Self-reported Health Behaviors Research Articles

Health Status and Occupational Health and Safety Access among Informal Workers in the Rural Community, Southern Thailand.

PurposeThailands’ informal workers are faced with job insecurity and poor working conditions. Good health status can promote lifelong working and increase quality of life. This study analyzed factors associated with the health status of the community informal workers.MethodsA cross-sectional study was conducted with 390 informal workers aged 15 to 59 years in Thasala district, Nakhon Si Thammarat, southern Thailand. A multi-stage sampling method using proportional to size selection was employed in various types of informal workers. The interviews on self-reported health status, health behaviors, occupational hazards, healthcare utilization, occupational health and safety (OHS) access are reported as descriptive. The multivariate association was explored using the simple logistic regression.FindingsThe results revealed that 80.77% of the participants had good health, 57.44% had healthy behavior, 76.41% had safe work practices, 22.05% had moderate to high exposed of occupational hazards, and 56.41% had the low OHS access. Safe work practices, moderate to high OHS access, low exposed to occupational hazards, and low income were more likely to produce good health status, which yielded the adj. OR 2.57, 1.86, 0.39, and 0.48, respectively.ConclusionsThe community informal workers health status was associated by income, work practices, occupational hazards, and OHS access. To strengthening the informal workers’ health, the OHS program should be managed intensively by the primary care services, especially the OHS risk management.

Is Wellbeing Associated with Time Spent in Nature?

IntroductionGreen and blue spaces (GBS), such as parks, woodlands, rivers, and beaches, are thought to be important for mental health and wellbeing. Our longitudinal cohort contains objective household-level environment data linked at the invidual level to routinely recorded mental health data, augmented with cross sectional self-reported health behaviours, including leisure visits to the outdoors.
 Objectives and ApproachOur overall approach will evaluate if residential proximity to GBS is associated with mental health and wellbeing, and if any associations aremodified by visits to outdoors spaces following individual-level data linkage. Here, we examined cross-sectional survey data on time spent visiting nature outdoors. Wellbeing outcomes were assessed using self-reported scores. Data were analysed using generalised additive models in the SAIL Databank.
 ResultsUsing a sample of National Survey for Wales respondents (2016/17, n=3,481), over 40% of adults in Wales reported spending less than 30 minutes outdoors each week. Weekly time outdoors was positively associated with wellbeing (p=0.007) and life satisfaction (p=0.03) having adjusted for potential confounders including, age, rurality, loneliness, employment status. Confidence intervals varied along the fitted GAM model. Models using a second wave of survey data (n≈7,000), anonymously record-linked to residential environment and health data will explore these associations further.
 ConclusionA previous study based in England (White et al. 2019) found an upper wellbeing benefit threshold of 2 hours per week for time spent in nature. This was not apparent in our preliminary models, but may be revealed in further analyses. We will next incorporate longitudinal mental health and environmental data for 2 million adults living in Wales, UK. Linking to ambient and accessible residential GBS, while taking into account changes due to migration and actual visits, will allow us to provide valuable guidance to local government, who are often responsible for provisioning and maintaining outdoor facilities.

Longitudinal Evidence of How Media Audiences Differ in Public Health Perceptions and Behaviors During a Global Pandemic.

The current study investigates how public attitudes and perceptions about the COVID-19 pandemic evolve over time and influence self-reported health behaviors (e. g., social distancing). Specific attention was paid to respondents' exposure to different news media channels (public vs. commercial). We used data from a two-wave panel study with a 3-week interval (W1 at the start and W2 at the peak of the pandemic) and a large sample of the adult population in Flanders, Belgium (n = 870). The results of mixed ANOVAs indicate that besides a time-effect there was also a significant effect of the different types of news media exposure and respondents' support for protective health measures and behaviors. Whereas, perceived vulnerability to disease, feelings of loneliness, and solidarity were mostly determined by respondents' overall frequency of media exposure, support of governmental measures and self-reported health behaviors were mostly determined by the type of news media exposure. Respondents with a predominantly public/quality news media diet had the highest scores on these variables. A stepwise linear regression analysis with individual's change scores demonstrated that (self-)protective behavior was positively determined by respondents' age, solidarity, and the belief that the measures are necessary, but negatively determined by one's cumulative exposure to commercial/tabloid news media. This longitudinal study provides a new perspective on the role of news media in times of a public health crisis. It offers support for (A) the “double bind hypothesis” (i.e., while news media consumption encourages (self-)isolation, it fosters feelings of loneliness); and (B) the “dual effects hypothesis” (i.e., exposure to commercial/tabloid news media generates different outcomes than exposure to public/quality news media). Affective responses and socio-psychological perceptions are influenced by overall news media exposure, whereas support for the government and its handling of the crisis are mainly determined by one's selection of media channels, whereby audiences of public news media evaluate these outcomes more positively than the audiences of commercial news media channels.

Health behaviours of Indigenous and non-Indigenous cancer survivors living in regional and remote geographic areas of Australia: a short report

Abstract Background: Health behaviors are becoming increasingly recognized as important for cancer survivors in optimizing health after diagnosis. The current study aims to describe adherence to health behaviour guidelines in a sample of Indigenous and non-Indigenous cancer patients in Australia's Northern Territory. Methods: A structured survey collecting self-reported sociodemographic and health behaviour data was administered to a sample of cancer patients within 1 year of their cancer diagnosis at a cancer care center in Darwin, Northern Territory. Clinical data were collected via medical chart review. Results: In 63 participants (median age 58 years; 32% Indigenous), most met guidelines for fruit (73%), red meat (76%), and alcohol (75%) intake, whereas adherence to vegetable (10%), processed meat (33%), and physical activity (25%) guidelines was low. Almost one-third (32%) reported being current smokers. Indigenous patients more frequently met guidelines than non-Indigenous patients for fruit intake and physical activity, and less for vegetable, red and processed meat, alcohol intake and smoking. Although there were some notable changes post-cancer diagnosis, about half of the participants reported no change in most behaviors. Conclusions: Adherence to some recommended health behaviors was poor in this sample, regardless of Indigenous status, reflecting previous cancer survivorship and general national reports. For some this may be due to changes resulting from their cancer and treatment, whereas for others this may reflect pre-diagnosis low adherence. Further investigation is needed to better understand health behaviour decision-making for cancer patients and survivors in Northern Territory, to inform public health messaging and interventions for this population.

Coronary Heart Disease Risk in Blood or Marrow Transplant Survivors

INTRODUCTION: Exposure to total body irradiation (TBI) increases the risk for cardiovascular risk factors (CVRFs) such as diabetes, hypertension and dyslipidemia in Blood or Marrow Transplant (BMT) survivors with the potential to increase the risk of post-BMT Coronary Heart Disease (CHD). Chest radiation is associated with accelerated atherosclerosis in conventionally treated patients. These factors, with or without additional factors such as smoking likely place BMT survivors at a high risk for CHD. Yet, a comprehensive evaluation of the risk of late-occurring CHD in BMT survivors is lacking. We addressed this gap using the resources offered by the BMT survivor study (BMTSS). METHODS: BMTSS includes patients transplanted between 1974 and 2014 at 3 US sites, and who had survived ≥2 years after BMT, and were alive and ≥18 years at BMTSS survey completion. The BMTSS survey asked participants to report chronic health conditions diagnosed by their healthcare provider (including CHD, diabetes, hypertension and dyslipidemia), along with age at diagnosis. The participants self-reported sociodemographics and health behaviors. Information regarding primary cancer diagnosis, therapeutic exposures, donor type, stem cell source, and history of chronic graft vs. host disease (GvHD; for allogeneic BMT recipients) was abstracted from medical records. A cohort of 1,131 siblings completed the BMTSS survey and served as a comparison group. We obtained informed consent from all participants. RESULTS: The study included 3,479 BMT survivors; 50.3% had received an allogeneic BMT, 54.8% were males, and 71.4% were non-Hispanic whites. Median age at study participation was 59 years (interquartile range [IQR]: 48-66 years) for BMT survivors and 57 years (IQR: 46-64 years) for siblings. BMT survivors were followed for a median of 9 years (range: 2-41 years) from BMT. CHD developed after BMT in 122 BMT survivors (52 allogeneic, 70 autologous). BMT recipients compared with siblings: After adjusting for sociodemographics and comorbidities, allogeneic BMT survivors were at a 7.2-fold higher odds (95%CI: 4.0-13.0, p<0.0001) and autologous BMT recipients at a 11.7-fold higher odds (95%CI: 6.8-20.2, p<0.0001) of reporting CHD as compared to siblings. Allogeneic BMT survivors: The 20 year cumulative incidence of CHD was 4.7% for allogeneic BMT recipients. Increasing age at BMT (HR=1.05/year, 95%CI: 1.02-1.07, p<0.0001), male sex (HR=2.09, 95%CI: 1.14-3.82, p=0.017), history of CVRFs (HR=3.6, 95%CI: 1.72-7.41, p=0.0006), and pre-BMT targeted chemotherapy such as tyrosine kinase inhibitors (HR=2.7, 95%CI: 1.10-6.77, p=0.030) were associated with increased CHD risk. The 20 year cumulative incidence of CHD among patients with CVRFs was 6.6% vs. 1.9% (p=0.005) among those who did not have CVRFs (Fig 1). Autologous BMT survivors: The 20 year cumulative incidence of CHD was 9.1% for autologous BMT recipients. The risk factors for CHD in autologous BMT survivors included: increasing age at BMT (HR=1.06/year, 95%CI: 1.03-1.09, p<0.0001), male sex (HR=2.3, 95%CI: 1.30-3.90, p=0.004), history of smoking (HR=1.66, 95%CI: 1.03-2.67, p=0.038), CVRFs (HR=1.77, 95%CI: 1.04-3.01, p=0.036), arrhythmia (HR=1.85, 95%CI: 1.01-3.42, p=0.048) and history of pre-BMT chest radiation (HR=4.56, 95%CI: 2.1-9.88, p=0.0001). For every 1 Gray increase in the dose of chest radiation, there was a 4% increase in the risk of CHD, p=0.0002. The 20 year cumulative incidence of CHD among patients with CVRFs was 10.2% vs. 7.4% among those who did not have CVRFs (p=0.04) (Fig 2). CONCLUSION: BMT survivors are at a 7-fold to 12-fold higher risk of CHD compared with a sibling comparison group. CVRFs are independent risk factors for CHD both among allogeneic and autologous BMT recipients. Pre-BMT chest radiation further increases this risk in autologous BMT recipients. These findings suggest a need for aggressive management of CVRFs in BMT recipients to prevent CHD-related morbidity. Disclosures Gangaraju: Sanofi Genzyme, Consultant for Cold Agglutinin Disease: Consultancy. Weisdorf:FATE Therapeutics: Consultancy; Incyte: Research Funding. Arora:Pharmacyclics: Research Funding; Kadmon: Research Funding; Syndax: Research Funding; Fate Therapeutics: Consultancy.

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care.

AimYoung people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK.MethodsParticipants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months.ResultsMean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence.ConclusionsThe 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a “real world EIP setting” and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.

Association of Sensory Impairments With Cognitive Decline and Depression Among Older Adults in China

Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China. To examine the association of visual and/or hearing impairments with cognitive decline and depression. This cross-sectional study used the data from 18 038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses. The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions. Overall, 3 composite measures were used to assess the respondents' cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies-Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants' overall health, were used. Of 18 038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (β = -0.12; 95% CI, -0.19 to -0.05) and global cognition (β = -0.16; 95% CI, -0.31 to -0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (β = -0.24; 95% CI, -0.30 to -0.18), mental intactness (β = -0.19; 95% CI, -0.28 to -0.10), and global cognition (β = -0.43; 95% CI, -0.55 to -0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: β = -0.23; 95% CI, -0.31 to -0.14; mental intactness: β = -0.13; 95% CI, -0.27 to -0.0003; global cognition: β = -0.37; 95% CI, -0.55 to -0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52). In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China's health care system to address age-related sensory impairments.

The mediating role of unhealthy behaviors and body mass index in the relationship between high job strain and self-rated poor health among lower educated workers

ObjectivesThe objective of this study is to examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relationship between high job strain and self-rated poor health in workers with a low education.MethodsA total of 8369 low educated workers, who participated in the Lifelines cohort study during the period 2012–2017, were included. Self-reported job strain, health behaviors (smoking, physical activity, and fruit and vegetable consumption), and BMI were assessed at baseline, and self-rated health after 2 years. To assess mediation by the health behaviors and BMI, structural equation modeling with logistic and multinomial regression analyses were performed.ResultsWorkers with high job strain had a higher odds of poor health (OR 1.34; 95% CI 1.13–1.60) compared to those with low job strain. Workers with high job strain were more likely to have a lack of physical activity (OR 1.14; 95% CI 1.01–1.28), but were not more likely to smoke, to be overweight or obese, or to have a low fruit or vegetable consumption. Workers who smoke, have a lack of physical activity or are overweight or obese are more likely to report poor health (OR 1.37; 95% CI 1.16–1.60, OR 1.25; 95% CI 1.08–1.43, OR 1.37; 95% CI 1.16–1.61, OR 2.25; 95% CI 1.86–2.72). Indirect (mediating) effects of unhealthy behaviors and BMI in the relationship between high job strain and poor health were small and not statistically significant.ConclusionsNo mediating effects of unhealthy behaviors or BMI were found in the relationship between high job strain and self-rated poor health among workers with a low educational level.

Evaluation of an interdisciplinary group education curriculum for hypertension

Hypertension disproportionately affects African American communities. This interdisciplinary, group education curriculum aimed to improve hypertension knowledge, behavioral risk factors , weight, and blood pressure (BP) in an urban African American population with uncontrolled hypertension. Outcomes were assessed with paired t-tests in a pre-post study design. Participants (n = 20) demonstrated a significant increase in hypertension knowledge. Among self-reported health behaviors, maintaining a healthy weight improved significantly. Participants demonstrated significant weight loss at one month compared to baseline, and trended towards significance at three and six months. Participants’ baseline BP was 165/88 mmHg. Decreases in systolic BP trended towards significance at one month (△ = 12.27 mmHg) and decreased significantly at three months (△ = 23.06 mmHg) and six months (△ = 21.44 mmHg). Diastolic BP significantly decreased at one month (△ = 8.37 mmHg) and six months (△ = 8.61 mmHg) and trended towards significance at three months (△ = 7.41 mmHg). This interdisciplinary, group education intervention shows promise for improving hypertension management in African American populations. • This pre-post study assessed if an interdisciplinary, group education program improved hypertension among African Americans. • Post-intervention, participants had improved hypertension knowledge and weight loss. • Participants had a significant decrease of 21 mmHg in systolic BP and 9 mmHg in diastolic BP at six months follow-up.

Physical measures and biomarker collection in health surveys: Propensity to participate.

Population-based surveys have long been a key tool for health researchers, policy makers and program managers. The addition of bio-measures, including physical measures and specimen collection, to self-reported health and health behaviors can increase the value of the research for health sciences. At the same time, these bio-measures are likely to increase the perceived burden and intrusiveness to the respondent. Relatively little research has been reported on respondent willingness to participate in surveys that involve physical measures and specimen collection and whether there is any associated non-response bias. This paper explores the willingness of respondents to participate in surveys that involve physical measures and biomarkers. A Census-balanced sample of nearly 2000 adults from a national mobile panel of persons residing in the U.S. were interviewed. Willingness to participate in six specific bio-measures was assessed. The survey finds a high correlation in the willingness of respondents to participate among these specific bio-measures. This suggests there is a general propensity towards (and against) bio-measures among potential respondents, despite some differences in willingness to participate in the more sensitive, intrusive or burdensome biomarkers. This study finds the general propensity to participate in bio-measures is correlated with a number of key measures of health and illness. This suggests that the inclusion of biomarkers in health surveys may introduce some bias in key measures that need to be balanced against the value of the additional information.

Resilience and CVD-protective Health Behaviors in Older Women: Examining Racial and Ethnic Differences in a Cross-Sectional Analysis of the Women's Health Initiative.

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds. Methods: A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women’s Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity. Results: High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15–1.30)), adhering to recommended physical activity (≥ 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7–9) (1.36 (1.28–1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1–7 days per week) (1.28 (1.20–1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03). Conclusion: Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions.

Joint effect of depression and health behaviors or conditions on incident cardiovascular diseases: A Korean population-based cohort study

BackgroundThe precise relationships among depression, risk factors for cardiovascular disease (CVD), and incident CVD remain uncertain. This study examined the joint effect of depression and other CVD risk factors on the incidence of CVD. MethodsWe conducted a prospective cohort study using South Korea's National Health Insurance Service-National Sample Cohort (NHIS-NSC). To estimate incident CVD, 199,544 participants without CVD diagnosed with depression between 2003 and 2005 were followed through 2013. The clinician's diagnosis used measurements for depression, CVD risk factors, and CVD. ResultsControlling for other CVD risk factors, depressed individuals had a higher risk for ischemic heart disease (AHR, 1.01; 99%%CI, 1.01–1.50) and other forms of heart disease likely related to atherosclerosis (AHR, 1.43; 99%%CI, 1.13–1.82). There were no statistically significant interactions between depression and CVD risk factors. However, when depression was comorbid with overweight or diabetes, there was a higher risk for incident ischemic heart disease, as compared to depression or CVD risk factors alone. For other forms of heart disease likely related to atherosclerosis, the coexistence of depression and physical inactivity or overweight showed a similar pattern to that shown in ischemic heart disease. LimitationsThe severity of depression was not reported for depressed patients, and our dataset provided a limited number of covariates. Also, the self-reported health behavior data may be biased. ConclusionAs depression could be a significant predictor of incident CVD independently with other CVD risk factors, professionals should recognize and manage depression as a major CVD risk factor.

Self-Reported Oral Health Attitudes and Behaviors, and Gingival Status of Dental Students.

AimThe aim of this study was to assess self-reported oral health attitudes and behaviors of the Iraqi dental students and compare the variations in these attitudes and behaviors that linked to dental education level and gender.Materials and MethodsA self-administered questionnaire depended on the English version of the Hiroshima University Dental Behavioral Inventory (HU-DBI) was prepared, the questionnaire given to 198 dental students.ResultsAbout 91.4% of the dental students were worried about the teeth colour, and merely minor percentage of them (18.8%) thought it is not crucial to seek dental advice until they acquire a tooth pain; however, 26.3% of the students were disturbed because of their gum colour, and 75.3% of them examined their teeth after brushing. Besides, 72.2% of the students replied that gum disease could not be prevented by tooth brushing only, 60.1% of the students do not give visiting the dentist such concern, and 14.1% of dental students were smokers. The plaque and gingival indices were significantly higher in preclinical students than clinical students.ConclusionIraqi dental students had somewhat good oral health behavior and attitudes; however, extra concentrating is required on the anticipatory and behavioral aspects of oral self-care practices. Female dental students displayed better oral health behavior and attitudes than male colleagues on some issues.

Effects of a Workplace Wellness Program on Employee Health, Health Beliefs, and Medical Use

Many employers use workplace wellness programs to improve employee health and reduce medical costs, but randomized evaluations of their efficacy are rare. To evaluate the effect of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months. This randomized clinical trial of 4834 employees of the University of Illinois at Urbana-Champaign was conducted from August 9, 2016, to April 26, 2018. Members of the treatment group (n = 3300) received incentives to participate in the workplace wellness program. Members of the control group (n = 1534) did not participate in the wellness program. Statistical analysis was performed on April 9, 2020. The 2-year workplace wellness program included financial incentives and paid time off for annual on-site biometric screenings, annual health risk assessments, and ongoing wellness activities (eg, physical activity, smoking cessation, and disease management). Measures taken at 12 and 24 months included clinician-collected biometrics (16 outcomes), administrative claims related to medical diagnoses (diabetes, hypertension, and hyperlipidemia) and medical use (office visits, inpatient visits, and emergency department visits), and self-reported health behaviors and health beliefs (14 outcomes). Among the 4834 participants (2770 women; mean [SD] age, 43.9 [11.3] years), no significant effects of the program on biometrics, medical diagnoses, or medical use were seen after 12 or 24 months. A significantly higher proportion of employees in the treatment group than in the control group reported having a primary care physician after 24 months (1106 of 1200 [92.2%] vs 477 of 554 [86.1%]; adjusted P = .002). The intervention significantly improved a set of employee health beliefs on average: participant beliefs about their chance of having a body mass index greater than 30, high cholesterol, high blood pressure, and impaired glucose level jointly decreased by 0.07 SDs (95% CI, -0.12 to -0.01 SDs; P = .02); however, effects on individual belief measures were not significant. This randomized clinical trial showed that a comprehensive workplace wellness program had no significant effects on measured physical health outcomes, rates of medical diagnoses, or the use of health care services after 24 months, but it increased the proportion of employees reporting that they have a primary care physician and improved employee beliefs about their own health. American Economic Association Randomized Controlled Trial Registry number: AEARCTR-0001368.

Associations of leisure screen time with cardiometabolic biomarkers in college-aged adults.

We examined whether screen time was associated with cardiometabolic disease (CMD) risk factors in young adults. Ninety-five adults (19.9 ± 11.4years) self-reported medical and health behavior history, screen time (television viewing, video games and computer games), and dietary intake. Waist circumference, blood pressure, fasting glucose and lipid levels, cardiorespiratory fitness (VO2peak), and body composition were measured. Total sedentary behavior and moderate-to-vigorous physical activity (MVPA) were measured by accelerometer. On average, leisure screen time (2.0 ± 1.6hday-1) accounted for 24% of total sedentary time (8.4 ± 1.5hday-1). After adjustment for demographics, smoking, sleep duration, total energy intake, total sedentary time and MVPA, a 1-standard deviation increase in leisure screen time was associated with a 26% higher BMI, 29% higher waist circumference, 25% higher fat mass, 23% higher triglyceride, and 24% lower VO2peak (p < 0.05). Our findings suggest that screen time may contribute to the risk of obesity and CMD in young adults.

Perceived Stress, Coping Styles and Mindfulness as Predictors of Students’ Self-Reported Health Behaviors

Perceived Stress, Coping Styles and Mindfulness as Predictors of Students’ Self-Reported Health Behaviors

Young Adult Human Papillomavirus and Influenza Vaccine Coverage: A Comparison Across College Enrollment Status.

To determine human papillomavirus and influenza vaccine coverage among young adults in the US and assess differences in vaccine uptake by college enrollment status, we conducted an online surveyof young adults aged 18-26 (n = 417) using Survey Monkey, with recruitment occurring through Amazon's Mechanical Turk (MTurk) platform. We collected data on self-reported preventive health behaviors, including vaccine receipt, current college enrollment status, and other demographics. Overall, 49% of participants reported receiving at least one dose of human papillomavirus vaccine and 57% reported receiving at least one influenza vaccine over the past three years. Vaccine coverage estimates did not differ between college-enrolled and non-enrolled respondents. Low vaccine coverage rates demonstrate the need to improve vaccine strategies for young adults. The strongest predictor of vaccine receipt was having received a provider recommendation. There does not appear to be healthcare utilization differences related to ability to access care through student health or community-based settings. Additional research is needed to develop interventions to improve vaccination coverage among young adults, both currently enrolled and not enrolled in college.

Effect of a Health System Sponsored Mobile App on Perinatal Health Behaviors [13E

INTRODUCTION: The increasing popularity of pregnancy mobile applications raises the need for prenatal apps to include evidence-based content. We aimed to assess the potential for a health system-sponsored mobile app to improve health outcomes and increase healthy behaviors by providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care. METHODS: The study took place over 18 months at the Providence St. Joseph Health system in Portland, Oregon. Our sample included women who received prenatal care at a Providence clinic and had a live birth at a Providence hospital. We compared a treatment group (app users) and a control group (non-app users) using a self-reported health behavior survey and outcomes data from electronic medical records. Providence Health and Services IRB approved this study. RESULTS: We enrolled 167 women in the treatment group and 400 in the control group. Compared to non-app users, app users had greater odds of breastfeeding beyond 6 months postpartum and of exercising three or more times per week during pregnancy. They also had lower odds of missed prenatal appointments. There was no significant impact of app use on nutritional measures or clinical outcomes, including premature births, low birth weight babies, and neonatal intensive care unit stays. CONCLUSION: The use of a prenatal mobile app and access to personalized, evidence-based health information was associated with an increase in certain healthy behaviors, while there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on pregnancy and infant outcomes.

Self-reported health behaviors and longitudinal cognitive performance in late middle age: Results from the Wisconsin Registry for Alzheimer's Prevention.

BackgroundStudies have suggested associations between self-reported engagement in health behaviors and reduced risk of cognitive decline. Most studies explore these relationships using one health behavior, often cross-sectionally or with dementia as the outcome. In this study, we explored whether several individual self-reported health behaviors were associated with cognitive decline when considered simultaneously, using data from the Wisconsin Registry for Alzheimer’s Prevention (WRAP), an Alzheimer’s disease risk-enriched cohort who were non-demented and in late midlife at baseline.MethodWe analyzed longitudinal cognitive data from 828 participants in WRAP, with a mean age at baseline cognitive assessment of 57 (range = 36–78, sd = 6.8) and an average of 6.3 years (standard deviation = 1.9, range = 2–10) of follow-up. The primary outcome was a multi-domain cognitive composite, and secondary outcomes were immediate/delayed memory and executive function composites. Predictors of interest were self-reported measures of physical activity, cognitive activity, adherence to a Mediterranean-style diet (MIND), and interactions with each other and age. We conducted linear mixed effects analyses within an Information-theoretic (IT) model averaging (MA) approach on a set of models including covariates and combinations of these 2- and 3-way interactions. The IT approach was selected due to the large number of interactions of interest and to avoid pitfalls of traditional model selection approaches.ResultsModel-averaged results identified no significant self-reported health behavior*age interactions in relationship to the primary composite outcome. In secondary outcomes, higher MIND diet scores associated with slower decline in executive function. Men showed faster decline than women on delayed memory, independent of health behaviors. There were no other significant interactions among any other health behaviors and cognitive trajectories.ConclusionsWhen multiple covariates and health behaviors were considered simultaneously, there were limited weak associations with cognitive decline in this age range. These results may be explained alone or in combination by three alternative explanations: 1) the range of cognitive decline is in middle age is too small to observe relationships with health behaviors, 2) the putative associations of these health behaviors on cognition may not be robust in this age range, or 3) the self-reported measures of the health behaviors may not be optimal for predicting cognitive decline. More study may be needed that incorporates sensitive measures of health behaviors, AD biomarker profiles, and/or other disease comorbidities.

Health Behaviors in the Service Sector: Substance Use Among Restaurant Employees

Restaurant workers in the United States exhibit high levels of alcohol and drug use. However, there is a scant amount of qualitative research uncovering how and why restaurant employees use and abuse legal and illegal substances. Examining restaurant workers’ self-reported risky health behaviors is important for improving employee and occupational quality of life. The purpose of this article is to investigate the health behaviors of restaurant workers and pathways to such outcomes. Specifically, this article explores the question of what social conditions and processes within restaurants relate to employee adverse health behaviors. Drawing on qualitative data collected between 2009 and 2014, this article focuses on a case study of restaurant employees, detailing their substance use and the ways in which they discuss and talk about taking health risks. An analysis of 52 in-depth, semistructured interviews with restaurant workers broadens the theoretical explanation for deviant health behaviors in the service sector. Results indicate that workplace characteristics—such as occupational socialization, norms and values, job stress and coping mechanisms, social networks and friendships, and personnel policies—permit and encourage substance use and risky health behaviors. Research implications include underscoring service industry adverse health behaviors and recommendations for positive social change in terms of personal, social, and job-related well-being.