decrease of 0.22 percentage points in county-level uninsured (95% confidence interval = −0.32, −0.12). The association between female political representation and preventable hospitalization rate differed according to state political party in control, with a decrease found only among counties in democratic/split controlled states (−80.51, 95% confidence interval = −149.65, −11.38). ConclusionsThe results suggest that policy intervention addressing the underrepresentation of women in government may help increase the proportion of uninsured and, under certain circumstances, decrease county-level unnecessary hospitalizations. However, further research is needed to better understand the role of political party control in modifying noted associations.

The Impact of Age on the Health Locus of Control in Different Cultural Contexts during the Covid-19 Pandemic

The current study analyzes the impact of age life cycles on the Health Locus of Control construct in different cultural contexts during the Covid-19 pandemic. The purpose is to examine whether different age categories impact the health behavior of individuals and change the Internal Health Locus of Control (IHLC), Powerful Others Health Locus of Control (PHLC), and Chance Health Locus of Control (CHLC) during the outbreak in Asia and Europe of the Covid-19 pandemic. A total of 2617 respondents aged 18–80 from Asia and Europe completed an online version of the Multidimensional Health Locus of Control Scale – Form A. To examine the impact of age on the Health locus of control construct, the study participants were divided into three age groups: up to 35, from 36 to 50, and over 50. Data analysis reveals that along with the influence of cultural context on the Health locus of control construct, age periods also impact and change IHLC, PHLC, and CHLC levels. Respondents from Asia, under the age of 35 and in mature adulthood, have a strong tendency to rely on themselves (IHLC) in the regulation of their health behavior. Europeans, compared to Asians, have consistently lower IHLC levels throughout the life cycle. Results also yield differences in relation to PHLC: Europeans, compared to Asians, are less likely to trust powerful others at an early age, while in adulthood, the health control by powerful others increases dramatically. Data analysis also shows that young Asians tend to rely on chance, fate, or luck (CHLC), however, this tendency is not observed among young Europeans. The opposite trend is observed with age: while in Asian culture levels of CHLC decrease with age, in European contexts, these levels increase.

Disparities in Perceived Physical and Mental Wellness: Relationships Between Social Vulnerability, Cardiovascular Risk Factor Prevalence, and Health Behaviors Among Elderly US Residents.

Cardiovascular disease (CVD) is the leading cause of death for males, females, and people of most racial and ethnic groups in the United States. In addition to known epidemiological and behavioral risk factors, recent evidence suggests that circumstantial or behavioral factors may also be associated with CVD. This study evaluates the contribution of cardiovascular disease (CVD) risk factors, community vulnerabilities, and individual health behaviors to individual physical and mental wellness among Black and White, male, and female Medicare beneficiaries. This study utilized data from the Behavioral Risk Factor Surveillance System, county-level CVD risk factor prevalence, and selected items from the Social Vulnerability Index. Correlations were found between unhealthy days reported by males and area social vulnerabilities and health behaviors. Prevalence of disease was correlated with mentally unhealthy days for White males. Among White females, health behaviors, disease prevalence, and social vulnerability measures were associated with unhealthy days. Among Black females, disease prevalence was highly correlated with mentally unhealthy days. While individual-level health behaviors are highly associated with perceived physical and mental health, the self-reported health of Black respondents is also heavily correlated with local area vulnerabilities, including community poverty, group housing, and crowding.

The effects of information framing on self-protective behavior: Evidence from the COVID-19 vaccine uptake.

The Healthy China 2030 strategy outlines the government's plans for healthcare reform, emphasizing the need for increased awareness about infectious diseases to prevent and fight future infections. Information campaigns can be used as a medium to raise awareness and encourage citizens' willingness to protect themselves against diseases, such as COVID-19. Extant studies have found that individual health behavior decision-making can be changed under different information frames. However, limited evidence is available about emerging infectious diseases. Based on the Prospect Theory and Theory of Planned Behavior, the impact of information frames on self-protective behavior-vaccination against COVID-19 is investigated in this study. A 2(gain/loss frame)*2(factual/emotional frame) intergroup experimental design was designed to explore the effects of different information frames. 228 valid participants in China were recruited and the experiment was performed online. First, the gain frame was more effective in promoting public self-protection behavior than the loss frame under information frame intervention. Compared with the factual frame, the emotional frame is more effective in reducing individual risk perception. Second, perceptual behavior control has masking effects on self-protection behavior under the influence of the gain/loss frame. Third, age, subjective norms, attitudes, and the gain frame, have predictive effects on self-protection behavior. This study provides empirical evidence on the impact of information framing interventions on public self-protection behavior during the COVID-19 pandemic and provides important practical implications for public administrators and media practitioners.

Intensive longitudinal mediation in Mplus.

Much of the existing longitudinal mediation literature focuses on panel data where relatively few repeated measures are collected over a relatively broad timespan. However, technological advances in data collection (e.g., smartphones, wearables) have led to a proliferation of short duration, densely collected longitudinal data in behavioral research. These intensive longitudinal data differ in structure and focus relative to traditionally collected panel data. As a result, existing methodological resources do not necessarily extend to nuances present in the recent influx of intensive longitudinal data and designs. In this tutorial, we first cover potential limitations of traditional longitudinal mediation models to accommodate unique characteristics of intensive longitudinal data. Then, we discuss how recently developed dynamic structural equation models (DSEMs) may be well-suited for mediation modeling with intensive longitudinal data and can overcome some of the limitations associated with traditional approaches. We describe four increasingly complex intensive longitudinal mediation models: (a) stationary models where the indirect effect is constant over time and people, (b) person-specific models where the indirect effect varies across people, (c) dynamic models where the indirect effect varies across time, and (d) cross-classified models where the indirect effect varies across both time and people. We apply each model to a running example featuring a mobile health intervention designed to improve health behavior of individuals with binge eating disorder. In each example, we provide annotated Mplus code and interpretation of the output to guide empirical researchers through mediation modeling with this increasingly popular type of longitudinal data. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Drivers of smoking and physical activity in Russia: Do individual time preferences matter?

This article analyzes the relationship between individual decisions to smoke and to do physical exercises. It is assumed that individual time preferences play a major role in explaining individual health behavior. The database is the special survey of Russians’ lifestyle conducted in 2017. A multivariate probit model with endogenous binary variable enables to analyze the relationship between smoking, doing physical exercises, and individual time preferences. Individual time preferences are determined through a hypo­thetical money experiment. An individual discount rate is used as a proxy for the rate of time preferences. We reveal that there is a negative relationship between smoking and doing physical exercises because of unobservable factors. It might be an individual inclination to follow a healthy or unhealthy lifestyle. There is a negative influence of the higher individual discount rate on doing physical exercises and a positive in­fluence of the higher individual discount rate on smoking. Social policy should accentuate the short-term benefits from smoking cessation and regular physical exercises rather than probable future health improvements. For target groups with the higher individual discount rate, highlighting the short-term negative consequences of avoiding healthy behaviors will be more effective than drawing attention to future health risks.

Diné teachings and public health students informing peers and relatives about vaccine education: Providing Diné (Navajo)-centered COVID-19 education materials using student health messengers.

On 9 April 2021, the Centers for Disease Control and Prevention (CDC) reported that only 19. 9% of United States (US) adults were fully vaccinated against COVID-19. In that same week, the Navajo Nation (NN) reported that 37.4% of residents were fully vaccinated, making the NN a leader in the uptake of COVID-19 vaccines. Despite high vaccination rates, vaccine hesitancy exists within the NN. The Diné (Navajo) Teachings and Public Health Students Informing Peers and Relatives about Vaccine Education (RAVE) intervention was designed to utilize trusted health messengers as an effective means to address adults' vaccine concerns and hesitancy. The research team used COVID-19 vaccine materials developed in a previous collaboration with non-Navajo tribal communities and publicly available materials. Diné Traditional Knowledge Holders (TKHs) were interviewed to develop and incorporate Diné-specific information on individual and collective health behaviors into the RAVE materials. These drafted health education materials were presented to NN community health representatives (CHRs) and Diné public health students using a consensus panel approach. NN residents who participated in the intervention completed a 16-element retrospective pretest. The adaptation and tailoring process of materials yielded 4 health education materials. The students recruited 46 adults for health education sessions. These participants then completed the retrospective pretest. Changes in the 16 elements were in the desired direction, although only six were significant: four related to attitudes and two concerned with vaccination intention. Participants were more likely to consider vaccination and to try to get vaccinated after the education session. Trusted messengers and culturally centered materials have been identified as effective means of health behavior education with Native American audiences. RAVE applied these intervention elements by (1) training Diné College public health students to leverage their cultural knowledge and social relationships (cultural and social capital) to recruit vaccine-hesitant adults and provide education; (2) building on previous understanding of Native American communities' vaccine concerns; and (3) integrating Diné perspectives on individual and collective health into the adaptation of materials designed for general audiences; this knowledge was gained from interviews with TKHs.