Post-diagnostic lifestyle and mortality of cancer survivors: Results from a prospective cohort study.

OBJECTIVE: Lifestyle factors after cancer diagnosis could influence cancer survival. This study aimed to investigate the joint effects of smoking, physical activity, alcohol consumption, diet and sleep duration on all-cause, cancer and non-cancer mortality of cancer survivors in UK biobank. METHODS: The follow-up period concluded in December 2021, with post-diagnostic lifestyle factors assessed at baseline. A lifestyle score ranging from 0 to 5 was assigned based on adherence to the selected lifestyle factors. The study employed Cox regression models for hazard ratios (HRs) and Kaplan-Meier for survival rates, with stratified and sensitivity analyses to assess the robustness of our findings under various assumptions. RESULTS: During a median follow-up of 12.7 years, 5652 deaths were documented from 34,184 cancer survivors. Compared to scoring 0-1, the HRs (95% CIs) for all-cause mortality with lifestyle scores of 2, 3, 4, and 5 were 0.70 (95% CI: 0.64, 0.76), 0.57 (0.52, 0.62), 0.50 (0.45, 0.54) and 0.43 (0.38, 0.48), respectively. Specific cancer types, particularly digestive, breast, female reproductive, non-solid, and skin cancers, showed notable benefits from adherence to healthy lifestyle, with the HRs of 0.55 (0.39, 0.79), 0.54 (0.42, 0.70), 0.32 (0.19, 0.53), 0.58 (0.39, 0.86), and 0.36 (0.28, 0.46) for lifestyle score of 5, respectively. Stratified analyses indicated the association was particularly significant among those with normal/lower BMI and higher Townsend Deprivation Index (Pinteraction = 0.001 and < 0.001, respectively). CONCLUSIONS: Healthier lifestyles were significantly linked with reduced mortality among cancer survivors. These findings highlight the need for adherence to healthy lifestyle habits to improve survival.

miR-145a-5p/SIK1/cAMP-dependent alteration of synaptic structural plasticity drives cognitive impairment induced by coke oven emissions.

Exposure to fine particulate matter (PM) is associated with the neurodegenerative diseases. Coke oven emissions (COEs) in occupational environment are important sources of PM. However, its neurotoxicity is still unclear. Therefore, evaluating the toxicological effects of COE on the nervous system is necessary. In the present study, we constructed mouse models of COE exposure by tracheal instillation. Mice exposed to COE showed signs of cognitive impairment. This was accompanied by a decrease in miR-145a-5p and an increase in SIK1 expression in the hippocampus, along with synaptic structural damage. Our results demonstrated that COE-induced miR-145a-5p downregulation could increase the expression of SIK1 and phosphorylated SIK1, inhibiting the cAMP/PKA/CREB pathway by activating PDE4D, which was associated with reduced synaptic structural plasticity. Furthermore, restoring of miR-145a-5p expression based on COE exposure in HT22 cells could partially reversed the negative effects of COE exposure through the SIK1/PDE4D/cAMP axis. Collectively, our findings link epigenetic regulation with COE-induced neurotoxicity and imply that miR-145a-5p could be an early diagnostic marker for neurological diseases in patients with COE occupational exposure.

Ultra-Processed Food Consumption and Mortality: Three Cohort Studies in the United States and United Kingdom.

INTRODUCTION: Given the increase in ultra-processed food (UPF) consumption, their potential health effects have aroused concern. Whether UPF consumption is associated with cancer and cardiovascular disease mortality is debatable. This study evaluates the association of UPF consumption with mortality. METHODS: A total of 108,714 U.S. adults from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (1993-2001), 208,051 UK adults from UK Biobank (2006-2010), and 41,070 U.S. adults from National Health and Nutrition Examination Survey (1999-2018) were included. Dietary data were collected by dietary questionnaire and classified using the NOVA classification. UPF consumption was expressed as the weight proportion of UPFs in total foods consumed. Cox proportional hazard models were used to calculate hazard ratios and 95% CIs. Mediation analysis was used to evaluate whether multiple metabolic pathways mediated the associations in UK Biobank. Analyses were performed in 2022-2023. RESULTS: Combined analyses of the three cohorts showed that those with the highest quartile of UPF consumption had higher risks of all-cause mortality (hazard ratio, 1.16; 95% CI, 1.11-1.20) and cardiovascular disease mortality (hazard ratio, 1.17; 95% CI, 1.06-1.28) compared to the lowest quartile of UPF consumption. UPF consumption was not associated with cancer mortality risk. Biomarkers of liver function have the greatest mediating effects on all-cause mortality (20.3%), and biomarkers of inflammation have the greatest mediating effects on cardiovascular disease mortality (29.2%). CONCLUSIONS: Higher UPF consumption was associated with increased all-cause and cardiovascular disease mortality risk, with multiple metabolic pathways playing mediating roles.

Potential impact of time trend of whole grain intake on burden of major cancers in China.

Numerous studies have revealed associations between high intake of whole grains and reduced risk of various cancers. Yet, in recent decades, the traditional Chinese diets have been challenged by reduction in whole grains and increase in refined grains. To assess the impact of this dietary transition on cancer prevention, we analyzed the time trend of whole grain intake using nationally representative sampling data of over 15 thousand individuals from the China Health and Nutrition Survey. We applied the comparative risk assessment method to estimate the population attributable fraction of cancers due to insufficient whole grain intake from 1997 to 2011 and projected the trend of whole grain intake and the associated burden of cancers to 2035. We found a significant decrease of approximately 59% of whole grain intake in the Chinese population from 1997 to 2011. Compared with 1997, insufficient intake of whole grains was responsible for 9940 more cases of breast cancer, 12,903 more cases of colorectal cancer and 434 more cases of pancreatic cancer in 2011. Our projections suggest that if every Chinese would consume 125 g whole grain per day as recommended by the latest Chinese Dietary Guidelines, 0.63% bladder cancer, 8.98% breast cancer, 15.85% colorectal cancer, 3.86% esophageal cancer, 2.52% liver cancer and 2.22% pancreatic cancer (totaling 186,659 incident cases) could theoretically be averted by 2035. Even if everyone maintained the 2011 whole grain intake level, an estimated 8.38% of cancer events could still be prevented by 2035.

The Security and Driving Factors of the Innovative Ecosystem: Evidence from the Yellow River Basin.

Ecological protection and high-quality development of the Yellow River Basin have always been seriously restricted by its unreasonable economic structure and low level of innovation. A two-dimensional indicator system was constructed to evaluate the security of the innovative ecosystem in the Yellow River Basin and identify its driving factors. The R clustering, the method of coefficient of variation, and the entropy method were used to screen and empower the indicators, and then the Lotka-Volterra symbiotic coupling model was introduced innovatively to calculate the security index and analyze its spatio-temporal evolution. Finally, the fixed-effect regression model and Granger causality test were used to identify the driving factors. It was found that (1) The security of the innovative ecosystem in the Yellow River Basin from 2012 to 2021 showed an overall upward tendency, but it was still at a low level, and the innovative landscape community lagged behind the innovative biome for a long time; (2) The security status of the innovative ecosystem showed a differential pattern of "high in the east and south, and lower in the west and north"; (3) Innovation transformation ability, innovation consumption capacity, education, and natural ecological environment are crucial driving factors for improving the security level of an innovative ecosystem.

Chemo-drugs in cell microparticles reset antitumor activity of macrophages by activating lysosomal P450 and nuclear hnRNPA2B1.

Macrophages in tumors (tumor-associated macrophages, TAMs), a major population within most tumors, play key homeostatic functions by stimulating angiogenesis, enhancing tumor cell growth, and suppressing antitumor immunity. Resetting TAMs by simple, efficacious and safe approach(s) is highly desirable to enhance antitumor immunity and attenuate tumor cell malignancy. Previously, we used tumor cell-derived microparticles to package chemotherapeutic drugs (drug-MPs), which resulted in a significant treatment outcome in human malignant pleural effusions via neutrophil recruitments, implicating that drug-MPs might reset TAMs, considering the inhibitory effects of M2 macrophages on neutrophil recruitment and activation. Here, we show that drug-MPs can function as an antitumor immunomodulator by resetting TAMs with M1 phenotype and IFN-ß release. Mechanistically, drug molecules in tumor MPs activate macrophage lysosomal P450 monooxygenases, resulting in superoxide anion formation, which further amplifies lysosomal ROS production and pH value by activating lysosomal NOX2. Consequently, lysosomal Ca2+ signaling is activated, thus polarizing macrophages towards M1. Meanwhile, the drug molecules are delivered from lysosomes into the nucleus where they activate DNA sensor hnRNPA2B1 for IFN-ß production. This lysosomal-nuclear machinery fully arouses the antitumor activity of macrophages by targeting both lysosomal pH and the nuclear innate immunity. These findings highlight that drug-MPs can act as a new immunotherapeutic approach by revitalizing antitumor activity of macrophages. This mechanistic elucidation can be translated to treat malignant ascites by drug-MPs combined with PD-1 blockade.

Conductive PPy@cellulosic Paper Hybrid Electrodes with a Redox Active Dopant for High Capacitance and Cycling Stability.

Polypyrrole@cellulose fibers (PPy@CFs) electrode materials are promising candidates in the energy storage. Various strategies have been pursued to improve their electrochemical performance. However, the poor conductivity, specific capacitance, and cyclic stability still hindered its application. Compared with the previous studies, we selected AQS with electrochemical activity as a dopant to improve these defects. It exhibits a high capacitance of 829.8 F g-1 at a current density of 0.2 A g-1, which is much higher than that of PPy@CFs electrode material (261.9 F g-1). Moreover, the capacitance retention of PPy:AQS/p-PTSA@CFs reaches up to 96.01% after 1000 cycles, indicating superior cyclic stability. Therefore, this work provides an efficient strategy for constructing high-performance electrode materials for energy storage.

Synthesis and fluorescent properties of europium(III) complexes based on novel coumarin derivatives.

Four novel coumarin fluorescence small-molecules were successfully prepared and validated by proton nuclear magnetic resonance (1 H-NMR), carbon-13 (13 C)-NMR, and mass spectrometry (MS). Their corresponding europium(III) complexes were synthesized and characterized. The ligand can emit green fluorescence in solutions, and the best concentration was 40 µmol/L. The emission peak of ligand has a red-shift with the increase of concentration and solvent polarity. And the effect of various substituents in ligand was ordered using fluorescence intensity as standard: -NO2 > -Cl > -OCH3 > -OH. The order of fluorescence quantum yield is in line with the order of fluorescence intensity. The title europium complexes exhibit red fluorescence of europium ion (Eu3+ ) with good thermal stability. The effect of various substituents in ligand on the fluorescence intensity of title europium complexes was also consistent with the earlier results. This suggests that the prepared coumarins fluorescence small-molecules and their corresponding europium complexes have potential application prospects in the field of optical materials.

Graph neural network and multi-data heterogeneous networks for microbe-disease prediction.

The research on microbe association networks is greatly significant for understanding the pathogenic mechanism of microbes and promoting the application of microbes in precision medicine. In this paper, we studied the prediction of microbe-disease associations based on multi-data biological network and graph neural network algorithm. The HMDAD database provided a dataset that included 39 diseases, 292 microbes, and 450 known microbe-disease associations. We proposed a Microbe-Disease Heterogeneous Network according to the microbe similarity network, disease similarity network, and known microbe-disease associations. Furthermore, we integrated the network into the graph convolutional neural network algorithm and developed the GCNN4Micro-Dis model to predict microbe-disease associations. Finally, the performance of the GCNN4Micro-Dis model was evaluated via 5-fold cross-validation. We randomly divided all known microbe-disease association data into five groups. The results showed that the average AUC value and standard deviation were 0.8954 ± 0.0030. Our model had good predictive power and can help identify new microbe-disease associations. In addition, we compared GCNN4Micro-Dis with three advanced methods to predict microbe-disease associations, KATZHMDA, BiRWHMDA, and LRLSHMDA. The results showed that our method had better prediction performance than the other three methods. Furthermore, we selected breast cancer as a case study and found the top 12 microbes related to breast cancer from the intestinal flora of patients, which further verified the model's accuracy.

High-contrast OPCPA front end in high-power petawatt laser facility based on the ps-OPCPA seed system.

A high-energy, high-beam-quality, high-contrast picosecond optical parametric chirped-pulse amplification (ps-OPCPA) laser system was demonstrated. The pulse from a femtosecond oscillator was stretched to 4 ps, after which it was amplified from 140 pJ to 600 µJ by an 8 ps/6 mJ pump laser in two non-collinear OPCPA stages. The total gain was >106, and the root mean square of the energy stability of the laser system was 1.6% in 10 h. The contrasts of the solid and fiber mode-locked femtosecond oscillator-seeded ps-OPCPA systems were compared, and a signal-to-noise ratio of >1011 was achieved. Using this system, the contrast of the front end in high-power picosecond petawatt laser facility was improved by ∼40 dB to >1011, beyond ∼200 ps ahead of the main pulse with an output level of 60 mJ.

Integrated Conductive Hybrid Electrode Materials Based on PPy@ZIF-67-Derived Oxyhydroxide@CFs Composites for Energy Storage.

Due to excellent flexibility and hydrophilicity, cellulose fibers (CFs) have become one of the most potential substrate materials in flexible and wearable electronics. In previous work, we prepared cobalt oxyhydroxide with crystal defects modified polypyrrole (PPy)@CFs composites with good electrochemical performance. In this work, we redesigned the crystalline and nanoscale cobalt oxyhydroxide with zeolitic imidazolate frameworks-67 (ZIF-67) as precursor. The results showed that the PPy@ZIF-67 derived cobalt oxyhydroxide@CFs (PZCC) hybrid electrode materials possess far better capacitance of 696.65 F·g-1 than those of PPy@CFs (308.75 F·g-1) and previous PPy@cobalt oxyhydroxide@CFs (571.3 F·g-1) at a current density of 0.2 A·g-1. The PZCC delivers an excellent cyclic stability (capacitance retention of 92.56%). Moreover, the PZCC-supercapacitors (SCs) can provide an energy density of 45.51 mWh cm-3 at a power density of 174.67 mWh·cm-3, suggesting the potential application in energy storage area.

Sialic Acid Conjugate-Modified Liposomal Dexamethasone Palmitate Targeting Neutrophils for Rheumatoid Arthritis Therapy: Influence of Particle Size.

Many anti-inflammatory therapies targeting neutrophils have been developed so far. A sialic acid (SA)-modified liposomal (SAL) formulation, based on the high expression of L-selectin in peripheral blood neutrophils (PBNs) and SA as its targeting ligand, has proved to be an effective neutrophil-mediated drug delivery system targeting rheumatoid arthritis (RA). The objective of this study was to investigate the influence of particle size of drug-carrying SALs transported and delivered by neutrophils on their anti-RA effect. Dexamethasone palmitate-loaded SALs (DP-SALs) of different particle sizes (300.2 ± 5.5 nm, 150.3 ± 4.3 nm, and 75.0 ± 3.9 nm) were prepared with DP as a model drug. Our study indicated that DP-SALs could efficiently target PBNs, with larger liposomes leading to higher drug accumulation in cells. However, a high intake of large DP-SALs by PBNs inhibited their migration ability and capacity to release the payload at the target site. In contrast, small DP-SALs (75.0 ± 3.9 nm) could maintain the drug delivery potential of PBNs, leading to their efficient accumulation at the inflammatory site, where PBNs would be excessively activated to form neutrophil extracellular traps along with efficient payload release (small DP-SALs) and finally to induce excellent anti-RA effect.

Novel intramolecular charge transfer effect-based ligands and aggregation-induced emission-active europium complexes: synthesis, characterization, and fluorescence properties.

Two novel coumarin derivatives and the corresponding europium complexes were prepared using a simple procedure. The pH response of the ligand and the aggregation-induced emission (AIE) properties of the target europium complex were studied. The ligand had an intramolecular charge transfer (ICT) effect and was linearly and sharply responsive under acidic conditions. The goal europium complexes exhibited excellent AIE performance when subjected to increasing concentrations of target europium complex or proportion of poor solvent. The effect of substituents on fluorescence strength or thermogravimetric and electrochemical properties was further investigated. The target complexes displayed the typical fluorescence of europium. The fluorescence amplitude of the target europium complexes was enhanced by the addition of electron-donating groups to ligands. Thermogravimetric research findings indicated that the target complexes possessed extreme thermal stability. Electrochemistry discovery findings indicated that the highest occupied molecular orbit energy level of EuL1 was greater than EuL2 , but the lowest unoccupied molecular orbit energy level was smaller than that of EuL2 . These complexes could be applied in medicinal chemistry, substance chemistry, and fluorescence labelling areas.

Construction of flexible electrodes based on ternary polypyrrole@cobalt oxyhydroxide/cellulose fiber composite for supercapacitor.

With the development of flexible electronic devices, flexible energy storage systems have been research hotpot. Conductive polymers is potential pseudocapacitor materials in energy storage field. Meanwhile, cellulose fiber with natural, degradable, renewable and flexible properties is one of tremendous promising alternatives to the flexible substrates. Hence, a polypyrrole@cobalt oxyhydroxide/cellulose fiber composite electrode is prepared via "liquid phase reduction" strategy in open system at room temperature. The composite electrode exhibits excellent electrochemical properties, which has a high specific capacitance and capacitance retention. The highest specific capacitance of 571.3 F g-1 at 0.2 A g-1 is obtained. Besides, the specific capacitance of the composite electrode has no significant loss, showing high cycle stability (93.02% after 1000 cycles). The excellent electrochemical properties can be ascribed to the introduction of cobalt oxyhydroxide, which restrains the volumetric change of polypyrrole in the electrochemical redox process, and promotes the rapid migration of electrons.

N6-methyladenosine-dependent primary microRNA-126 processing activated PI3K-AKT-mTOR pathway drove the development of pulmonary fibrosis induced by nanoscale carbon black particles in rats.

The pulmonary fibrosis could be caused by long-term inhalation of carbon black (CB) particles. Studies on the mechanisms of pulmonary fibrosis induced by CB are required to develop the stratagem of prevention and treatment on fibrosis. The RNA-binding protein DiGeorge syndrome critical region gene 8 (DGCR8)-dependent pri-miRNAs processing is regulated by N6-methyladenosine (m6A) modification, which targets the downstream signal pathway. However, its role in pulmonary fibrosis has not been known clearly. In the present study, rats inhaled CB at dose of 0, 5 or 30 mg/m3 for 28 days, 6 h/day, respectively. The rats inhaled CB at dose of 0 or 30 mg/m3 for 14 days, 28 days and 90 days, respectively. In vitro experiments, the normal human bronchial epithelial cell line (16HBE) was treated with CB (0, 50, 100 and 200 µg/mL) for 24 h. In vitro and vivo study, the levels of fibrosis indicators including α-SMA, vimentin, collagen-I and hydroxyproline in CB treatment groups statistically increased in dose- or time- dependent manners compared with the control. After CB treatment, PI3K-AKT-mTOR pathway was activated and regulated by miRNA-126. We found that both of m6A modifications of pri-miRNA-126 and its binding with DGCR8 were decreased after CB treatment, which resulted in the reduction of mature miRNA-126 accompanied by accumulation of unprocessed pri-miRNA-126. This work demonstrated that m6A modification of pri-miRNA-126 and its binding with DGCR8 decreases blocked miRNA-126 maturation, and then activated the PI3K/AKT/mTOR pathway, which drove the fibro genesis in the lung after CB exposure.

Targeted delivery of ibrutinib to tumor-associated macrophages by sialic acid-stearic acid conjugate modified nanocomplexes for cancer immunotherapy.

Ibrutinib (IBR), an irreversible Bruton's tyrosine kinase (BTK) inhibitor, is expected to be a potent therapeutic modality, given that BTK is overexpressed in tumor-associated macrophages (TAMs) and participates in promoting tumor progression, angiogenesis, and immunosuppression. However, rapid clearance in vivo and low tumor accumulation have rendered effective uptake of IBR by TAMs challenge. Herein, we designed and synthesized a sialic acid (SA)-stearic acid conjugate modified on the surface of nanocomplexes to encapsulate IBR (SA/IBR/EPG) for targeted immunotherapy. Amphiphilic egg phosphatidylglycerol (EPG) structure and strong IBR-EPG interactions render these nanocomplexes high IBR loading capacity, prolonged blood circulation, and optimal particle sizes (∼30 nm), which can effectively deliver IBR to the tumor, followed by subsequent internalization of IBR by TAMs through SA-mediated active targeting. In vitro and in vivo tests showed that the prepared SA/IBR/EPG nanocomplexes could preferentially accumulate in TAMs and exert potent antitumor activity. Immunofluorescence staining analysis further confirmed that SA/IBR/EPG remarkably inhibited angiogenesis and tumorigenic cytokines released by TAM and eventually suppressed tumor progression, without eliciting any unwanted effect. Thus, SA-decorated IBR nanocomplexes present a promising strategy for cancer immunotherapy. STATEMENT OF SIGNIFICANCE: Ibrutinib (IBR), an irreversible Bruton's tyrosine kinase (BTK) inhibitor, is expected to be a potent therapeutic modality, given that BTK is overexpressed in tumor-associated macrophages (TAMs) and participates in promoting tumor progression, angiogenesis, and immunosuppression. However, rapid clearance in vivo and low tumor accumulation have rendered effective uptake of IBR by TAMs challenge. Herein, we designed and synthesized a sialic acid (SA)-stearic acid conjugate modified on the surface of nanocomplexes to encapsulate IBR (SA/IBR/EPG) for targeted delivery of IBR to TAMs. The developed SA/IBR/EPG nanocomplexes exhibited high efficiency in targeting TAMs and inhibiting BTK activation, consequently inhibiting Th2 tumorigenic cytokine release, reducing angiogenesis, and suppressing tumor growth. These results implied that the SA/IBR/EPG nanocomplex could be a promising strategy for TAM-targeting immunotherapy with minimal systemic side effects.

Self-Extinguishing Resin Transfer Molding Composites Using Non-Fire-Retardant Epoxy Resin.

Introducing fire-retardant additives or building blocks into resins is a widely adopted method used for improving the fire retardancy of epoxy composites. However, the increase in viscosity and the presence of insoluble additives accompanied by resin modification remain challenges for resin transfer molding (RTM) processing. We developed a robust approach for fabricating self-extinguishing RTM composites using unmodified and flammable resins. To avoid the effects on resin fluidity and processing, we loaded the flame retardant into tackifiers instead of resins. We found that the halogen-free flame retardant, a microencapsulated red phosphorus (MRP) additive, was enriched on fabric surfaces, which endowed the composites with excellent fire retardancy. The composites showed a 79.2% increase in the limiting oxygen index, a 29.2% reduction in heat release during combustion, and could self-extinguish within two seconds after ignition. Almost no effect on the mechanical properties was observed. This approach is simple, inexpensive, and basically applicable to all resins for fabricating RTM composites. This approach adapts insoluble flame retardants to RTM processing. We envision that this approach could be extended to load other functions (radar absorbing, conductivity, etc.) into RTM composites, broadening the application of RTM processing in the field of advanced functional materials.

Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model.

OBJECTIVES: This study was aimed to determine the factors associated with antihypertensive adherence based on the Health Belief Model (HBM). METHODS: A cross-sectional study was conducted in a rural area of China in 2014. The questionnaire included information about demographics, a scale based on the HBM, and the four-item Morisky Medication Adherence Scale. RESULTS: 745 hypertensive patients participated in the study (345 men, 400 women). Patients' mean age was 56.4±10.8years. The prevalence of adherence was 43.5%. Structural equation modeling showed that men, older participants, and those with greater knowledge of hypertension showed better medication adherence than did other participants. Based on the HBM, higher levels of self-efficacy and perceived severity and a lower level of perceived barriers were associated with better antihypertensive adherence. Self-efficacy was one of the most important mediating variables affecting antihypertensive adherence. CONCLUSIONS: Antihypertensive adherence was not optimal among patients in Beijing. Given that many factors are associated with medication adherence, individualized intervention strategies should be carried out in Beijing, China, especially in community settings. PRACTICE IMPLICATIONS: Medication adherence can be improved by enhancing patients' self-efficacy because it was the most important influence and mediating variable.

How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials.

OBJECTIVES: To study the effects of peer support on glycemic control and examine effects of different providers and types of support, intervention duration and effect duration.

Relationships of health literacy, health behavior, and health status regarding infectious respiratory diseases: application of a skill-based measure.

This study aimed to explain the relationships among health literacy, health behavior, and health status, using a newly developed skills-based measure of health literacy regarding respiratory infectious diseases. This instrument was designed to measure individuals' reading, understanding, and calculating ability, as well as their oral communication and Internet-based information-seeking abilities. A pilot survey was conducted with 489 residents in Beijing, China, to test the reliability and validity of the new measure. Next, a larger study with 3,222 residents in three cities with multistage stratified cluster sampling was implemented to validate a latent variable model (goodness of fit index=0.918, root mean square residual=0.076). In this model higher educational attainment (ß=0.356) and more health knowledge (ß=0.306) were positively and directly associated with greater health literacy skill, while age was negatively associated with it (ß=-0.341). Age (ß=0.201) and health knowledge (ß=0.246) had positive and direct relationship with health behavior, which was, in turn, positively associated with health status (ß=0.209). The results illustrate the complex relationships among these constructs and should be considered when developing respiratory intervention strategies to promote health behavior and health status.