Evaluating the Factor Structure of the Preliminary Version of EuroQol Health and Well-Being Instrument in China: A Replication of the Confirmatory Factor Analysis.

Sense of competency and caregiver burden among parents of children with medical complexity: A cross-sectional study.

Chronic skin diseases and life trajectories: Development and validation of "Dermatology Long-Term Life Impact Measure".

This study aimed to cross-culturally adapt and validate the Health Activation Scale for Children (HAS-C) in Chinese elementary school populations. The 12-item HAS-C was cross-culturally adapted into Chinese using Brislin's translation model. Psychometric validation was conducted with 588 urban schoolchildren in Huzhou, assessing content validity, construct validity via exploratory analysis and internal consistency reliability. Results demonstrated excellent content validity (scale-level content validity index [S-CVI/Ave] = 0.96; item-level content validity index [I-CVI] = 0.83-1.00), a robust three-factor structure accounting for 58.87% of the total variance (confirmatory factor analysis: comparative fit index [CFI] = 0.962, root mean square error of approximation [RMSEA] = 0.079) and strong reliability (Cronbach's α = 0.812 for the total scale; 0.734-0.839 for subscales). As the first standardized instrument assessing health beliefs, behavioural confidence and intention for action in Chinese children, the HAS-C enables school nurses to identify early risks in health behaviours, design personalized interventions and provide benchmark data for evaluating national health policies.

ABSTRACT Background Reliable measurement of occupational stress is essential for designing effective interventions for healthcare workers; however, Vietnam currently lacks culturally validated assessment tools. Objectives To develop and validate the Healthcare Worker Stress Scale – Vietnam (HWSS-V), a profession-inclusive, culturally grounded instrument that extends the Health Professions Stress Inventory (HPSI) and the Nursing Stress Scale (NSS) by adding Vietnam-salient domains and crisis-monitoring utility. Methods We conducted a cross-sectional survey of 520 physicians, nurses, and medical technicians at two university hospitals (June–December 2021). Fifty items adapted from HPSI/NSS underwent forward – backward translation and expert review. Psychometric evaluation included item-level content validity index (I-CVI), scale-level content validity index (S-CVI), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing (Cronbach’s alpha). Results All fifty items showed strong content validity (I-CVI ≥0.80; κ 0.67–0.97; S-CVI = 0.90). EFA supported a five-factor structure. After removing six low-loading items, forty-four items explained 87.1% of variance with excellent reliability (overall Cronbach’s alpha = 0.96; subscales 0.85–0.95). CFA indicated acceptable fit (Root Mean Square Error of Approximation = 0.077; Standardized Root Mean Squared Residual = 0.060; Tucker – Lewis Index = 0.827; Comparative Fit Index = 0.816). Conclusions HWSS-V enables practical hospital-level stress surveillance and quality improvement. Hospitals can: (i) embed HWSS-V into biannual staff health checks to benchmark units and triage high-risk groups; (ii) integrate scores into dashboards to trigger tailored responses; and (iii) deploy rapid assessments during crises (e.g. outbreaks, patient surges) to guide resource allocation. By addressing culturally specific stressors across major clinical professions, HWSS-V provides actionable capabilities beyond HPSI/NSS for Vietnam’s hospitals.

Purpose: Maternal depression can persist beyond the immediate postpartum period and can adversely affect maternal functioning and child development. However, evidence describing long-term trajectories and multidimensional predictors remains limited. This study investigated the 7-year trajectory of maternal depressive symptoms from childbirth to when the child reached 6 years of age and identified significant predictors across child, maternal, and family domains.Methods: In total, 1,030 mothers from the Panel Study on Korean Children were included. Depressive symptoms were assessed at postpartum years 1, 3, 5, and 7 using the Kessler Depression Scale. Latent growth modeling was used to examine symptom trajectories, and logistic regression analyses were conducted to identify predictors of depressive-symptom risk.Results: Overall, 55.6% of mothers experienced at least one episode of mild-to-moderate or severe depressive symptoms. Among at-risk mothers, depressive symptoms demonstrated a slight upward trajectory with significant individual variability (linear model fit: χ²=12.65, root mean square error of approximation=.052, comparative fit index=.961). Significant predictors included preterm or low-birth-weight delivery (odds ratio [OR]=2.29), prenatal depression (OR=2.61), postpartum depression at 1 month (OR=3.41), high parenting stress (OR=1.63), low self-esteem (OR=2.33), and marital conflict (OR=2.02). Higher educational attainment emerged as a protective factor (OR=0.59).Conclusion: These findings demonstrate the persistence of maternal depressive symptoms and highlight key predictors for promptly identifying mothers at elevated risk. Integrating routine longitudinal screening with interventions targeting maternal stress, self-esteem, and family functioning may be critical for mitigating long-term depressive trajectories. Family-centered approaches, including partner involvement and conflict-management strategies, appear essential for improving maternal mental health and promoting healthier developmental environments for children.

Purpose: This study was conducted to evaluate the validity and reliability of the Korean version of the Healthy Work Environment Assessment Tool (K-HWEAT), originally developed by the American Association of Critical-Care Nurses. Methods: The study was conducted among nurses working at three university hospitals located in metropolitan areas between May 29 and October 10, 2019. A total of 543 nurses participated. Data were analyzed using AMOS version 26.0 to assess the construct validity of the K-HWEAT. Results: Confirmatory factor analysis initially failed to meet acceptable model fit indices. Model fit improved after reassigning item 1 from factor 1 to factor 2 and item 12 from factor 4 to factor 6, as well as allowing correlated error terms based on high modification indices. Following these adjustments, standardized root mean square residual remained unchanged (0.05 to 0.05) and root mean square error of approximation decreased from 0.09 to 0.07, whereas goodness of fit index increased from 0.88 to 0.91, adjusted goodness of fit index from 0.83 to 0.86, Normed Fit Index from 0.85 to 0.89, and comparative fit index from 0.88 to 0.92. The K-HWEAT demonstrated a moderate correlation with the Korean version of the Practice Environment Scale of the Nursing Work Index (r=.60, p<.001), supporting criterion validity. The overall Cronbach’s α was .92, with the six factors showing internal consistency coefficients ranging from 0.62 to 0.74. Conclusion: These findings support the reliability and validity of the K-HWEAT. However, further conceptual refinement of individual items may be necessary to enhance construct clarity.

Ancient walnut trees (Juglans regia L.), revered as “cultural heritage in motion,” have coexisted harmoniously with dense clusters of Tibetan traditional villages for centuries. However, accelerating climate change and expanding human activities along the middle reaches of the Yarlung Tsangpo River have increasingly threatened their survival. To quantitatively evaluate the health of these ancient trees and identify the underlying driving mechanisms, this study developed a remote sensing-enhanced Structural Equation Model (SEM) that integrated satellite-derived ecological indices, land-use intensity, and field-measured morphological and physiological indicators. A total of 135 ancient walnut trees from villages such as Gamai in Jiacha County, Tibet, were examined. Key findings: (1) The SEM demonstrated an excellent model–data fit (Minimum Discrepancy Divided by Degrees of Freedom (CMIN/DF) = 1.372, Root Mean Square Error of Approximation (RMSEA) = 0.053, Tucker–Lewis Index (TLI) = 0.956, and Comparative Fit Index (CFI) = 0.962), confirming its robustness. (2) Among the latent variables, overall condition exerted the strongest influence (weight = 0.360), whereas foliage condition contributed least (0.289). (3) Approximately 35.56% of trees were healthy or sub-healthy, while 61.48% showed varying levels of decline. (4) Tree health was jointly shaped by intrinsic and extrinsic factors, with intrinsic drivers exhibiting stronger explanatory power. Externally, human disturbance negatively affected health, whereas ecological quality was positively associated. These results highlight the effectiveness of integrating remote sensing and SEM for ancient tree assessment and underscore the urgent need for long-term monitoring and adaptive conservation strategies to enhance ecological resilience.

ObjectiveTo adapt the Outpatient Physical Therapy Improvement in Movement Assessment Log questionnaire into Turkish and to evaluate its cultural adaptation, validity, and reliability.DesignA cross-sectional study involving cross-cultural adaptation and psychometric validation.SettingOutpatient physiotherapy clinics at a university hospital in Turkey.Participants272 adult patients receiving outpatient physiotherapy.InterventionParticipants completed the Turkish version of the scale, along with the Tampa Kinesiophobia Scale, Katz Activities of Daily Living Scale, and the International Physical Activity Questionnaire-Short Form. A subgroup of 84 participants completed the questionnaire again after two weeks to assess test-retest reliability.Main measuresContent validity was assessed using the Davis technique; structural validity was examined using exploratory factor analysis and confirmed using confirmatory factor analysis. Internal consistency was determined using Cronbach's alpha coefficient; test-retest reliability was evaluated using the intraclass correlation coefficient; and parallel-forms reliability was assessed.ResultsThe Content Validity Index of the scale was 0.92. Confirmatory factor analysis fit indices for the three-factor structure were acceptable: chi-square/degrees of freedom = 1.672; root mean square error of approximation = 0.047; comparative fit index = 0.953; Tucker-Lewis index = 0.945. Cronbach's alpha was .859, and the intraclass correlation coefficient was 0.856, indicating high internal consistency and reliability.ConclusionsThe Turkish version of the scale is a culturally adapted, valid, and reliable tool for assessing movement-related confidence in adult outpatients receiving physiotherapy. It can guide clinical decisions and support patient-centered rehabilitation.

BackgroundThe Cognitive Domains and Functional Assessment Questionnaire (CDFAQ) assesses cognitive and functional decline based on the DSM‐5 criteria for Neurocognitive Disorders. Its accuracy has been assessed, and it has been translated and adapted into English. The participant version (CDFAQ‐PV) is a 30‐item questionnaire that assesses six cognitive domains, based on the DSM‐5, with five items each: Complex Attention (CA), Executive Functions (EF), Learning and Memory (LM), Language (L), Perceptual‐Motor (PM) and Social Cognition (SC). Although the informant version (CDFAQ‐IV) has already been assessed by factor analysis with convergence to the DSM‐5 cognitive domains, this assessment hasn’t been done yet for the participant version.ObjectiveTo perform a Confirmatory Factor Analysis of the CDFAQ‐PV to assess the six‐factor cognitive domain model.MethodsOlder adults and their informants were invited to participate in this study. The CDFAQ‐PV was applied in 377 older adults. We used the JASP for a Confirmatory Factor Analysis based on Lavaan R Packages. The confirmatory factor analysis was run with a manual six‐factor model. This study was approved by the ethics committee of UFMG.ResultsConfirmatory factor analysis model fitness was significant with X2(p < .001), with standardized root mean square residual (SRMR) .065 (accepted < .08), and with the goodness of fit index (GFI) .983 (accepted > .9). However, the root mean square error of approximation (RMSEA) was over the accepted values .073 (accepted < .06), as well as the comparative fit index CFI that was .792 under the accepted cutoff (accepted > .9).ConclusionThe six‐factor model of the showed a good fit for three parameters, and negative for two. These results point to a convergence of the CDFAQ‐PV and CDFAQ‐IV, as well to the DSM‐5 cognitive domains. These are still preliminary results and we aim to increase our sample to further assess the confirmatory factor analysis.

Purpose This study aims to develop and validate a multidimensional scale to measure environmental, social and governance (ESG) awareness among frontline production employees, addressing a critical gap in understanding how ESG principles are perceived and enacted at the employee level. Design/methodology/approach A theory-driven approach was used to design a 12-item scale grounded in social cognitive theory, moral action model and ethical climate theory. Data were collected via anonymous questionnaires from 486 production workers in China’s Baijiu manufacturing sector. The scale was tested using exploratory factor analysis and confirmatory factor analysis to establish its factorial structure, reliability and validity. Findings Results confirmed a robust three-factor structure corresponding to ESG awareness. The model demonstrated excellent fit indices (e.g. comparative fit index = 0.998, root mean square error of approximation = 0.012) and strong internal consistency. The scale captures cognitive, emotional and normative dimensions of ESG engagement. Practical implications The scale provides organizations with a tool to assess and enhance employee-level ESG alignment, supporting ESG reporting, workforce development and sustainable operations. Originality/value This research contributes a novel, psychometrically validated instrument that integrates ESG theory with employee behavioral measurement, offering new insights for embedding sustainability from the ground up.

Organizations, particularly higher education centers, play a crucial role in fostering learning through various mechanisms and structures. The cultural and contextual factors of a country significantly influence organizational dynamics. This study aimed to evaluate the psychometric properties of the Learning Organization Perception Measurement Scale within Iranian Universities of Medical Sciences. The validity and reliability of the Persian version of the Learning Organization Comprehension Scale (LOCS) was evaluated among 176 faculty members from Isfahan, Arak, and Tehran Universities of Medical Sciences. Construct validity was confirmed using confirmatory factor analysis, with exploratory factor analysis omitted due to the well-established structure of the original scale. Reliability was excellent, with Cronbach's alpha exceeding 0.70 for the total scale and all subscales, confirming the Persian LOCS as psychometrically sound. The Cronbach's alpha coefficient was 0.93 for the entire questionnaire, 0.79 for the personal mastery component, 0.81 for mental models, 0.83 for shared visions, 0.86 for team learning, and 0.85 for system thinking. The chi-square index per degree of freedom for the five-factor model was 1.466, while this index was 2.147 in the single-factor model. Modification to use of the five-factor model was done to improve the model indices; therefore, the chi-square index per degree of freedom (χ2/df) decreased to 1.374. Also, the comparative fit indices (CFI) increased to 0.91, the incremental fit index (IFI) increased to 0.91, the goodness-of-fit index (GFI) increased to 0.79, and the root mean square error of approximation (RMSEA) decreased to 0.05. In education, learning organizations require personal mastery, mental models, shared vision, team learning, and systems thinking. These elements promote growth, decision-making, unity, and complexity handling. Assessing and improving educators' abilities in these areas is crucial for addressing challenges and fostering successful learning environments.

Existing studies on citizen trust at the macro level often fail to capture the organizational and contextual dimensions of trust in public institutions. This study develops a multidimensional and context-sensitive scale tailored to Türkiye's centralized and multi-actor administrative system. Building on but moving beyond the widely cited Citizen Trust in Government Organizations scale, the present study introduces a 19-item scale, the Citizen Trust Perception Scale for Public Institutions, structured around competence, benevolence and integrity. The scale was tested on a heterogeneous sample including public employees, service users and citizens with varying levels of familiarity with the Ministry of Youth and Sports, thereby ensuring broader representativeness. The development process encompassed content validation, exploratory and confirmatory factor analyses, and reliability assessments. Results showed strong construct validity (e.g. Comparative Fit Index = .972, root mean square error of approximation = .068) and high internal consistency (α = .922–.956 across dimensions; overall α = .977). These findings confirm the scale as a robust and reliable tool for measuring institutional trust, capturing not only performance-based perceptions but also ethical and governance-related factors. Beyond Türkiye, the Citizen Trust Perception Scale for Public Institutions offers applicability to other centralized or hybrid governance systems, providing both theoretical depth and methodological advancement to the study of institutional trust. Points for practitioners The Citizen Trust Perception Scale for Public Institutions (CTPS-PI) offers a clear framework to assess citizens’ trust across competence, benevolence and integrity in Türkiye and comparable centralized or hybrid administrative systems. The scale supports analysis of trust patterns across central and provincial units, enabling practitioners to identify vulnerabilities such as communication problems or perceptions of unfairness. Its structured approach helps managers integrate trust considerations into performance management, service delivery and organizational improvement efforts. Applying the scale in trust-building strategies can strengthen transparency, consistency and responsiveness in public administration.

Background and Purpose: Pediatric nursing requires tools that reflect the unique nature of care provided to children and their families. Nurse caregiving behaviors are critical to patient satisfaction, quality of care, and return intentions, yet validated instruments in Persian are lacking. This study aimed to translate and psychometrically evaluate the caregiver version of the Nurse Caring Behavior Scale into the Persian language. Methods: This study employed a cross-sectional design with psychometric validation methods including exploratory and confirmatory factor analyses. The participants were 450 parents of hospitalized children, 15 nursing faculty, and 8 pediatric head nurses who were selected in various phases of the study. The caregiver version of the Nurse Caring Behavior Scale was translated into the Persian language via a forward-backward process. The psychometric evaluation encompassed three phases: face validity, content validity, and construct validity. Reliability was estimated through internal consistency. Results: Content validity was confirmed with an Scale-level Content Validity Index, Average method (S-CVI/Ave) of .945 and Scale-level Content Validity Index, Universal Agreement (S-CVI/AU) of .714. Exploratory factor analysis supported a single-factor structure comprising 14 items, explaining 60.7% of the variance. Confirmatory factor analysis confirmed acceptable model fit (χ2 divided by degrees of freedom = 2.078, root mean square error of approximation = .074), leading to the removal of one item (item 11) due to low factor loading. Reliability indices were strong: Cronbach's alpha = .925, composite reliability = .930, McDonald's omega = .930, and intraclass correlation coefficient = .885. Conclusions: The Nurse Caring Behavior Scale-Iranian version for parents demonstrated strong validity and reliability. This scale is appropriate for use in future studies among Persian-speaking parents of hospitalized children. Assessing the nurses' caring behavior according to the parents of hospitalized children can provide useful information for nursing stakeholders to evaluate the quality of their care.

This study aims to develop a new scale to measure treatment adherence in rheumatic diseases and to measure participants' attitudes towards treatment adherence. The data were obtained using the "treatment adherence scale for rheumatic diseases," which was developed to measure treatment adherence in rheumatic conditions. The research sample comprised 402 patients, and demographic variables were collected. During the scale development process, the Pearson correlation coefficient, Bartlett's test, the Kaiser-Meyer-Olkin value, and exploratory and confirmatory factor analysis methods were used. In confirmatory factor analysis, the validity of the model was evaluated using root mean square error of approximation, non-normed fit index/Tucker-Lewis indices, comparative fit index, normed fit index, and chi-square goodness-of-fit test. In reliability analyses, composite reliability and Cronbach's alpha coefficient were calculated. For descriptive analyses, frequency distributions, measures of dispersion and central tendency, and multiple linear regression analyses were employed. Findings related to the scale development phase: The developed "treatment adherence scale for rheumatic diseases" consists of four factors: behavioral adherence to the treatment process, collaboration and communication with healthcare professionals, medication awareness and consciousness, and medication treatment commitment. The scale comprises 20 items and is scored on a Likert scale. The scale's reliability was 0.92, explaining 55.7% of the total variance. According to confirmatory factor analysis results, the fit indices were found to be χ2/df ratio of 1.99; root mean square error of approximation = 0.07; comparative fit index = 0.99; normed fit index = 0.99; non-normed fit index = 0.99. The multiple linear regression analysis indicated that the model was significant (F = 5.930; p = 0.001) and that approximately 8% of the variation in treatment adherence scores could be explained (R2 = 0.083). The findings reveal that the researchers' treatment adherence scale for rheumatic diseases is a reliable and valid assessment instrument. Using this scale may enhance patient care and treatment management in rheumatic disorders. Furthermore, understanding characteristics that influence treatment adherence might improve treatment efficacy and help lower the total societal burden. Key Points • This study reveals that a newly developed scale for assessing treatment adherence in rheumatic patients is valid and reliable. • The scale offers a thorough assessment by examining patients'' treatment approaches from multiple perspectives, including behavioral, communicative, and drug awareness. • Age and particular individual factors can influence treatment adherence; therefore, customized encouragement and interventions are important..

Applied researchers often encounter situations where certain item response categories receive very few endorsements, resulting in sparse data. Collapsing categories may mitigate sparsity by increasing cell counts, yet the methodological consequences of this practice remain insufficiently explored. The current study examined the effects of response collapsing in Likert-type scale data through a simulation study under the confirmatory factor analysis model. Sparse response categories were collapsed to determine the impact on fit indices (i.e., chi-square, comparative fit index [CFI], Tucker-Lewis index [TLI], root mean square error of approximation [RMSEA], and standardized root mean square residual [SRMR]). Findings indicate that category collapsing has a significant impact when sparsity is severe, leading to reduced model rejections in both correctly specified and misspecified models. In addition, different fit indices exhibited varying sensitivities to data collapsing. Specifically, RMSEA was recommended for the correctly identified model, and TLI with a cut-off value of .95 was recommended for the misspecified models. The empirical analysis was aligned with the simulation results. These results provide valuable insights for researchers confronted with sparse data in applied measurement contexts.

IntroductionThere are 10.5 million children with epilepsy (CWE) around the world. Approximately 70% of people with epilepsy could become seizure-free with appropriate antiseizure therapy. Beliefs may play an important role in medication adherence according to the Health Belief Model. The Belief about Medicines Questionnaire–Specific (BMQ-S) was developed to assess individuals’ beliefs about medicines, yet few studies have examined its application among caregivers of CWE in China.ObjectiveThe study aimed to verify the validity and reliability of the Chinese BMQ-S among caregivers of CWE.Materials and methodsA cross-sectional study was conducted in West China Second University Hospital, Sichuan University, from June 2021 to May 2024. The Chinese version of the BMQ-S, originally validated for depression, was adapted for use in this study. After obtaining informed consent, participants were asked to complete a general information questionnaire and the Chinese BMQ-S. Reliability was assessed using McDonald’s omega in SPSS 26 (IBM Corporation, Armonk, NY, USA), and construct validity was evaluated using confirmatory factor analysis in Mplus 8.1 (Muthén & Muthén, Los Angeles, CA, USA). The Morisky Medication Adherence Scale was used to assess medication adherence of CWE. The relationship between BMQ-S and adherence was explored using the binary logistic regression analysis.ResultsA total of 2,730 caregivers were recruited, of whom 2,405 (88.01%) completed the survey. The children of participants included 1,283 (53.35%) boys and 1,122 (46.65%) girls, ranging in age from 0.08 to 17.80 years. McDonald’s omega values were 0.808 for BMQ-necessity and 0.709 for BMQ-concern. Confirmatory factor analysis showed the following fit indices for the final two-factor model: comparative fit index = 0.975, Tucker–Lewis index = 0.964, standardized root mean square residual = 0.038, and root mean square error of approximation = 0.079. The results indicated that 1,513 CWE (62.91%) were adherent to their medication therapy and 892 (37.09%) were non-adherent. However, no statistically significant association was observed between BMQ-S scores and medication adherence.ConclusionThe Chinese BMQ-S is a reliable and valid tool for assessing medicine beliefs among caregivers of CWE. Further studies are needed to explore the relationship between BMQ scores and antiseizure medicine adherence.

Background: The Beck Depression Inventory Second Edition (BDI-II) is used to assess depression worldwide. In Mexico, the BDI-II Spanish translation is widely used. Despite more than 23 million people being identified as indigenous, there is no empirical evidence on the BDI-II psychometric properties among indigenous languages, including Otomi. Therefore, this study aimed to cross-culturally adapt the BDI-II for the Otomi population and evaluate its psychometric properties. Methods: This cross-sectional instrumental study with non-probability sampling was conducted with 228 participants from the Otomi community. The cross-cultural adaptation of the BDI-II followed Beaton's guidelines for self-report measures: (i) translation, (ii) synthesis, (iii) back translation, (iv) expert committee review, (v) pretesting, and (vi) submission of documentation to the developers. Reliability was assessed using Cronbach's alpha. Exploratory and confirmatory factor analyses were used to determine structural and construct validity. Results: The cross-culturally adapted instrument showed adequate reliability, with a total Cronbach's α of 0.756, comprising 14 items and four factors (with alpha coefficients ranging from 0.505 to 0.633). These factors included three cognitive-affective dimensions and one somatic dimension, which conceptually align with Beck's original model. Confirmatory factor analysis (CFA) presented adequate indices: Comparative Fit Index (CFI) = 0.901, Root Mean Square Error of Approximation (RMSEA) = 0.056, IC90% [0.028-0.079], and Goodness-of-Fit Index = 0.908, which indicate a balanced and parsimonious fit of the model. Conclusions: The BDI-II is a reliable and culturally valid instrument for measuring depressive symptoms among the Otomi people of the Mezquital Valley.

Racial segregation is a recognized cause of racial health disparities. One factor that has contributed to racial segregation is municipal zoning policies that exclude people of color and those of low income from advantaged residential neighborhoods. Few studies have explicitly explored the relationship between zoning policies and health. Using data on zoning policies in Chicago in 1923 and 2012, we examined inequities in life expectancy across census tracts in relation to the proportion of land in each tract zoned for specific purposes. For each Chicago census tract, we obtained data on historical and current zoning policies and current health outcomes and life expectancy. Using regression analysis and structural equation modeling, we examined the relationship between zoning policies and life expectancy and possible mediators of this relationship. Life expectancy across 694 census tracts in Chicago varied from a low of 59.9 years to a high of 90.0 years. The greatest predictor of differences in life expectancy across census tracts was the degree of racialized economic advantage. Zoning policies in both 1923 and 2012 were significantly related to life expectancy, and this relationship was mediated by differences in racialized economic advantage. The structural equation model had a root mean square error of approximation of 0.064, a Tucker-Lewis index of 0.960, a confirmatory fit index of 0.973, and a standardized root mean square residual of 0.048. Zoning policy is significantly related to life expectancy, a relationship mediated by racialized economic advantage. Both past and modern-day exclusionary zoning policies appear to be associated with current health outcomes. These findings suggest that zoning reform could be one possible mechanism for redress if it gives specific attention to decreasing concentrated advantage and creating opportunities for Black households to build wealth.

IntroductionOrthorexia Nervosa (ON), first described by Steven Bratman in 1997, refers to a pathological obsession with healthy eating, often resulting in restrictive dietary behaviors, nutritional deficiencies, and impaired psychosocial functioning. In the absence of standardized diagnostic criteria, this study aimed to develop and validate the Türkiye Orthorexia Nervosa Scale (TONS-29).MethodsAfter excluding individuals with a diagnosed eating disorder (n = 7) or without informed consent (n = 8), a total of 720 adults (489 women, 231 men) participated. Scale development was guided by expert opinions from professionals in nutrition, psychiatric nursing, and Turkish linguistics. Construct validity was assessed through Exploratory Factor Analysis (EFA; n = 360) and Confirmatory Factor Analysis (CFA; n = 360) on randomly divided samples. A test-retest analysis was conducted with 128 participants.ResultsThe final scale includes 29 items across five subfactors, with a Cronbach’s alpha of 0.941 and explained variance of 49.63%. Subdimension reliability was good to excellent (α = 0.724–0.908). CFA results indicated good model fit (chi-square/degrees of freedom [χ²/df] = 2.319, Root Mean Square Error of Approximation [RMSEA] = 0.061, Standardized Root Mean Square Residual [SRMR] = 0.052, Incremental Fit Index [IFI] = 0.907, Comparative Fit Index [CFI] = 0.906, Goodness of Fit Index [GFI] = 0.855, and Tucker–Lewis Index [TLI] = 0.907). The scale demonstrated temporal stability, with an intraclass correlation coefficient of 75.1% (95% CI: 0.647–0.824).ConclusionThe findings support the TONS-29 as a valid and reliable tool for assessing ON tendencies in Turkish adults.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40359-025-03634-8.