Health Interventions Research Articles

Gamified Interventions for Promoting the Psychosocial Well-Being of School-Aged Children: A Scoping Review.

Gamified health interventions can offer child-centered and tailored health-promoting strategies. Evidence suggests that its various mechanics foster engagement that can be utilized to promote health and well-being and influence health behavior. At present, psychosocial challenges among school-aged children are becoming a global predicament. We conducted a scoping review to explore the range and nature of evidence on gamified interventions for promoting the psychosocial well-being of school-aged children from the general population. We followed the Arksey and O'Malley framework and extracted sources of evidence from five databases. Our review findings were summarized with basic numerical analysis and provided with narrative accounts based on a gamification taxonomy and the Template for Intervention Description and Replication (TIDieR). We identified 12 gamified interventions and included 23 records that reported their development and evaluation. Theories on emotions, behaviors, social skills, and mental health were commonly applied frameworks. Narrative was found as the most commonly used gamification mechanic (11/12, 91.7%), followed by avatar and tasks (10/12, 83.3%), feedback system and level progression (9/12, 75%), points (7/12, 58.3%), badges (5/12, 41.7%), progress bar (4/12, 33.3%), and virtual goods, reminders, and time pressure (2/12, 16.7%). The included sources of evidence reported significant improvements in some of the measured psychosocial outcomes; however, studies on this domain for this particular target group are still considerably limited. Further research is needed to determine how the applied theories and gamification mechanics brought about the change in psychosocial outcomes, bridging the gap in current evidence.

Prevention of dementia using mobile phone applications (PRODEMOS): a multinational, randomised, controlled effectiveness–implementation trial

The expected increase of dementia prevalence in the coming decades will mainly be in low-income and middle-income countries and in people with low socioeconomic status in high-income countries. This study aims to reduce dementia risk factors in underserved populations at high-risk using a coach-supported mobile health (mHealth) intervention. This open-label, blinded endpoint, hybrid effectiveness-implementation randomised controlled trial (RCT) investigated whether a coach-supported mHealth intervention can reduce dementia risk in people aged 55-75 years of low socioeconomic status in the UK or from the general population in China with at least two dementia risk factors. The primary effectiveness outcome was change in cardiovascular risk factors, ageing, and incidence of dementia (CAIDE) risk score from baseline to after 12-18 months of intervention. Implementation outcomes were coverage, adoption, sustainability, appropriateness, acceptability, fidelity, feasibility, and costs assessed using a mixed-methods approach. All participants with complete data on the primary outcome, without imputation of missing outcomes were included in the analysis (intention-to-treat principle). This trial is registered with ISRCTN, ISRCTN15986016, and is completed. Between Jan 15, 2021, and April 18, 2023, 1488 people (601 male and 887 female) were randomly assigned (734 to intervention and 754 to control), with 1229 (83%) of 1488 available for analysis of the primary effectiveness outcome. After a mean follow-up of 16 months (SD 2·5), the mean CAIDE score improved 0·16 points in the intervention group versus 0·01 in the control group (mean difference -0·16, 95% CI -0·29 to -0·03). 1533 (10%) invited individuals responded; of the intervention participants, 593 (81%) of 734 adopted the intervention and 367 (50%) of 734 continued active participation throughout the study. Perceived appropriateness (85%), acceptability (81%), and fidelity (79%) were good, with fair overall feasibility (53% of intervention participants and 58% of coaches), at low cost. No differences in adverse events between study arms were found. A coach-supported mHealth intervention is modestly effective in reducing dementia risk factors in those with low socioeconomic status in the UK and any socioeconomic status in China. Implementation is challenging in these populations, but those reached actively participated. Whether this intervention will result in less cognitive decline and dementia requires a larger RCT with long follow-up. EU Horizon 2020 Research and Innovation Programme and the National Key R&D Programmes of China. For the Mandarin translation of the abstract see Supplementary Materials section.

The Mental Abuse Matters Virtual Reality Project: creative practice in cinematic VR and immersive sound

ABSTRACT This article discusses my practice work The Mental Abuse Matters VR Project; a live action narrative drama and Virtual Reality experience where the user is an embodied victim, experiencing an episode of emotional abuse in a domestic setting. Immersive sound is used to replicate emotions in the body such as shame, dread, anxiety, humiliation and panic in the user and to represent inner thoughts, memories and states of dissociation, with the goal of moving beyond language towards a visceral narrative. This is a prototype intervention that aims to be used as an empathy training tool for frontline Health and Social Care and Justice sector staff to improve trauma care, and potentially a therapeutic VR experience for victims and perpetrators of mental abuse. The article aims to discuss the development, creative practice and planned dissemination of this pilot VR experience, evaluating it in the context of traditional study methods and existing health and social care interventions in VR.

Real-Time Use of a Dynamic Model To Measure the Impact of Public Health Interventions on Measles Outbreak Size and Duration - Chicago, Illinois, 2024.

Measles is a highly infectious, vaccine-preventable disease that can cause severe illness, hospitalization, and death. A measles outbreak associated with a migrant shelter in Chicago occurred during February-April 2024, in which a total of 57 confirmed cases were identified, including 52 among shelter residents, three among staff members, and two among community members with a known link to the shelter. CDC simulated a measles outbreak among shelter residents using a dynamic disease model, updated in real time as additional cases were identified, to produce outbreak forecasts and assess the impact of public health interventions. As of April 8, the model forecasted a median final outbreak size of 58 cases (IQR=56-60 cases); model fit and prediction range improved as more case data became available. Counterfactual analysis of different intervention scenarios demonstrated the importance of early deployment of public health interventions in Chicago, with a 69% chance of an outbreak of 100 or more cases had there been no mass vaccination or active case-finding compared with only a 1% chance when those interventions were deployed. This analysis highlights the value of using real-time, dynamic models to aid public health response, set expectations about outbreak size and duration, and quantify the impact of interventions. The model shows that prompt mass vaccination and active case-finding likely substantially reduced the chance of a large (100 or more cases) outbreak in Chicago.

Emergency medical services in Armenia: national call trends and future directions.

Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods. For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%). Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.

Evaluation of HIV and Syphilis Co-infected Cases, Data from a University Hospital.

HIV and syphilis are sexually transmitted infections with overlapping risk factors, potentially leading to increased HIV transmission and treatment challenges. Understanding the clinical management of syphilis co-infection among people living with HIV is crucial for public health interventions. This retrospective cohort study aimed to assess the prevalence of syphilis co-infection, clinical characteristics, treatment response, and public health implications among people living with HIV in southern Turkey. Records of 1352 people living with HIV 18 years and older, followed at a tertiary infectious diseases clinic between 2013 and 2023, were analyzed. Data on demographics, clinical stage of syphilis and HIV/AIDS, laboratory parameters, treatment response, and co-infections were collected. Statistical analyses were performed using SPSS 20.0 software. Among the people living with HIV, 103 (7.6%) were diagnosed with syphilis. Most cases were male (97.1%), with a median age of 33 (IQR 28-49) years. Heterosexual transmission was predominant (60.2%), with a history of condomless sexual intercourse in 90.3% of cases. The majority (88.3%) were asymptomatic with latent syphilis. Syphilis was diagnosed concurrently with HIV in 77.7% of cases. Serological response to syphilis treatment was observed in 46.8% of patients, while 53.2% showed a serofast reaction. Neurosyphilis was rare, diagnosed in only one patient. Co-infections with hepatitis B and C were detected in 3.9% and 1.9% of patients, respectively. Syphilis co-infection among people living with HIV is a significant public health concern in southern Turkey. Routine screening for syphilis, along with comprehensive education on sexually transmitted infection prevention, is essential for early detection and optimal management. Further research is needed to improve treatment outcomes and address emerging challenges in HIV-syphilis co-infection management.

Communicating evidence-based information on the effects of health interventions to various types of recipients – a qualitative study on the perception of formats of information among lay and professional audiences

Communicating evidence-based information on the effects of health interventions to various types of recipients – a qualitative study on the perception of formats of information among lay and professional audiences

A framework to guide oral healthcare at long-term care facilities in the eThekwini district

Oral healthcare is an important aspect of the general healthcare of individuals residing in long-term care (LTC) facilities. However, it is often neglected in these settings and contributes to oral health disparities and oral diseases among residents. The World Health Organization promotes the reduction of health disparities and diseases through health promotion as an ethical obligation. The utilization of frameworks to promote oral health provides a structured approach to the design, implementation, and evaluation of oral health promotion programs. This study proposed a framework to guide the development, implementation, and review of an oral health promotion intervention, so as to ensure that a systematic and evidence-based approach is used for the delivery of oral health promotion activities. The framework comprised three stages: needs analysis, implementation and review of an oral health intervention, which was guided by the Precede-Proceed model and Intervention mapping. The empirical aspect involved a 4-phased mixed method exploratory study, based on action research and the plan-act-observe-reflect cycle, which illustrated how the framework was operationalized. The oral health intervention indicated positive outcomes with regard to knowledge and attitudes among caregivers. ConclusionThe framework incorporated the key components that influenced oral health provision at LTC facilities.

Effectiveness of a Behavioral Activation Intervention for Peripartum Women with Opioid Use Disorder.

Pregnant women with opioid use disorder show elevated rates of comorbid mental health problems, both of which are associated with negative health outcomes for mothers and children. There is substantial evidence supporting the benefits of treatment of perinatal opioid use disorder, as well as perinatal depression and anxiety, but there are gaps in knowledge about the effectiveness of perinatal behavioral health interventions in the context of co-occurring substance use disorder. The current study seeks to address this gap by examining outcomes of a behavioral activation treatment in a group of peripartum women with opioid use disorder (N = 68). Behavioral activation has shown promise in treating co-occurring depression and substance use problems. The intervention was delivered as part of an integrated care treatment model, in which patients received co-located obstetric, substance use, and mental health care in a hospital-based clinic. Hierarchical linear modeling was used to assess change in symptoms over time. Results suggest that the group behavioral activation intervention was associated with reduced depression and anxiety symptoms, demonstrated by significant reductions in PHQ-9 and GAD-7 scores over the course of treatment. Moreover, there were indications that increased attendance was associated with further reductions in depressive symptoms. Results contribute to understanding the effectiveness of behavioral activation in the context of peripartum opioid use disorder. Findings also add to the evidence supporting integrated care models and offer a potential blueprint for improving outcomes and reducing barriers to care in this population.

Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions.

Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population. Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices. Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents. Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

Nutritional Challenges in Nursing Homes: Pilot Study on Macronutrient Intake and Status of Vitamins D and B12.

Older adults living in nursing homes (NH) are considered a population group that could be at risk in terms of nutrition, even more so than their community-dwelling peers. Evidence on the nutritional status of NH residents is scarce, as they are commonly excluded from population-based dietary studies. This is also the case in Slovenia. In the presented pilot study, we assessed the intake of macronutrients as well as the intake and status of vitamin D and vitamin B12 on a sample of NH and NH daycare center users to explore the need for a larger representative study. The pilot study included 37 participants from three Slovenian NH (20 participants) and their daycare centers (17 participants). Daycare centers offer daytime care services for older adults, where users are also provided with major meals during their stay. Intakes of energy and nutrients were estimated by three 24 h dietary records. Fasting blood samples were collected for the assessment of vitamin D and vitamin B12 status. Over 90% of the participants had daily energy and protein intakes below recommendations (reference values: energy intake: males 2100 kcal and females 1700 kcal; protein intake > 1 g/kg body mass). The males' median daily intakes of vitamin D were 1.7 µg (1.5 µg females), and 2.3 µg for vitamin B12 (2.0 µg females). None of the participants had adequate vitamin D intake (>20 µg), and 92.3% males and 87.5% females had inadequate vitamin B12 intake (<4 µg). The prevalence of vitamin D deficiency (serum 25-OH-D conc. < 30 nmol/L) was 100% among NH residents and 53% among NH daycare center users. The prevalence of vitamin B12 deficiency was found in 20% of NH residents. The study results highlighted that certain nutrients might be critical in this population, especially among NH residents; however, a more thorough investigation with the inclusion of other important markers of nutritional status should be performed on a larger, representative sample to support the development and implementation of appropriate public health interventions.

Learning from the Active Hospital-Based Cancer Registry in India: An Ethnography Study

PurposeThe increasing incidence of cancer in low- and middle-income countries highlights the need for better cancer data management. Hospital-based cancer registries (HBCRs) enhance patient outcomes by managing cancer data, reviewing clinical performance and allocating resources. However, sustainability remains a challenge despite government initiatives. Therefore, this study documented the functionalities, core processes, and team involvement of active HBCRs in India, aiming to identify factors that facilitate their sustainability.MethodsAn ethnographic study was conducted in two Indian hospitals, one specializing in cancer care and the other offering multispecialty services, focusing on their HBCRs. The study involved process observations, interviews, and record reviews, with thematic analysis guided by ethnographic investigations. The staff managing the HBCRs were key participants.ResultsThe findings are categorized into three themes: (1) existing management strategies and infrastructure, (2) the implementation process, and (3) the sustainability and scalability of the registry model. This study highlights the key factors necessary for a sustainable HBCR, including human resources, training, and a well-structured management system. The involvement of oncologists and physicians, funding, qualified staff, adequate space, and digitalization are crucial for success. Data management errors can be minimized through training, while interdepartmental coordination and data quality play essential roles.ConclusionThis study offers critical insights into enhancing cancer surveillance systems, thereby improving cancer care and public health interventions in India and similar contexts worldwide. Policymakers and healthcare practitioners can leverage these findings to strengthen existing systems and address the growing burden of cancer effectively.

Determinants of per- and polyfluoroalkyl substances (PFAS) exposure among Wisconsin residents

BackgroundPer- and polyfluoroalkyl substances (PFAS) include thousands of manufactured compounds with growing public health concerns due to their potential for widespread human exposure and adverse health outcomes. While PFAS contamination remains a significant concern, especially from ingestion of contaminated food and water, determinants of the variability in PFAS exposure among regional and statewide populations in the United States remains unclear. ObjectivesThe objective of this study was to leverage The Survey of the Health of Wisconsin (SHOW), the only statewide representative cohort in the US, to assess and characterize the variability of PFAS exposure in a general population. MethodsThis study sample included a sub-sample of 605 adult participants from the 2014–2016 tri-annual statewide representative sample. Geometric means for PFOS, PFOA, PFNA, PFHxS, PFPeS, PFHpA, and a summed measure of 38 analyzed serum PFAS were presented by demographic, diet, behavioral, and residential characteristics. Multivariate linear regression was used to determine significant predictors of serum PFAS after adjustment. ResultsOverall, higher serum concentrations of long-chain PFAS were observed compared with short-chain PFAS. Older adults, males, and non-Hispanic White individuals had higher serum PFAS compared to younger adults, females, and non-White individuals. Eating caught fish in the past year was associated with elevated levels of several PFAS. DiscussionThis is among the first studies to characterize serum PFAS among a representative statewide sample in Wisconsin. Both short- and long-chain serum PFAS were detectable for six prominent PFAS. Age and consumption of great lakes fish were the most significant predictors of serum PFAS. State-level PFAS biomonitoring is important for identifying high risk populations and informing state public health standards and interventions, especially among those not living near known contamination sites.

Effectiveness and uptake of a transdiagnostic emotion regulation mobile intervention among university students: Protocol for a randomized controlled trial

BackgroundGoing to university is a major life event, which can be stressful and negatively affect mental health. However, it also presents an opportunity to establish a foundation for positive life trajectories. To support university students, a mobile transdiagnostic emotion regulation (ER) intervention has been developed, offering both broad-based (universal) and targeted (indicated) preventative support. ER, a transdiagnostic factor underlying various mental health problems, is a critical intervention target in students, a demographic particularly susceptible to mental health issues. Cultivating ER can help manage immediate stressors and foster long-term wellbeing. This paper describes the study protocol for a Randomized Controlled Trial (RCT) evaluating the effectiveness and uptake of such mobile transdiagnostic ER intervention. MethodThe superiority parallel-group RCT involves 250 participants randomized to either the intervention condition (i.e., full access to the mobile intervention, (n = 125) or to a waitlist control condition (n = 125). Primary outcomes include ER skills and stress symptoms. Secondary outcomes include mental health parameters (anxiety, depression, resilience) and intervention uptake (i.e., objective engagement, subjective engagement, ER skills application in real life). Outcomes are assessed at baseline, week 3, 8 and 12, with continuous log-data collection for user engagement. DiscussionThis study evaluates the effectiveness and uptake of a transdiagnostic ER mobile intervention for the student population addressing their ER developmental needs. If successful, the results will validate our approach to intervention development and whether focusing on learning transfer (i.e., application of the learnt skills in real-life) and personalization using a recommendation system, can boost the real-world application of skills and intervention impact.

Association of Socioeconomic Characteristics with Health and Well-Being of Rural Older Cambodians.

This study examined the demographic, socioeconomic, health, and well-being of rural-dwelling older Cambodians and identified differentials based on age and gender. The goal is to understand disparities in wealth, health, well-being, and support systems among older adults within the context of Cambodia's history of civil unrest and socio-cultural norms. A regionally representative sample from three northwestern Cambodian provinces was used to evaluate household wealth, economic satisfaction, health, psychological well-being, social support, and a government welfare program. Analysis was conducted to document how these factors differed by age and gender. Significant gender differentials in demographics, well-being, and support systems were observed. Older women outnumbered men and reported lower levels of social support and psychological well-being, potentially influenced by high widowhood rates and gender-linked cultural norms. Education levels were generally low, possibly due to disruption from wars and conflicts. Relative to neighboring countries, the health status of older Cambodians was poor, though no significant gender-based health disparities were identified. There were differences in debt and wealth accumulation among age groups but no variation in welfare support by age or gender. These findings underline the significance of addressing gender disparities and socio-cultural factors affecting older Cambodians. They underscore the need for policy attention toward older women's psychological well-being and support systems, as well as health and social support interventions for the oldest age groups. Future research should investigate these observed patterns, accounting for regional variations and survivor selection bias.

Fractional-Order Dynamics in Epidemic Disease Modeling with Advanced Perspectives of Fractional Calculus

Piecewise fractional-order differential operators have received more attention in recent years because they can be used to describe various evolutionary dynamical problems to investigate crossover behaviors. In this manuscript, we use the aforementioned operators to investigate a mathematical model of COVID-19. By utilizing fractional calculus, our approach aims to capture the crossover dynamics of disease spread, considering heterogeneity and transitions between epidemic phases. This research seeks to develop a framework using specialized mathematical techniques, such as the Caputo fractional derivative, with the potential to investigate the crossover dynamical behaviors of the considered epidemic model. The anticipated contribution lies in bridging fractional calculus and epidemiology, offering insights for both theoretical advancements and practical public health interventions. In order to improve our understanding of epidemic dynamics and support, we used MATLAB to simulate numerical results for a visual representation of our findings. For this interpretation, we used various fractional-order values. In addition, we also compare our simulated results with some reported results for infected and death classes to demonstrate the efficiency of our numerical method.

Sequencing analysis of SARS-CoV-2 cases in Slovenian long-term care facilities to support outbreak control.

Residents of long-term care facilities (LTCFs) are at high risk of morbidity and mortality due to COVID-19, especially when new variants of concern (VOC) emerge. To provide intradisciplinary data in order to tailor public health interventions during future epidemics, available epidemiologic and genomic data from Slovenian LTCFs during the initial phases of the COVID-19 pandemic was analyzed. The first part of the study included SARS-CoV-2 reverse-transcription Real-Time PCR (rtRT-PCR) positive LTCF residents, from 21 facilities with COVID-19 outbreaks occurring in October 2020. The second part of the study included SARS-CoV-2 rtRT-PCR positive LTCF residents and staff between January and April 2021, when VOC Alpha emerged in Slovenia. Next-generation sequencing (NGS) was used to acquire SARS-CoV-2 genomes, and lineage determination. In-depth phylogenetic and mutational profile analysis were performed and coupled with available field epidemiological data to assess the dynamics of SARS-CoV-2 introduction and transmission. 370/498 SARS-CoV-2 positive residents as well as 558/699 SARS-CoV-2 positive residents and 301/358 staff were successfully sequenced in the first and second part of the study, respectively. In October 2020, COVID-19 outbreaks in the 21 LTCFs were caused by intra-facility transmission as well as multiple independent SARS-CoV-2 introductions. The Alpha variant was confirmed in the first LTCF resident approximately 1.5 months after the first Alpha case was identified in Slovenia. The data also showed a slower replacement of existing variants by Alpha in residents compared to staff and the general population. Multiple SARS CoV-2 introductions as well as intra-facility spreading impacted disease transmission in Slovenian LTCFs. Timely implementation of control measures aimed at limiting new introductions while controlling in-facility transmission are of paramount importance, especially as new VOCs emerge. Sequencing, in conjunction with epidemiological data, can facilitate the determination of the need for future improvements in control measures to protect LTCF residents from COVID-19 or other respiratory infections.

Leveraging systems science and design thinking to advance implementation science: moving toward a solution-oriented paradigm.

Many public health challenges are characterized by complexity that reflects the dynamic systems in which they occur. Such systems involve multiple interdependent factors, actors, and sectors that influence health, and are a primary driver of challenges of insufficient implementation, sustainment, and scale of evidence-based public health interventions. Implementation science frameworks have been developed to help embed evidence-based interventions in diverse settings and identify key factors that facilitate or hinder implementation. These frameworks are largely static in that they do not explain the nature and dynamics of interrelationships among the identified determinants, nor how those determinants might change over time. Furthermore, most implementation science frameworks are top-down, deterministic, and linear, leaving critical gaps in understanding of both how to intervene on determinants of successful implementation and how to scale evidence-based solutions. Design thinking and systems science offer methods for transforming this problem-oriented paradigm into one that is solution-oriented. This article describes these two approaches and how they can be integrated into implementation science strategies to promote implementation, sustainment, and scaling of public health innovation, ultimately resulting in transformative systems changes that improve population health.

COVID-19 Implications on Worksite Wellness Programming.

As multi-racial and multi-ethnic populations are anticipated to be 11.6% of the U.S. population by 2060, it is essential that public health research and practice find ways to effectively capture and reach these diverse groups. Single racial identification has been a norm in public health practice; however, this method has limitations for capturing the health of multi-racial and multi-ethnic individuals. Drawing on personal experience of the author and multi-disciplinary scholarship, this research commentary examines the limitations of single-race identification and how this influences the processes of racialization. The author provides important implications for public health research by suggesting more complex and effective ways to capture personal racial identification and racial perceptions and addresses how to reach multi-racial and multi-ethnic groups through public health interventions where individuals might identify with multiple cultural identities.

INDIVIDUAL AND COMBINED EFFECTS OF LIFESTYLE BEHAVIORS ON THE HEALTH-RELATED QUALITY OF LIFE OF ADOLESCENTS

Background: Identifying lifestyle behaviors that can influence health-related quality of life (HRQoL) in the young population is necessary for the design and implementation of more effective educational and public health interventions. Objective: To investigate the individual and combined effects of a set of lifestyle behaviors, including physical activity, sedentary behavior, sleep and food consumption, on the HRQoL of a sample of Brazilian adolescents. Methods: It is a school-based observational study with the participation of 308 adolescents aged 14 to 18 years. A questionnaire with structured questions was applied to gather demographic and lifestyle behavior data. A healthy lifestyle index was created including positive scores for each individual behavior. HRQoL was measured using the KIDSCREEN-27 questionnaire. Analysis of covariance and linear regression models were used for statistical analysis of the data. Results: Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior (F = 5.496; p = 0.016) and sleep duration between 8-10 hours/night (F = 6.542; p = 0.009) had significantly higher HRQoL. Adolescents who reported simultaneous adhesion in ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR = 2.12; 95%CI 1.27 – 4.79] to three times [OR = 3.04; 95%CI 1.93 – 5.62] more odds to have higher perceptions of HRQoL compared to those fulfilling none. Conclusion: Although healthy lifestyle behaviors had a positive individual effect on HRQoL, simultaneous adhesion to healthy behaviors enhances the cumulative effect. The findings reinforce the importance of promoting a healthy lifestyle to ensure HRQoL and well-being in adolescence, with repercussions throughout adulthood.