National Representative Sample Research Articles

Racial, Ethnic, and Immigrant Generational Disparities in Physically Strenuous and Hazardous Work Conditions

Despite the importance of work in adult life, research on the social determinants of health often ignores its effects. We examine race/ethnic, immigrant generational, and gender differentials in exposure to work conditions associated with poor health outcomes, using a nationally-representative sample of adults. On average, Latino 1st generation workers are more exposed to strenuous and hazardous work conditions than other workers, even after adjusting for sociodemographic differences. Exposure is lower for 2nd and 3rd generation Latinos. In contrast, Asian 1st generation men often have the lowest exposure levels of all groups and Asian 2nd and 3rd generation men have higher levels of exposure than the first generation, primarily due to intergenerational differences in education. Asian 1st generation women have higher exposures than those in the 2nd or 3rd generation. These results illustrate the importance of considering work conditions in research and policy related to the social determinants of health.

Long working hours and self-rated health in the national Brazilian working population: gender and employment status differences, 2019

BackgroundThe regulation of working hours is governed by legal standards in formal employment. While the association between long working hours and various health outcomes has been extensively studied, there is limited evidence regarding Brazil. The objective of this study was to investigate the association among working hours, employment status, and self-rated health (SRH), taking into account differences between men and women in a national representative sample of the working population in Brazil.MethodsA cross-sectional study was conducted among a representative sample of 33,713 workers in Brazil to assess self-rated health (SRH). We examined the associations between working hours and employment status, categorizing working hours as standard (40–44 h per week) or long (> 44 h per week), and employment status as formal or informal. Logistic regression models were employed, adjusting for sociodemographic, occupational characteristics, and health behaviors. Probabilities of negative SRH were calculated for men and women in different exposure profiles. Results were stratified by gender, and 95% confidence intervals (CIs) were applied to the findings.ResultsThe prevalence of long working hours was higher among informal workers for both men and women. Adjusted odds ratio (AOR) results revealed that informal employment (AORwomen = 1.53; 95% CI: 1.13–2.07 and AORmen = 1.55; 95% CI: 1.22–1.96) and long working hours (AORwomen = 1.23; 95% CI: 1.06–1.43 and AORmen = 1.14; 95% CI: 1.00-1.30) were independently associated with negative SRH. Significant interactions between long working hours and informal employment were observed. Among individuals with the same exposure profile, women who engaged in long working hours had a higher probability of reporting negative SRH compared to men.ConclusionsThe results of this study are in line with the literature, as differences between men and women in the likelihood of negative self-rated health were observed. The adverse health effects underscore the importance of implementing intersectoral actions to inform the revision of regulations concerning weekly working hours and the expansion of informal employment in low- and middle-income countries.

Inadequate nutrient intake in people with disabilities: National representative sample in Korea

Abstract Background Individuals with disabilities often face significant issues related to nutrition such as food insecurity. However, only few studies have investigated whether people with disabilities have relatively poorer nutritional status than those without disabilities. Methods To compare the differences in the nutritional adequacy of diets between people with and without disabilities, 5296 adults aged ≥19 years from the 2013 Korea National Health and Nutrition Examination Survey were included in the analysis. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 10 nutrients and the corresponding mean adequacy ratio (MAR). A multivariate logistic regression model was used to assess the likelihood of having nutrient inadequacy in people with disabilities. Results NAR for energy, protein, vitamin B2, niacin, calcium, and phosphorus, excluding vitamin A, B1, C, and iron, was significantly lower in people with disabilities compared to in those without disabilities (all P < 0.05). MAR of 10 nutrients was also lower in people with disabilities (P = 0.003). The proportion of overall nutrient inadequacy, defined as having a MAR below 0.75, was 40.6% in people with disabilities versus 27.5% in those without disabilities (P < 0.001). In a multivariate logistic regression model, people with disabilities had a higher odds of having nutrient inadequacy than people without disabilities (odds ratio = 1.53, 95% confidence interval = 1.11-2.11). Conclusions People with disabilities are more likely to not meet nutritional adequacy. Therefore, it is necessary to develop a nutrition assistance policy to comprehensively support people with disabilities who have poor nutritional status. Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1C1C2008683) and the Ministry of Education (No. 2019R1I1A1A01063639). Key messages • People with disabilities had a higher prevalence of nutrient inadequacy than those without disabilities. • A support system to improve the access of people with disabilities to safe and healthy food must be ensured.

Associations between physical activity and digital gaming activity among Finnish adolescents

Abstract Background Physical activity (PA) for adolescents is an important health promotion habit to develop, yet other activities may be more appealing during this stage in life. According to the displacement hypothesis, time on digital games takes away the opportunity to be physically active. As there is a notable decline in PA levels between the ages of 11y- 15y in Finland, there is an urgent need to investigate potential areas that contribute to the decline. According to the 2021 Finnish Player Barometer, 65% of Finns play digital games regularly. The aims of this study were to investigate the associations between PA and digital gaming, and to examine how these associations may change by gaming genres. Methods A Finnish national representative sample (n = 1979) of 11y-15y olds, completed a self-report survey in spring 2022. Variables included PA behaviour, the frequency of digital gameplay, by sport simulation and Esports genres, and various confounders (gender, age, disability, economic status). Analyses were carried out by chi-square tests and multi-logistic regression analyses (no/low activity as reference categories). Results A third (32%) reported daily PA. Daily digital gameplay was more common among males (74%) than females (26%) and decreased from 11y (53%), 13y (30%) to 15y (17%) olds. After controlling for confounders, playing ball sport simulations (e.g. FIFA) was associated with taking part in 5 or more days/week of PA, or sport club participation (OR = 2.8, CI = 1.7-4.4), whereas playing a lot of first-person shooter games, as an Esport, was negatively associated with sport club participation (OR = 0.6, CI = 0.4-0.9) when compared to the reference categories. Conclusions The displacement hypothesis was supported partly among Esport players, but not by simulated sport gamers. Targeted interventions to promote physical activity with digital gaming, require a genre-specific approach. Key messages • Associations between physical activity and digital gaming activity among young adolescents is genre specific. • Frequent playing of digital games were more common among male 11-15y olds than females.

Irish people’s views on electronic health records and data security

Abstract Background Electronic health records (EHRs) can enhance the quality of care by ensuring timely and improved access to data and enabling linkage to facilitate better communication and coordination between healthcare teams. People differ in their views on EHRs, mainly due to perceived concerns relating to data security. It is important that people's views are considered in the design and implementation of EHRs to support successful implementation. The aim of this research was to explore public views on EHRs and data security to inform future policy in this area. Methods Qualitative secondary analysis of open-ended survey questions included in a National Public Engagement Survey on Health Information was conducted. A total of 433 respondents, from a nationally-representative sample of 1,228, provided a response that related to data security and EHRs. The national survey was carried out between October and December 2020 using a computer-assisted telephone interviewing (CATI) approach. Verbatim responses to the open-ended questions were captured and inductive thematic analysis was conducted. Results Four themes were identified: attitudes towards a move to eHealth; trust in relation to information security; technical infrastructure to support EHRs; and protective measures to safeguard EHRs. Most people view EHR implementation positively but cited concerns in relation to both the security of the electronic systems and the individuals that process this data and manage these systems. Conclusions As more countries introduce national EHRs, there is a need to establish and maintain a balance between the security of electronic systems and the competency of individuals that manage such systems. Equal consideration should be given to addressing both elements as the effectiveness of one is contingent on the other. A rise in cyber security attacks and growing public concern surrounding data breaches creates a sense of urgency to address such issues. Key messages • Trust was an important influence on people’s attitudes to electronic health records which was shaped by people’s trust in the individuals and organisations that have access to their health data. • There is an interdependent relationship between security systems and the individuals that manage them; both must be equally considered to provide assurance to the public on data security.

Comparison of Influenza-Like Illness (ILI) incidence data from the novel LeCellPHIA participatory surveillance system with COVID-19 case count data, Lesotho, July 2020 – July 2021

BackgroundWhile laboratory testing for infectious diseases such as COVID-19 is the surveillance gold standard, it is not always feasible, particularly in settings where resources are scarce. In the small country of Lesotho, located in sub-Saharan Africa, COVID-19 testing has been limited, thus surveillance data available to local authorities are limited. The goal of this study was to compare a participatory influenza-like illness (ILI) surveillance system in Lesotho with COVID-19 case count data, and ultimately to determine whether the participatory surveillance system adequately estimates the case count data.MethodsA nationally-representative sample was called on their mobile phones weekly to create an estimate of incidence of ILI between July 2020 and July 2021. Case counts from the website Our World in Data (OWID) were used as the gold standard to which our participatory surveillance data were compared. We calculated Spearman’s and Pearson’s correlation coefficients to compare the weekly incidence of ILI reports to COVID-19 case count data.ResultsOver course of the study period, an ILI symptom was reported 1,085 times via participatory surveillance for an average annual cumulative incidence of 45.7 per 100 people (95% Confidence Interval [CI]: 40.7 – 51.4). The cumulative incidence of reports of ILI symptoms was similar among males (46.5, 95% CI: 39.6 – 54.4) and females (45.1, 95% CI: 39.8 – 51.1). There was a slightly higher annual cumulative incidence of ILI among persons living in peri-urban (49.5, 95% CI: 31.7 – 77.3) and urban settings compared to rural areas. The January peak of the participatory surveillance system ILI estimates correlated significantly with the January peak of the COVID-19 case count data (Spearman’s correlation coefficient = 0.49; P < 0.001) (Pearson’s correlation coefficient = 0.67; P < 0.0001).ConclusionsThe ILI trends captured by the participatory surveillance system in Lesotho mirrored trends of the COVID-19 case count data from Our World in Data. Public health practitioners in geographies that lack the resources to conduct direct surveillance of infectious diseases may be able to use cell phone-based data collection to monitor trends.

Child’s age at migration, high school course-taking and higher education

The study examined the effect of child age at migration on high school course-taking and higher education attainment, focusing on Former Soviet Union (FSU) immigrants who arrived in Israel at primary-school age. Based on a representative Israeli national sample, combining data from Israel's Central Bureau of Statistics, Ministry of Education, and higher education institutions, we applied multinomial regression models. The data did not support the ‘critical age’ hypothesis, according to which the educational outcomes of immigrant children start to decrease after a distinct age at migration when the ability to learn a new language begins to shrink. However, children who were older at migration and thus arrived closer to the stage when curricular differentiation begins in lower secondary education had higher chances of enrolling in less prestigious educational programs. Age at migration was not related to the chances of attaining an academic degree.

Foot and Ankle Outcome Score (FAOS): Reference Values From a National Representative Sample.

The Foot and Ankle Outcome Score (FAOS) is widely used in clinical practice and research. However, FAOS reference values are missing to aid interpretation. This study aimed to establish national record-based reference values for the FAOS. A national representative sample of 9996 adult Danish citizens was derived from the Danish Civil Registration System. The FAOS questionnaire was sent to all participants, including 2 supplemental questions regarding previous foot and ankle problems and body mass index (BMI). A threshold of 10 FAOS points was predefined as a clinically relevant difference across all 5 subscales. A total of 2759 participants completed the FAOS. Mean age of participants was 60.5 years, and 51% were women. The mean FAOS subscale scores were as follows: pain, 87.1 (95% CI 86.4-87.8); symptoms, 85.1 (95% CI 84.5-85.8); activity of daily living (ADL), 88.9 (95% CI 88.2-89.6); sport and recreation function 78.5 (95% CI 77.4-79.6); and quality of life (QOL), 79.9 (95% CI 79.0-80.9). The mean difference between men and women was small and not clinically relevant (ranged from 0.9 in ADL to 3.4 in QOL). The largest differences in mean scores between age groups ranged from 4.3 in symptoms to 16.4 in sport/rec. Except for the subscale sport/rec, all age-related differences were below the predefined threshold of 10 for clinical relevance. The difference in mean subscale scores between the lowest BMI group (<24.7) and the obese group (>30) ranged from 19.6 in ADL to 39.1 in sport/rec. We found in our population that BMI severely impacted FAOS scores. We recommend using BMI-specific reference FAOS values. Separate FAOS reference values for men and women appear not needed. Stratifying reference values for age is likely not needed except for the subscale sport and recreation function. Level III, cohort study.

The association between wealth and sleep medication use in a nationally-representative sample of older Medicare beneficiaries.

Sleep disorders are common among older adults, leading to high prevalence of over-the-counter and prescription sleep medication use. Socioeconomically disadvantaged individuals have higher prevalence of sleep disorders. Frequent use of sleep medications can increase the risk of falls. Little is known about the association between wealth and sleep medication use in older adults. We conducted a cross-sectional analysis using a nationwide sample of 7603 Medicare beneficiaries (65+ years) from Round 1 (2011) of the National Health and Aging Trends Study. We measured self-reported wealth as the sum of assets (retirement savings, stocks/bonds, checking/savings accounts, business assets, and home value) minus liabilities (mortgage, credit card, and medical debt). Self-reported sleep medication use in the past month was categorized as frequent (5-7 nights/week), sometimes (1-4 nights/week), or never (0 night/week). We estimated differences in the prevalence of sleep medication use by quintiles of wealth using crude and adjusted binomial regression models. Individuals missing sleep medication information were excluded. Median wealth was $152 582 (IQR: $24 023-412 992). Sixteen percent reported frequent sleep medication use, 15% reported some use, and 70% reported no use. Frequent sleep medication use was more common in lower wealth quintiles (lowest: 20%, highest: 12%). Alternatively, some use was more common in higher wealth quintiles (lowest: 11%, highest: 18%). Results were similar after adjustment for demographic factors, anxiety, depression, and sleep disorders. In this study, less wealthy older adults had higher prevalence of frequent sleep medication use. This may lead to dependency or increased fall risk in this vulnerable population.

Social determinants of anxiety and mood disorders in a nationally-representative sample - Results from the Saudi National Mental Health Survey (SNMHS).

Social determinants of health (SDH) influence and modify the risk for mental health disorders. To our knowledge, no study has explored SDH in the context of mental health in Saudi Arabia (SA) using population-based data. This study investigated the association between several SDH and anxiety and mood disorders in SA. We utilized data from the nationally-representative Saudi National Mental Health Survey (SNMHS) conducted in 2014 to 2016. This study examined associations between personal-level, socioeconomic, physical health, and family environment characteristics and anxiety and mood disorders. Participants were classified as having anxiety-only disorders, mood-only disorders, or comorbidity of both disorders. Multinomial logistic regression models were employed to examine the associations between SDH and anxiety and/or mood disorders, comparing them to participants who had not experienced these disorders. A total of 4,004 participants were included in this analysis; the lifetime prevalence of disorders was: anxiety only (18%), mood only (3.8%), and comorbidity of both (5.3%). Regression models indicated that females, young adults (26-35 years), individuals with a higher level of education, and those who were separated or widowed had higher odds of experiencing anxiety and/or mood disorders. Furthermore, there was a significant and direct association between having physical chronic conditions and all three categories of anxiety and mood disorders. Experiencing Adverse Childhood Events (ACEs) was also associated with a significant risk of developing anxiety and/or mood disorders, with the highest risk associated with physical or sexual abuse, followed by violence and neglect. This study underscores the correlation between several personal-level, socioeconomic, and environmental SDH and anxiety and mood disorders in SA. These findings provide a foundation for future analyses examining the intricate interplay between upstream and downstream SDH in SA. Such research can enhance local scientific knowledge, aid in planning for social services, and inform policy decisions and treatment strategies.

Predictors of height in Romanian infants 6-23 months old: findings from a national representative sample.

The research explored the association between infants' height and various demographic factors in Romania, a country where such critical information has been lacking. This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6-23 months of age (M=14.26; SD=5.15). Infants' height-for-age z-scores (HAZ) were calculated using the World Health Organization's computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother's age, location, marital status, socioeconomic status (SES), as well as infant's term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ. The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18-23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age. The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.

Associations between partisan media consumption, opioid use disorder stigma, and opioid policy support: An exploration of the media’s role in the ongoing opioid epidemic

We report on a preliminary investigation into the relationship between partisan media consumption (PMC) among U.S. adults and their (1) opioid use disorder (OUD) stigma, (2) national OUD policy support (e.g., Medicaid coverage for OUD treatment), (3) local OUD policy support (e.g., safe injection sites), (4) discriminatory OUD policies (e.g., denying housing), and (5) carceral OUD policies (e.g., jailing people who use opioids). We performed a cross-sectional survey of a nationally-representative sample of U.S. adults (n = 6,515) from October 1-November 19, 2021. We surveyed a sample of U.S. adults ages 18 and older drawn from NORC's AmeriSpeak® Panel. AmeriSpeak is a probability-based ongoing panel of over 40,000 households designed to represent the U.S. household population. Cross-sectional analyses revealed significant relationships between PMC and OUD stigma (b = 0.29, p <.001, CI95 = 0.14,0.43), support for national (b = -0.31, p <.01, CI95 = -0.54,-0.09) and local policy responses (b = -0.38, p <.001, CI95 = -0.59,-0.17), and support for discriminatory opioid use disorder policies (b = 0.27, p <.01, CI95 = 0.07,0.45). After controlling for self-reported political affiliation and other potential covariates, Republican-leaning media consumption was significantly associated with increased OUD stigma, less support for national and local harm reduction or rehabilitative policies, and more support for discriminatory policies against individuals experiencing OUD. The opposite associations were observed for Democratic-leaning media consumption. Markers for racism mediated the relationship between PMC and support for carceral policies (indirect path b = -0.41,p <.001, CI95 = -0.50,-0.31). Our results indicate that public health advocates must collaborate with conservative leaders to find bipartisan common ground for targeted communication campaigns.

Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021

The study aimed to estimate the prevalence of lipid abnormalities in Iranian adults by demographic characterization, geographical distribution, and associated risk factors using national and sub-national representative samples of the STEPs 2021 survey in Iran. In this population-based household survey, a total of 18,119 individuals aged over 25 years provided blood samples for biochemical analysis. Dyslipidemia was defined by the presence of at least one of the lipid abnormalities of hypertriglyceridemia (≥ 150 mg/dL), hypercholesterolemia (≥ 200 mg/dL), high LDL-C (≥ 130 mg/dL), and low HDL-C (< 50 mg/dL in women, < 40 mg/dL in men), or self-reported use of lipid-lowering medications. Mixed dyslipidemia was characterized as the coexistence of high LDL-C with at least one of the hypertriglyceridemia and low HDL-C. The prevalence of each lipid abnormality was determined by each population strata, and the determinants of abnormal lipid levels were identified using a multiple logistic regression model. The prevalence was 39.7% for hypertriglyceridemia, 21.2% for hypercholesterolemia, 16.4% for high LDL-C, 68.4% for low HDL-C, and 81.0% for dyslipidemia. Hypercholesterolemia and low HDL-C were more prevalent in women, and hypertriglyceridemia was more prevalent in men. The prevalence of dyslipidemia was higher in women (OR = 1.8), obese (OR = 2.8) and overweight (OR = 2.3) persons, those residents in urban areas (OR = 1.1), those with inappropriate physical activity (OR = 1.2), patients with diabetes (OR = 2.7) and hypertension (OR = 1.9), and participants with a history (OR = 1.6) or familial history of CVDs (OR = 1.2). Mixed dyslipidemia prevalence was 13.6% in women and 11.4% in men (P < 0.05). The prevalence of lipid abnormalities was highly heterogeneous among provinces, and East Azarbaijan with 85.3% (81.5–89.1) and Golestan with 68.5% (64.8–72.2) had the highest and lowest prevalence of dyslipidemia, respectively. Although the prevalence of high cholesterol and LDL-C had a descending trend in the 2016–2021 period, the prevalence of dyslipidemia remained unchanged. There are modifiable risk factors associated with dyslipidemia that can be targeted by the primary healthcare system. To modify these risk factors and promote metabolic health in the country, action plans should come to action through a multi-sectoral and collaborative approach.

Prevalence of past-year major depressive episode among young adults between 2005 and 2021: Results from four national representative surveys in France

BackgroundThe objectives are to examine time trends in the prevalence of past year major depressive episode (MDE) among young adults, and to identify differences by occupational status comparing students, those employed, and those who are not in employment, education or training (NEET). MethodsData were drawn from the Health Barometer survey, a cross-sectional computer-assisted telephone interview survey on a national representative sample of residents of metropolitan France and conducted approximately every 5 years. The surveys relied on the Composite International Diagnostic Interview-Short Form to determine the presence of DSM-IV past-year major depressive episode. Data from the 2005, 2010, 2017, and 2021 surveys were pooled and respondents aged 18 to 25 were selected (n = 7556) and categorized based on their occupational status: students, those employed, and NEET. ResultsOverall, significant differences in the prevalence of MDE was observed by occupational status: NEET had the highest rate (18.5 %) followed by students (14.3 %) and those employed (11.0 %). The prevalence of MDE among young adults was 10.1 % in 2005, 9.7 % in 2010 and 11.3 % in 2017, reflecting a stable prevalence between 2005 and 2017. The prevalence then nearly doubled in 2021, with 20.9 % of MDE, with a significant increase of 9.6 points between 2017 and 2021. LimitationsNo assessment of lifetime psychopathology. ConclusionsThe prevalence of major depression among young adults significantly increased between 2005 and 2021, those at greatest risk are females and those not in employment, education or training. The contribution of pandemic-related factors may be elucidated in future national health surveys.

The impact of brand value co-creation on perceived CSR authenticity and brand equity

PurposeIn response to the rise of socially conscious consumers, brands have been taking a strategic approach to corporate social responsibility (CSR) to drive brand equity. Nevertheless, merely engaging in CSR is not enough to have a positive impact on the value consumers give to a brand. The success of a CSR program depends on its consumers’ perceived authenticity. Therefore, this study aims to investigate how the perception of CSR authenticity, and consequently brand equity, can be enhanced by leveraging brand value co-creation.Design/methodology/approachThe study uses a mixed-method approach to test its hypotheses. Study 1 collects survey data from a national representative sample in the USA, which is analyzed using structural equation modeling. Study 2 collects experimental data from a public university’s research pool, also in the USA, which is analyzed using ANOVA and mediation analysis.FindingsThis study demonstrates that when consumers believe that a brand is co-creative – i.e. consumers are allowed to participate in the creation of value – they will likely perceive the brand’s CSR program as more authentic, which in turn will positively affect brand equity.Originality/valueThe findings of this study offer implications for academics and brand managers interested on how to effectively leverage CSR for brand building. Specifically, it demonstrates that embracing CSR alone may not be sufficient to enhance brand equity and that brand managers should consider leveraging co-creation to strengthen perceptions of CSR authenticity.

An Intersectional Approach to Examining Breast Cancer Screening among Subpopulations of Black Women in the United States.

This study examines breast cancer screening behavior among subpopulations of Black women in the United States. Binary logistic regression was used to analyze breast cancer screening among a nationally-representative sample (n = 9,783) of Black women-US-born, non-US-born Caribbean, and non-US-born African-from the 2011-2017 National Health Interview Survey dataset. Non-US-born African Black women were less likely to have breast cancer screening, compared to US-born Black women. Among non-US-born Black women, non-US-born Caribbean Black women were more likely to have had breast cancer screening. Differential healthcare access associated with nativity differences among Black women can be informing their breast cancer screening behaviors. Efforts to improve breast cancer outcomes among Black women can benefit from interventions that account for differential access to healthcare and breast cancer screening behaviors among subgroups of Black women.

Assessing physical activity promotion in different settings and how its associated with public participation during COVID-19 epidemic: evidence from national policy evaluation

BackgroundVarious interventions, programs and policies have been implemented to improve physical activity (PA) levels worldwide. However, countries continue to face barriers and challenges in achieving their targets. To date, there is a lack of study on the evaluation of physical activity (PA) promotion and how it’s associated with public participation.MethodsThis study assessed PA promotion in eight different settings in terms of policy availability, policy implementation, and public participation in PA programs. Policy availability was assessed by reviewing 384 policy and strategy documents, rules, regulations, legislation, and guidelines on PA. We scored the documents by using the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Data to assess policy implementation and public participation were taken from the Thailand Report Card Survey 2021 (TRC2021), and the Thailand Surveillance on Physical Activity (SPA) 2021. Both surveys comprised over 5,000 nationally-representative samples from on-screen, face-to-face interviews, and an online self-administered survey. We scored the policy implementation and public participation based on respondents’ response towards policy implementation and participation indicators. A grading scheme was applied to indicate how successful an investment has been made.ResultsPublic education and mass media received the highest average score in policy availability, implementation and public participation in PA program (67.9%, grade B), followed by active urban design (66.1%, grade B-) and active transport (63.7%, grade B-). Workplace, whole-of-school, and community-wide initiatives were the investments with the lowest scores, implying low availability, limited implementation, and less accessibility to public. Females were less likely to participate in active transport, active urban design, sports/recreation for all, workplace activity, and community-wide initiatives. Age and educational attainment were consistent predictors of utilization in all investments.ConclusionsWith varying degrees of policy availability and accessibility, public participation in PA investments is likely to be constrained by biological and socioeconomic inequality. Future investments should aim at providing generalized or tailored interventions to ensure equal access and participation for all segments of the population.

Measuring child and adolescent well-being in Denmark: Validation and norming of the Danish KIDSCREEN-10 child/adolescent version in a national representative sample of school pupils in grades five through eight.

KIDSCREEN-10 is a generic instrument for measuring global health-related quality of life among 8-18-year-old children and adolescents. This study examines the criterion-related construct validity and psychometric properties of the Danish language version of the KIDSCREEN-10 using Rasch models. A further aim was to construct Danish norms based on the resulting person parameter estimates from the Rasch models. Data consists of a nationally representative cross-sectional survey of 8171 children in the 5th to 8th grade of primary school in Denmark. No adequate fit to the Rasch model or a graphical loglinear Rasch model could be established for the KIDSCREEN-10 in the full sample of children (n = 8171). Results based on analyses with increasing samples sizes showed that even with the smallest sample item 3 (Kid3) of the KIDSCREEN-10 did not fit the Rasch model. After elimination of Kid3, substantial local dependence and differential item functioning relative to gender and grade level was still present. Already with a sample size of 630 fit to the Rasch model or a graphical loglinear Rasch model adjusting for local dependence and differential item functioning was not established. Therefore, generation of Danish norms was not realizable, as this requires valid sum scores and estimates of the person parameters for an adequate number of cases. Thus, the Danish language version of the child/adolescent self-report KIDSCREEN-10 questionnaire cannot be recommended for use in population-level studies. Neither can use in small sample be recommended as adjustment for differential item functioning and local dependence is ambiguous.

Development of a measuring instrument to monitor the biodiversity awareness of the German population

Current biodiversity loss highlight the need for action towards nature and biodiversity protection. We report the revision of the nature awareness instrument used by the German Federal Agency for Nature Conservation for monitoring the biodiversity awareness of the German population every two years. In the revision process, an iterative interdisciplinary behavior prioritization approach was used to identify behavioral intentions with a high impact on biodiversity protection. The revised monitoring tool comprises two parts: the first part consists of a concise 16-item measure covering three subtypes of nature conservation behavioral intentions that can be performed by citizens. The second part consists of 33 items assessing six constructs of an extended theory of behavior model as predictors of the nature conservation behavioral intentions: attitudes, subjective norms, perceived behavioral control, awareness of negative consequences, social identity and connection to nature as additional. Two representative national samples (N = 1.075; N = 2.410) were used to test the measurement and structural models. The empirical evidence supports the reliability of the developed construct measures as well as their theoretically postulated relationships. Implications for stakeholder, study limitations and requirements for future research are discussed.

Association between acculturation, dental floss use, dental visits and unmet dental needs among Asians in the United States: Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2018.

The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations. This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of time in the United States. Dental floss use, dental visits and unmet dental care needs were included as outcomes in this study. Descriptive statistics and logistic regressions were used to analyse the samples. Acculturation was significantly associated with dental health behaviours: Individuals with higher levels of acculturation were more likely than less acculturated individuals to use dental floss (81.0% vs. 63.9%, respectively) and visit the dentist regularly (76.7% vs. 66.9% respectively). Insurance status moderated the association between acculturation and dental visits: Acculturation was significantly associated with dental visits in the past year among insured individuals (OR = 1.70, 95% CI: 1.29-2.23), but not among uninsured individuals. Unmet dental care needs were present in 11.1% of participants. While costs and insurance were the top two determinants of access to care, individuals with and without insurance differed with regard to their third major reason for unmet dental care needs: Being 'too busy' and not wanting to spend money on dental care. Among the Asian population in the United States, those with high acculturation scores were more likely to engage in dental flossing and visit the dentist regularly compared to those Asians with lower acculturation scores. To encourage dental flossing and regular dental visits among Asians with lower acculturation scores, cultural adaptation and language accessibility suggests being considered. Future research is necessary to confirm the moderating effect of insurance status on the association between acculturation and regular dental visits. Additionally, our findings emphasize the impact of costs and insurance on access to dental care among Asians in the United States, highlighting the importance of future public health programmes in addressing these barriers.