Maintaining Health Behaviors Research Articles

The mediating role of health behaviors in the relationship between internal locus of control and life satisfaction in public health students

Well-being is a continuous process requiring decisions and actions to maintain or build health. This study examines the indirect effect of health locus of control on life satisfaction via healthy behaviors based on living systems theory. Participants were 730 students of various majors related to medicine and health, aged between 19 and 30 (M = 22.29, SD = 1.64), including 79.04% women. Self-report measures were used to assess life satisfaction, multidimensional health locus of control, and health behavior. Women scored higher than men on the total health behavior scale, especially in a healthy diet and preventive behavior. Men scored higher than women on internal health locus of control (HLC), while women scored higher than men on the powerful others HLC in making decisions about their health. The study confirmed the mediating effect of healthy behavior on the relationship between the internal HLC and life satisfaction. The present mechanism highlights the crucial role of internal motivation in increasing subjective well-being by maintaining health behaviors among young adults. The role of intervention programs focused on improving internal HLC and health behaviors is discussed.

Trajectories of health behaviors during the COVID-19 pandemic: a longitudinal analysis of handwashing, mask wearing, social contact limitations, and physical distancing

Aim This study aimed to investigate the associations between health behavior adherence and psychological factors during the COVID-19 pandemic, with a particular focus on identifying trajectories of handwashing, mask wearing, social contact limitations, and physical distancing. Methods We employed a multi-trajectory group-based approach to analyze data from 6026 Belgian residents, including 60% women, with an average age of 52.65. Data were collected over six waves spanning from April 2021 to December 2021. Results Participants were categorized into trajectory groups based on persistently low (11.9%), moderate-low (20.9%), moderate-high (39.1%), and high (28.1%) levels of adherence to the specified health behaviors. Our findings indicate a declining trend in health behavior adherence over the study period. Additionally, we observed that females, older individuals, and those with prior COVID-19 infection had a higher likelihood of belonging to trajectory groups characterized by the highest levels of health behavior adherence. Similarly, individuals with positive vaccination intentions, a heightened perception of consequences, and increased health anxiety demonstrated greater adherence to health behaviors over time. Furthermore, our investigation into the relationship between health behaviors and mental health revealed that participants in trajectory groups with higher levels of adherence to social contact limitations and physical distancing reported increased feelings of loneliness and decreased life satisfaction. Conclusions The COVID-19 pandemic has reshaped our lives, and while vaccines have marked progress, maintaining health behaviors is crucial for virus prevention. To address potential mental health challenges from sanitary measures, policies and communication should promote health behaviors while acknowledging their psychological impact.

SOCIAL DISTANCING POLICY AS A MEANS OF IMPROVING PUBLIC AWARENESS DURING COVID-19 PANDEMIC: A LITERATURE REVIEW

To reduce COVID-19 transmission during the epidemic, most countries implemented a social distancing policy. However, without the people's compliance, this implementation will be useless. The combination of individual and environmental variables is critical to the success of initiating and maintaining health behaviors. The purpose of this study is to assess public participation toward obedience social distancing policy as a means of improving public awareness during COVID-19 pandemic. A literature review was used in this research. PubMed, Google Scholar, and ProQuest, with a cut-off date of 29 June 2021, were used to do an electronic search with no language constraints. There were ten included studies. Several research looked at the impact of combining social distancing strategies with other interventions such as school closure, reduced contact with the community, antiviral treatment and prophylaxis, and immunization. This study proves that social distancing has a good effect if the general public implements it well. More research is needed to determine the factors that influence the efficacy of social distancing strategies. In order for the community to comply with social distancing policies during the epidemic, the government must also be more aggressive in pursuing policy violators.

51-OR: Anxiety and Changes in Health Care Access and Health Behaviors during COVID-in Southwest Tribal Community Patients with Prediabetes and Diabetes

Objective: The impact of COVID-has been devastating to many, but particularly to rural populations of American Indians from Zuni Pueblo who suffer multiple vulnerabilities which places them at greater risk for infection and death. Very little is known about the change in health behaviors owing to the COVID pandemic among a chronically ill (diabetes) rural Zuni population. We evaluated the anxiety and stress about COVID-contributing to poorer mental health outcomes in Zuni Indians with PreDM and T2DM. Methods: We conducted a survey among individuals with hyperglycemia in Zuni Indians. There were 300 participants who responded to the survey, of which 193 participants also had baseline clinical health data. Results: Those with T2DM experienced higher pandemic-related anxiety than those with pre-DM (+3.9 vs. -0.6, p=0.0616, on a scale -30 to +30) . Those with T2DM were more likely to report decreased physical activity (54% vs. 44%) , decreased frequency in lab testing (21% vs. 10%) , and increased virtual contact with providers (61% vs. 48%) during the pandemic. We conducted regression analyses to describe correlations of anxiety and weight change with the changes in health behaviors. We found that participants with improved diet and exercise during the pandemic were less likely to experience weight gain (OR= 0.78, p=0.0017 and OR=0.75, p=0.0094, respectively) . We also found that those who reported worsening health care during the pandemic experienced increased anxiety (+4.9, p=0.0049) . Conclusion: Our study provides important insights into (unintended) consequential effect of COVID crisis in rural Zuni which will contribute to a better understanding of how to preserve mental health and maintain health behaviors in patients with diabetes during the pandemics. Disclosure J.Reno: None. Y.Zhu: None. V.Shah: n/a. Funding National Institute of General Medical Sciences of the National Institutes of Health (P20GM103451)

Individually Tailoring Messages to Promote African American Men’s Health

ABSTRACT In this paper, we describe our approach to individualizing messages to promote the health of middle-aged and older heterosexual, cisgender African American men. After arguing the importance of being population specific, we describe the process we use to increase the salience of health messages for this population by operationalizing the identity concepts of centrality and contextualization. We also present a measure of African American manhood and discuss how manhood is congruent with qualitative research that describes how African American men view their values, identities, goals, and aspirations in ways that can be utilized to create more meaningful and impactful messages to promote and maintain health behaviors. Our tailoring strategy uses an intersectional approach that considers how the centrality of racial identity and manhood and the salience of religiosity, spirituality, and role strains may help to increase the impact of health messages. We highlight the need to consider how the context of health behavior and the meaning ascribed to certain behaviors are gendered, not only from a man’s perspective, but also how his social networks, behavioral context, and the dynamic sociopolitical climate may consider gendered ideals in ways that shape behavior. We close by discussing the need to apply this approach to other populations of men, women, and those who are non-gender binary because this strategy builds from the population of interest and incorporates factors that they deem central and salient to their identities and behaviors. These factors are important to consider in interventions using health messages to pursue health equity.

Validation of the French-Canadian Version of a Short Questionnaire to Assess Knowledge in Cardiac Patients (CADE-Q SV).

The long-term success of cardiac rehabilitation programs rests in part on the patient's ability to maintain health behaviors, which is influence by the patient education received. Therefore, a short and reliable tool to assess patients' knowledge is warranted. The aim of this study was to translate, culturally-adapt and psychometrically validate the French-Canadian version of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). The French CADE-Q SV - translated and culturally-adapted - was reviewed by 3 bilingual experts in cardiovascular disease. This version was then psychometrically tested in 115 CR patients in two Canadian provinces (Québec and New Brunswick). The questionnaire was completed at patients' first CR session and in the end of their 6-month program to assess interpretability. The internal consistency was assessed using Kuder-Richardson-20 (KR-20) and Cronbach's alpha, factor structure using confirmatory factor analysis, and criterion validity regarding level of education and family income. KR-20 was 0.72. Factor analysis revealed 5 factors, all internally consistent. Criterion validity was supported by significant differences in total scores by educational level and family income (p < 0.05). Results showed that increases in knowledge can moderately increase mean steps per day and peakVO2, with an MCID of 3.00. The overall mean was 15.7 ± 2.0. The area with the highest knowledge was risk factors and the lowest was psychosocial risk. The French-Canadian CADE-SV was demonstrated to have good validity and reliability.

Implications and Recommendations for Research, Education, and Practice

Throughout this symposium, we have advocated for increased attention to how the chronicity and complexity of older adults’ health might impact their ability to maintain health behaviors over time. This final presentation will explore some implications of this chronicity and complexity on research study designs, formal education and professional training, and routine clinical practice. For example, existing research designs and funding mechanisms such as tightly controlled randomized controlled trials within a five-year grant may not permit researchers to study behaviors over an extended period of time and to do so within the real-world environments and social contexts in which older adults live. In contrast, integrating principles of community-engaged and participatory research, adaptive designs, pragmatic trials, and implementation science may encourage researchers to design for widespread dissemination. This session will close with recommendations to enhance educational initiatives and professional development to promote cross-disciplinary teams.

Maintenance of Health Behaviors: Exploring the Construct and Its Implications on Research, Education, and Practice

Modifying health behaviors, including diet, physical activity, sleep, and/or medication adherence, can have a range of positive effects on older adults’ overall health, function, and well-being. Although many evidence-based programs exist to support the initiation of health behavior changes, few address longterm maintenance. Emerging research suggests initiation and maintenance are distinct constructs, each requiring unique skills. Furthermore, maintaining health behaviors depends upon health promotion programs that are sustained, or continually delivered with high fidelity, at community and population levels. The objective of this symposium is to present findings from a series of research projects designed to investigate the concept of behavior change maintenance. Activities were supported by NIA Research Centers Collaborative Network (RCCN) funding and included community listening sessions plus an interdisciplinary think tank of national thought leaders. This symposium will begin with an overview of health behavior change, including the rationale for studying maintenance as a critical yet overlooked phase of successful behavior change (J. Hughes). A proposed conceptual model of maintenance will then be discussed, including constructs distinguishing maintenance from initiation (Raj). These introductory presentations will be followed by a discussion of multi-level barriers and facilitators related to maintenance on individual, community, and population levels (S. Hughes). The session will close with implications for research, education, and practice (Bettger).

Associations Between Physical Activity and Living Alone: Are There Differences by Gender?

Nearly one in three adults aged 65 and older live alone in the U.S. Despite this increasing trend, there remains little understanding regarding the relationship between living alone and physical activity (PA) in older adulthood. Is living alone a risk factor for lower levels of PA among older adults? The effects of living arrangements on health behaviors could differ by gender; however, findings from prior studies on this topic have been mixed or inconclusive. This is one of few studies to examine whether PA is associated with living alone (vs. living with others) and whether the association differs by gender using longitudinal data. Our data were drawn from 2006-2014 Psychosocial and Lifestyle Questionnaire of the Health and Retirement Study, a nationally representative sample of older adults in the U.S. (N=17371, mean age=75.4). PA was measured repeatedly using metabolic equivalents of task (MET) estimated values accounting for the vigor and frequency of self-reported PA (range 0-31). Using mixed-effects linear regression, we found that living alone was significantly associated with higher levels of PA (Coeff.: 0.41, p<0.001). When examined separately by gender, living alone was associated with significantly higher PA among women (Coeff.: 0.47, p<0.001) but not among men (Coeff.: 0.29, p=0.14) after controlling for marital status, other sociodemographic characteristics, and health-related indicators. Our study provides evidence of gendered differences in initiating and maintaining health behavior change in relation to living arrangements. Findings provide implications for the design of PA promotion programs and policies for older adults.

Validity and Reliability Study of the Turkish Version of Multiple Sclerosis Self-Management Scale

This study aimed to establish the equivalence, reliability, and validity of the Multiple Sclerosis Self-Management Scale Turkish Version (MSSM-T). This methodological study consisted of 240 multiple sclerosis (MS) patients who were followed in an outpatient clinic of a university hospital between October 2016 and April 2017. Data were collected using the demographic characteristics form and the 24-item MSSM-T. Language equivalence, content validity, and construct validity methods were used for the validity of the scale; internal consistency, item analysis, and test-retest methods were used for the reliability. Explanatory factor analysis was used for construct validity, and principal component analysis and varimax rotation were used in the analysis of factor structure. The item-total correlations for the Turkish version were found to be sufficient (between 0.238 and 0.674). The Cronbach α reliability coefficient was 0.85, indicating high reliability. The test-retest reliability coefficient was 0.84, indicating high consistency. The Turkish version was found to have 5 factors for the 24 items (F1, healthcare provider relationship/communication; F2, knowledge and information about MS; F3, treatment adherence/barriers; F4, maintaining health behavior; and F5, social/family support), which accounted for the 62.584% of the characteristics in question. The MSSM-T is valid and reliable in determining the self-management behaviors of patients with MS for Turkish patients.

Evaluation of a Self-Care Intervention to Improve Student Mental Health Administered through a Distance-Learning Course

ABSTRACTBackground: Graduate training is a high-risk period for worsening mental health. Previous research reported the effectiveness of a classroom-based self-care intervention for graduate students. Purpose: The study evaluated the effectiveness of an online self-care intervention for graduate-level students to prevent worsening mental health. Methods: Participants were 187 students in public health. The intervention consisted of behavior change assignments designed to increase health-promoting behaviors within four domains (nutrition, physical activity, mental health, social support). Students received bonus points for maintaining health behaviors for the duration of the 12-week semester. Outcomes included measures of nutrition, physical activity, depression, anxiety, and perceived stress. The study employed a control group of students not enrolled in the course (n = 29). Results: Health promotion behaviors increased over the course of the semester (ps<.001), with the largest effect sizes for increases in fruit and vegetable intake and physical activity. Improvements in self-reported health were reported. Control students reported no improvements. Discussion: The study provides support for the utility of a brief self-care intervention for students in the health sciences. Translation to Health Education Practice: This disseminable intervention can support student well-being in a variety of academic programs.A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Racial Differences in Maintaining Optimal Health Behaviors Into Middle Age

Earlier development of cardiovascular disease risk factors in blacks versus whites may result from differences in maintaining health behaviors. Age-specific racial differences in maintaining health behaviors from ages 18 to 50 years were determined. In 1985-1986, the population-based Coronary Artery Risk Development in Young Adults study enrolled 5,115 participants aged 18-30 years. In 2017, a total of 2,485 blacks and 2,407 whites with one or more optimal health behaviors at baseline who attended one or more of seven follow-up exams over 25 years (i.e., through 2010-2011) were analyzed. The primary outcome, maintaining four or more optimal health behaviors, included BMI <25; never smoking; ≥150 minutes/week of moderate to vigorous physical activity; no/moderate alcohol intake (women/men: zero to seven/zero to 14 drinks per week); and Dietary Approaches to Stop Hypertension diet adherence score ≥15 (i.e., baseline highest quartile). Hazard ratios comparing blacks with whites for maintaining optimal health behaviors were calculated among participants with each optimal behavior at baseline. From ages 18 to 50 years, 2.6% of blacks and 9.2% of whites maintained four or more optimal health behaviors (for optimal BMI: 16.0% and 30.1%, smoking status: 74.6% and 78.4%, physical activity: 17.7% and 21.4%, alcohol intake: 68.4% and 64.6%, diet adherence: 3.9% and 10.3%, respectively). The multivariable adjusted hazard ratio comparing blacks with whites was 0.63 (95% CI=0.56, 0.72) for maintaining four or more optimal health behaviors (for optimal BMI: 0.82 [95% CI=0.66, 1.01], smoking status: 0.57 [95% CI=0.52, 0.62], physical activity: 0.83 [95% CI=0.75, 0.91], alcohol intake: 1.19 [95% CI=1.03, 1.37], diet adherence: 0.71 [95% CI=0.61, 0.82]). Fewer blacks than whites maintained four or more optimal health behaviors until age 50 years, but maintenance was low among both races.

Exploring Childhood Obesity Perceptions Among Caregivers of African American Children

Childhood obesity efforts have been characterized by low levels of caregiver involvement. This qualitative study explores caregiver perceptions about childhood obesity prevention. We conducted 12 in-depth interviews with caregivers of African American children aged 8–11 years. We used thematic analysis to identify consistent patterns of preventing childhood obesity and encouraging healthy behaviors. Four themes emerged including rural culture and the built environment, physical and social health effects of childhood obesity, measuring childhood obesity, and preventive strategies. Caregivers are cognizant of childhood obesity risk factors and discussed challenges in their rural environment when attempting to practice and maintain health behaviors for their children. They also stated that caregivers were vital in preventing childhood obesity. Our findings highlight the value of involving caregivers in the design and implementation of childhood obesity initiatives. Additionally, future childhood obesity efforts should equip caregivers and children with behavioral skills and resources to assist in developing healthy habits.

General and Life-Domain Procrastination in Highly Educated Adults in Israel.

Procrastination is usually perceived as a general behavioral tendency, and was studied mostly in college students in academic settings. Recently there is a growing body of literature to support the study of procrastination in older adults and in different life-domains. Based on these advances in the literature, the present study examined procrastination in 430 highly educated adults in Israel. Findings showed that respondents reported significantly higher procrastination in maintaining health behaviors and spending leisure time rather in other life-domains. Forty percent of participants reported high procrastination in health behaviors, while only 9.5% reported this level of procrastination in parenting and 1% in the general tendency to procrastinate. Further findings suggested that 25% of respondents reported high procrastination in four or more life-domains, and 40%—in one to three life-domains. The general tendency to procrastinate was moderately associated with procrastination in finance, education, and career life-domains and weekly with other life-domains. Fourteen percent of participants reported that procrastination influenced their life the most in health behaviors, 12% in career and education and 11% in romance and family life. These initial findings contribute to the overall perspective of life-domain specificity of procrastination in adults, and emphasize the importance to further study and develop a life-span perspective.

Evaluation of a Behavioral Self-Care Intervention for Public Health Students

ABSTRACTBackground: Postgraduate education is recognized as a time of intense stress. Rates of anxiety and depression are elevated among graduate students, and longitudinal studies have documented increases in clinical symptoms over the course of training. Purpose: The current study was to evaluate whether an academically sponsored self-care intervention would increase engagement in health promotion activities. The primary goal was to determine whether self-care behaviors completed in the midst of a challenging academic program would prevent the worsening of student mental health. Methods: The self-care intervention included behavior change projects designed to increase health-promoting behaviors within 4 domains (nutrition, physical activity, mental health, social support). Students received incentives in the way of bonus points for maintaining health behaviors for the duration of the 12-week semester. Results: Results revealed significant increases in health-promoting behaviors. Importantly, mental health symptoms did not worsen over the course of the semester. Discussion: The study provides preliminary support for the utility of a brief self-care intervention for students in the health sciences. Translation to Health Education Practice: Future studies should examine the applicability of this intervention to students in other fields of study and through online education formats.

Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey.

BackgroundChronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions.ObjectiveThe aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors.MethodsA population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied.ResultsIt was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor’s advice.ConclusionsAlthough there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user’s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions.

교대근무 간호사의 수면, 식생활 행위, 신체활동이 삶의 질에 미치는 영향

Purpose: This study aimed to investigate the associations of sleep, dietary behaviors and physical activity with quality of life among shift-work nurses. Methods: For this cross-sectional descriptive study, data were collected from 191 shift-work nurses in a tertiary hospital. Multiple linear regression analysis was used to identify the relationships among variables. Results: The levels of sleep quality, dietary behaviors and physical activity were low. Factors associated with quality of life among shift-work nurses included sleep disturbance (B=-0.16, β=-0.26, p<.001), dietary behaviors (B=0.28, β=0.24, p<.001), and physical activity (B=0.05, β=0.19, p<.001). The strongest factor was sleep disturbance. Conclusion: In order to improve quality of life among shift-work nurses, it is significant to encourage and maintain health behaviors such as sleep, dietary behaviors and physical activity. Under the circumstances where shift-work cannot be avoided, personal efforts made by nurses to establish their own living standards for positive health behaviors will benefit their quality of life. Key Words: Nurses; Sleep; Feeding behavior; Exercise; Quality of life Key Words: 간호사; 수면; 식생활 행위; ì‹ ì²´í™œë™; 삶의 질

Employee Health Behaviors, Self-Reported Health Status, and Association With Absenteeism: Comparison With the General Population.

To perform a comparison between health behaviors and health status of employees with those of the general population, to evaluate the association between employee health behaviors, health status, and absenteeism. Cross-sectional study enrolled 2433 employees from 16 Korean companies in 2014, and recruited 1000 general population randomly in 2012. The distribution of employee health behaviors, health status, and association with absenteeism were assessed. Employees had significantly worse health status and low rates of health behaviors maintenance compared with the general population. Multiple logistic regression model revealed that regular exercise, smoking cessation, work life balance, proactive living, religious practice, and good physical health status were associated with lower absenteeism. Maintaining health behaviors and having good health status were associated with less absenteeism. This study suggests investment of multidimensional health approach in workplace health and wellness (WHW) programs.

Healthy through Habit: Interventions for Initiating &amp; Maintaining Health Behavior Change

Interventions to change health behaviors have had limited success to date at establishing enduring healthy lifestyle habits. Despite successfully increasing people's knowledge and favorable intentions to adopt healthy behaviors, interventions typically induce only short-term behavior changes. Thus, most weight loss is temporary, and stepped-up exercise regimens soon fade. Few health behavior change interventions have been successful in the longer term. In this article, we unpack the behavioral science of health-habit interventions. We outline habit-forming approaches to promote the repetition of healthy behaviors, along with habit-breaking approaches to disrupt unhealthy patterns. We show that this two-pronged approach—breaking existing unhealthy habits while simultaneously promoting and establishing healthful ones—is best for long-term beneficial results. Through specific examples, we identify multiple intervention components for health policymakers to use as a framework to bring about lasting behavioral public health benefits.

Healthy through habit: Interventions for initiating &amp; maintaining health behavior change

Interventions to change health behaviors have had limited success to date at establishing enduring healthy lifestyle habits. Despite successfully increasing people’s knowledge and favorable intentions to adopt healthy behaviors, interventions typically induce only short-term behavior changes. Thus, most weight loss is temporary, and stepped-up exercise regimens soon fade. Few health behavior change interventions have been successful in the longer term. In this article, we unpack the behavioral science of health-habit interventions. We outline habit-forming approaches to promote the repetition of healthy behaviors, along with habit-breaking approaches to disrupt unhealthy patterns. We show that this two-pronged approach—breaking existing unhealthy habits while simultaneously promoting and establishing healthful ones—is best for long-term beneficial results. Through specific examples, we identify multiple intervention components for health policymakers to use as a framework to bring about lasting behavioral public health benefits.