Health literacy - study protocol for LiSa cohort study.

BACKGROUND: Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, whether at home, at the workplace, in the community, marketplace, healthcare sector, or the political arena. The main aim of this project is to measure health literacy in the adult population living in the municipality of Leiria over the next 10 years. As secondary objectives it is intended to characterize anxiety and depression, metabolic risk and health behaviors in the same population and over the same period. METHODS: This is a prospective cohort study that collects data on HL, anxiety and depression, health characteristics, health behavior and sociodemographic data. The study population will be composed by adults (≥ 18 years old) who are non-institutionalized and living in private households in Leiria. The random sample is stratified by gender and age groups. A face-to-face interview will be conducted with the Computer Assisted Personal Interview at baseline. Follow-up will be carried out every 2 years via telephone call. The association between independent variables and health literacy is examined by means of variance analysis with measurement repetition, and taking into consideration follow-up. DISCUSSION: The LiSa project is a population-based study, derived from a random sampling technique that will allow the analysis of health outcomes in a representative sample of the population of the municipality of Leiria. The LiSa study will be a valuable resource for epidemiological research, as it will provide fundamental information to improve public health policies regarding health literacy in Portugal. TRIAL REGISTRATION: Clinical trials: NCT05558631 (registered on 26/09/2022).

The effect of educational intervention based on health belief model on colorectal cancer screening behaviors.

BACKGROUND: Colorectal cancer is the second most prevalent cause of death from malignancies globally. The present study was conducted targeting the influence of an educational intervention based on the health belief model (HBM) on colorectal cancer screening behaviors in people 50 years old and older. METHODS: All 134 samples were included in this quasi-experimental study from Fasa City Health Service Center, equal halves were random into experimental group and control group. The data collection tool was a questionnaire that contained questions on demographic variables, knowledge, and HBM constructs (perceived sensitivity, perceived intensity, perceived benefits, perceived barriers, self-efficacy, and screening behaviors). Both groups answered the questionnaire before and two months following the intervention. There were six 90-minute instruction sessions for the intervention group. SPSS 22 and descriptive and analytical tests (independent t-test, paired t-test, and Chi-square test) were used for data analysis (P < 0.05). RESULTS: 59 women and 75 men took part in this study. A majority of participants were married and had at least high school diploma. The findings indicated that the mean scores for knowledge, each of the HBM's constructs, and cancer screening behaviors did not differ significantly from one another before the intervention between the test group and the control group. However, post the intervention, the intervention group exhibited a significant rise in all mentioned dimensions. CONCLUSION: In light of the outcomes, the application of the HBM on colorectal cancer screening behaviors in people 50 years and older was successful. This approach might serve as a helpful foundation for planning, carrying out, and overseeing colorectal cancer screening programs.

Persuasion Through Focus Groups: Helping Teachers Maintain Healthy Voices.

This study was designed to determine whether participation in a single, 1-hour focus group would spur a change in health-related behavior. All the respondents were teachers who had participated in a focus group designed to learn about teachers' understanding that voice is a working tool. In the discussions, health-related behaviors were discussed as ways to deal with possible vocal strain or injury. Two months later, a follow-up survey was distributed to these participants asking them if they recalled the discussion and if they had sought out more information and/or had changed their vocal behavior due to their participation in the focus group. The qualitative data shows that the majority of these respondents both recalled the messages and had engaged in some type of health-related behavior change due to their participation in the focus group. Behavior change included such modifications as drinking more water and use of voice-amplification equipment in the classroom. Implications of this finding are discussed.

Associated factors of periodontitis and predicted study among young man in China: a population-based cross-sectional study.

BACKGROUND: Periodontitis represents the foremost oral condition in young men, strongly correlated with socioeconomic elements and oral health behaviors. This research aimed to assess the prevalence of periodontitis and associated associations with socio-demographics and oral health practices for subsequent Hazard Ratio (HR) estimation. METHODS: A total of 46,476 young men were recruited to the study between August 2022 and October 2023. A questionnaire on socio-demographic factors and oral health-related behaviors related to periodontitis was completed. The standard procedure was used for oral examination. Logistic regression and hazard ratios were used to estimate the influencing factors, whereas the nomogram was used to predict the risk of periodontitis in young men. RESULTS: A total of 46,476 young men were surveyed and completed the questionnaire. The overall prevalence of periodontitis among young men was 1.74%. Out of these, 1.7% had mild periodontitis and 0.6% had moderate periodontitis. Age and dental calculus were important factors in the periodontal health of young men. This nomogram, which includes 7 easily obtainable clinical characteristics routinely collected during periodontitis risk assessment, provides clinicians with a user-friendly tool to assess the risk of periodontal disease in young men. CONCLUSIONS: Regular dental prophylaxis is crucial for young men to maintain their gingival health and prevent the onset of periodontitis. Dental calculus plays a prominent role in this matter, as it serves as a significant contributing factor.

Implementation processes of social network interventions for physical activity and sedentary behavior among children and adolescents: a scoping review.

BACKGROUND: The characteristics of the implementation process of interventions are essential for bridging the gap between research and practice. This scoping review aims to identify the implementation process of social network interventions (SNI) to address physical activity and sedentary behaviors in children and adolescents. METHODS: The scoping review was conducted adhering to the established guidelines. The search was carried out in the ERIC, EBSCO, EMBASE, SCOPUS, and Lilacs databases in April 2023. Social network intervention studies in children and adolescents were included, addressing physical activity or sedentary behaviors. Replicability (TIDieR), applicability (PRECIS-2), and generalizability (RE-AIM) were the explored components of the implementation process. Each component was quantitatively and separately analyzed. Then, a qualitative integration was carried out using a narrative method. RESULTS: Most SNI were theoretically framed on the self-determination theory, used social influence as a social mechanism, and used the individual typology of network intervention. Overall, SNI had strong replicability, tended to be pragmatic, and three RE-AIM domains (reach, adoption (staff), and implementation) showed an acceptable level of the generalizability of findings. CONCLUSIONS: The analyzed SNI for physical activity and sedentary behaviors in adolescents tended to be reported with high replicability and were conducted pragmatically, i.e., with very similar conditions to real settings. The RE-AIM domains of reach, adoption (staff), and implementation support the generalizability of SNI. Some domains of the principles of implementation strategies of SNI had acceptable external validity (actor, action targets, temporality, dose, and theoretical justification).

Tobacco and nicotine use among active component U.S. military service members: a comparison of 2018 estimates from the Health Related Behaviors Survey and the Periodic Health Assessment.

This study compared estimates of the prevalence of and risk factors for tobacco and nicotine use obtained from the 2018 Health Related Behaviors Survey (HRBS) and Periodic Health Assessment (PHA) survey. The HRBS and the PHA are important Department of Defense sources of data on health behavior collected from U.S. military service members. While their collection methods differ, some survey questions are similar, which provides an opportunity to compare survey estimates. Active duty service members consistently reported a much lower prevalence of all types of tobacco and nicotine use on the PHA compared to the HRBS: cigarettes (11.1% vs. 18.4%), e-cigarettes (7.3% vs. 16.2%), chewing tobacco (9.7% vs. 13.4%), any tobacco or nicotine use (25.3% vs. 37.8%), and use of 2 or more tobacco or nicotine products (5.8% vs. 17.4%). Associations between tobacco and nicotine use as well as demographic and other behavioral variables were fairly similar, including age, sex, education, race and ethnicity, rank, and alcohol use. The associations with service branch, body mass index, and sleep were inconsistent. This results of this study suggest that the PHA can provide timely information on trends in military tobacco and nicotine use over time, but much higher estimates from the confidential, voluntary HRBS reported in this study suggest that the command-directed PHA may substantially underestimate the prevalence of all types of tobacco and nicotine use.

Conductas de salud en estudiantes universitarios: un análisis bayesiano / Health behaviors in college students: a Bayesian analysis / Comportamentos de saúde em estudantes universitários: uma análise bayesiana

En la actualidad, diversos estudios han explorado las diferencias de las conductas de salud en los estudiantes universitarios de acuerdo con características como edad, sexo y ciclo de estudio, no obstante, estos se han centrado en un enfoque frecuentista basado en la prueba de significancia de la hipótesis nula (NHST). Objetivo. Explorar las diferencias de las conductas de salud de acuerdo con el sexo, edad y ciclo académico, así como establecer la relación entre estas y la percepción de salud general en estudiantes universitarios peruanos, desde un enfoque bayesiano. Materiales y métodos. Se ejecutó un estudio cuantitativo, comparativo, correlacional y transversal, en una muestra de 708 universitarios seleccionados de manera intencional. Se utilizó el cuestionario de conductas de salud (CEJUV-R) y una ficha de datos sociodemográficos. Resultados. Los hallazgos muestran que los hombres tienen mejores hábitos de actividad y condición física y organización del sueño, con respecto a las mujeres. Asimismo, se observa una evidencia moderada a favor de la hipótesis alternativa del autocuidado en función de la edad y el ciclo académico. Finalmente, la actividad física, la organización del descanso, el autocuidado y la organización del sueño presentan evidencias muy fuertes (BF>100) de su relación con la percepción general de salud. Conclusión. El análisis bayesiano mostró evidencia a favor de la hipótesis alterna en algunas de las conductas de salud en función del sexo, edad y ciclo académico, lo que resaltan la importancia de promover conductas más saludables entre los estudiantes universitarios peruanos atendiendo a sus características personales.

Currently, several studies have explored the differences in health behaviors in university students according to characteristics such as age, sex and study cycle; however, these have focused on a frequentist approach based on the null hypothesis significance test (NHST). Objective. To explore the differences in health behaviors according to sex, age and academic cycle, as well as to establish the relationship between these and the perception of general health in Peruvian university students, from a Bayesian approach. Materials and methods. A quantitative, comparative, correlational and cross-sectional study was carried out in a sample of 708 intentionally selected university students. The health behaviors questionnaire (CEJUV-R) and a sociodemographic data sheet were used. Results. The findings show that men have better habits of activity and physical condition and sleep organization, with respect to women. Likewise, there is moderate evidence in favor of the alternative hypothesis of self-care as a function of age and academic cycle. Finally, physical activity, rest organization, self-care and sleep organization present very strong evidence (BF>100) of their relationship with the general perception of health. Conclusion. The Bayesian analysis showed evidence in favor of the alternative hypothesis in some of the health behaviors as a function of sex, age and academic cycle, which highlights the importance of promoting healthier behaviors among Peruvian university students according to their personal characteristics.

Atualmente, vários estudos exploraram as diferenças nos comportamentos de saúde em estudantes universitários de acordo com características como idade, gênero e ciclo de estudos; no entanto, eles se concentraram em uma abordagem frequentista baseada no teste de significância da hipótese nula (NHST). Objetivo. Explorar as diferenças nos comportamentos de saúde de acordo com o sexo, a idade e o ciclo acadêmico, bem como estabelecer a relação entre eles e a percepção da saúde geral em estudantes universitários peruanos, a partir de uma abordagem bayesiana. Materiais e métodos. Foi realizado um estudo quantitativo, comparativo, correlacional e transversal em uma amostra de 708 estudantes universitários selecionados intencionalmente. Foram utilizados o questionário de comportamento de saúde (CEJUV-R) e uma planilha de dados sociodemográficos. Resultados. Os achados mostram que os homens têm melhores hábitos de atividade física, condicionamento físico e organização do sono do que as mulheres. Também há evidências moderadas a favor da hipótese alternativa de autocuidado em função da idade e do ciclo acadêmico. Por fim, a atividade física, a organização do descanso, o autocuidado e a organização do sono mostram evidências muito fortes (BF>100) de sua relação com a percepção geral da saúde. Conclusão. A análise bayesiana mostrou evidências a favor da hipótese alternativa em alguns dos comportamentos de saúde em função do sexo, da idade e do ciclo acadêmico, destacando a importância de promover comportamentos mais saudáveis entre os estudantes universitários peruanos de acordo com suas características pessoais.

Parent childhood experiences, parenting strategies, and youth health-related outcomes in Hispanic families with unhealthy weight: An intergenerational study.

We aimed to examine whether (a) parents' childhood family mealtime experiences (CFM) (e.g., mealtime communication-based stress) and parents' socio-demographic characteristics (e.g., education level) predict parents' health-related parenting strategies (e.g., discipline), (b) health-related parenting strategies for eating and physical activity predict youth's health-related outcomes (e.g., dietary intake), (c) parenting strategies mediate the relationship between CFM and youth outcomes. A path model was used to examine the above-mentioned relationships. Data were obtained from the baseline assessment of a randomized clinical trial evaluating the efficacy of a family-based intervention to promote quality diet and increase physical activity. Participants were 280 Hispanic youth (52.1 % female, Mage = 13.01 ± 0.83) with unhealthy weight (MBody Mass Index %tile = 94.55 ± 4.15) and their parents (88.2 % female, Mage = 41.87 ± 6.49). Results indicated that childhood mealtime communication-based stress and mealtime structure were positively associated with control. Appearance weight control was positively associated with monitoring, discipline, limit-setting, and reinforcement. Parental mealtime control had positive associations with discipline, control, and limit-setting. Emphasis on mother's weight was positively associated with reinforcement. We also found positive associations between parental monitoring and youth's physical QOL and between parental discipline and fruits and vegetables intake. No mediating effect was found. Findings demonstrated significant effects of parents' childhood experience on parenting strategies, which in turn was associated with the youths' health-related outcomes. These results suggest the intergenerational effects of parent's childhood experience on their youth's health-related outcomes.

Marital status and cause-specific mortality: A population-based prospective cohort study in southern Sweden.

The aim was to investigate associations between marital status and mortality with a prospective cohort study design. A public health survey including adults aged 18-80 was conducted with a postal questionnaire in southern Sweden in 2008 (54.1% participation). The survey formed a baseline that was linked to 8.3-year follow-up all-cause, cardiovascular (CVD), cancer and other cause mortality. The present investigation entails 14,750 participants aged 45-80. Associations between marital status and mortality were investigated with multiple Cox-regression analyses. A 72.8% prevalence of respondents were married/cohabitating, 9.1% never married, 12.2% divorced and 5.9% widows/widowers. Marital status was associated with age, sex, socioeconomic status (SES) by occupation, country of birth, chronic disease, Body Mass Index (BMI), health-related behaviors and generalized trust covariates. Never married/single, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than the reference category married/cohabitating men throughout the multiple analyses. For men, CVD and other cause mortality showed similar significant results, but not cancer. No significant associations were displayed for women in the multiple analyses. Associations between marital status and mortality are stronger among men than women. Associations between marital status and cancer mortality are not statistically significant with low effect measures throughout the multiple analyses among both men and women.

Association between long working hours and engagement in preventive healthcare services in Korean workers: Findings from the Korean National Health and Nutrition Examination Survey.

BACKGROUND: Engagement in preventive healthcare services is crucial for preventing diseases. We explored how working hours are associated with engagement in preventive healthcare services, with a focus on gender differences. METHODS: This cross-sectional study used data from the 2007-2012 Korean National Health and Nutrition Examination Survey. The dependent variable was engagement in each of the five preventive healthcare services (health check-ups, influenza vaccination, and stomach, breast, and cervical cancer screenings). We estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) using robust Poisson regression. RESULTS: The study analyzed 19,819 workers (9119 women). The adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services among men were 0.95 (0.90-1.00) for health check-ups, 0.86 (0.77-0.96) for influenza vaccination, and 0.95 (0.87-1.03) for stomach cancer screening compared to working 35-40 h per week. Among women, the adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services were 0.84 (0.78-0.91) for health check-ups, 0.82 (0.73-0.92) for influenza vaccination, and 0.88 (0.80-0.97) for stomach, 0.85 (0.78-0.94) for breast, and 0.82 (0.74-0.91) for cervical cancer screenings. CONCLUSION: Long working hours were negatively associated with engagement in preventive healthcare services, and the association was pronounced among female workers. Efforts to promote preventive healthcare participation among individuals with long working hours are necessary, and it is essential to consider the unique vulnerabilities of women when developing such policies.

Data-driven lifestyle patterns and risk of dementia in older Australian women.

INTRODUCTION: Many lifestyle factors have been associated with dementia, but there is limited evidence of how these group together. The aim of this study was to examine the clustering of lifestyle behaviors and associations with dementia. METHODS: This population-based study included 9947 older Australian women. Latent class analysis was employed to identify distinct lifestyle classes, and Cox proportional hazard regression compared these with incident dementia over 17 years. RESULTS: Three classes were identified: (1) "highly social and non-smokers" (54.9%), (2) "highly social, smokers, and drinkers" (25.1%), and (3) "inactive and low socializers" (20.0%). Women in Class 3 exhibited a higher risk of dementia compared to both Class 1 (hazard ratio [HR] = 1.19, 95% confidence interval [CI]: 1.08 to 1.30) and Class 2 (HR = 1.12, 95% CI: 1.00 to 1.25). DISCUSSION: A lifestyle pattern characterized by physical inactivity and low social engagement may be particularly detrimental for dementia risk in older women and should be prioritized in preventive strategies. HIGHLIGHTS: Latent class analysis was employed to identify distinct lifestyle clusters. Three lifestyle-related clusters were differentially associated with dementia risk. Inactive and low socializers exhibited the greatest risk of dementia. Targeting physical inactivity and low social engagement in prevention is vital.

Embodied Conversational Agents Providing Motivational Interviewing to Improve Health-Related Behaviors: Scoping Review.

BACKGROUND: Embodied conversational agents (ECAs) are advanced human-like interfaces that engage users in natural face-to-face conversations and interactions. These traits position ECAs as innovative tools for delivering interventions for promoting health-related behavior adoption. This includes motivational interviewing (MI), a therapeutic approach that combines brief interventions with motivational techniques to encourage the adoption of healthier behaviors. OBJECTIVE: This study aims to identify the health issues addressed by ECAs delivering MI interventions, explore the key characteristics of these ECAs (eg, appearance, dialogue mechanism, emotional model), analyze the implementation of MI principles and techniques within ECAs, and examine the evaluation methods and primary outcomes of studies that use ECAs providing MI interventions. METHODS: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) methodology. Our systematic search covered the PubMed, Scopus, IEEE Xplore, ACM Digital, and PsycINFO databases for papers published between January 2008 and December 2022. We included papers describing ECAs developed for delivering MI interventions targeting health-related behaviors and excluded articles that did not describe ECAs with human appearances and without the necessary evaluation or MI explanation. In a multistage process, 3 independent reviewers performed screening and data extraction, and the collected data were synthesized using a narrative approach. RESULTS: The initial search identified 404 articles, of which 3.5% (n=14) were included in the review. ECAs primarily focused on reducing alcohol use (n=5, 36%), took on female representations (n=9, 64%), and gave limited consideration to user ethnicity (n=9, 64%). Most of them used rules-driven dialogue mechanisms (n=13, 93%), include emotional behavior to convey empathy (n=8, 57%) but without an automatic recognition of user emotions (n=12, 86%). Regarding MI implementation, of 14 studies, 3 (21%) covered all MI principles, 4 (29%) included all processes, and none covered all techniques. Most studies (8/14, 57%) conducted acceptability, usability, and user experience assessments, whereas a smaller proportion (4/14, 29%) used randomized controlled trials to evaluate behavior changes. Overall, the studies reported positive results regarding acceptability, usability, and user experience and showed promising outcomes in changes in attitudes, beliefs, motivation, and behavior. CONCLUSIONS: This study revealed significant advancements in the use of ECAs for delivering MI interventions aimed at promoting healthier behaviors over the past 15 years. However, this review emphasizes the need for a more in-depth exploration of ECA characteristics. In addition, there is a need for the enhanced integration of MI principles, processes, and techniques into ECAs. Although acceptability and usability have received considerable attention, there is a compelling argument for placing a stronger emphasis on assessing changes in attitudes, beliefs, motivation, and behavior. Consequently, inclusion of more randomized controlled trials is essential for comprehensive intervention evaluations.

Aplicaciones de un instrumento para evaluar factores de riesgo comportamentales asociados a enfermedades no transmisibles en población trabajadora / Applications of an instrument to assess behavioral risk factors associated with non-communicable diseases in the working population

Introducción: La Organización Mundial de la Salud diseñó un instrumento para la vigilancia de los factores de riesgo asociados con las enfermedades crónicas, este abarca tres pasos que incluyen los datos personales y comportamentales, antropométricos y bioquímicos. Objetivo: Describir las aplicaciones del Instrumento STEPS (paso 1) para la identificación de factores de riesgo comportamentales asociados a enfermedades no transmisibles en adultos trabajadores, según país y año de publicación. Metodología: Revisión narrativa de estudios originales que utilizaron el STEPS, publicados entre 2015 y 2019 en español, inglés y portugués en las bases de datos PubMed, SciELO y el motor de búsqueda Google Scholar. Resultados: Se revisaron 20 documentos de los cuales 6 fueron de Asia y África, y el año de mayor publicación fue 2017. El consumo nocivo del alcohol, tabaquismo, inactividad física y alimentación no saludable son los riesgos más estudiados. Conclusiones: La utilización del instrumento STEPS en publicaciones es más frecuente en países de África y Asia. Se requiere que su implementación sea sistemática y difundida en otros países, con la finalidad de diseñar e implementar estrategias de salud pública para la prevención, mitigación y tratamiento oportuno de las enfermedades no transmisibles.

Introduction: The World Health Organization designed an instrument for the surveillance of risk factors associated with chronic diseases, it has three steps that include personal and behavioral, anthropometric, and biochemical data. Objective: To describe the applications of the STEPS Instrument (step 1) to identify behavioral risk factors associated with noncommunicable diseases in working adults, according to country and year of publication. Methodology: Narrative review of original studies that used STEPS, published between 2015 and 2019 in Spanish, English and Portuguese in the databases PubMed, SciELO, and the search engine Google Scholar. Results: A total of 20 studies were reviewed, of which 6 were from Asia and Africa, and the year of most significant publication was 2017. The most studied risks are harmful alcohol consumption, smoking, physical inactivity, and unhealthy eating. Conclusions: the use of the STEPS instrument in publications is more frequent in countries of Africa and Asia. Its implementation must be systematic and disseminated in other countries to design and implement public health strategies for the prevention, mitigation, and timely treatment of noncommunicable diseases.

Network Analysis of Health-related Behaviors, Insomnia, and Depression Among Urban Left-behind Adolescents in China.

Mental health of urban left-behind adolescents (LBA) is a public issue of growing concern. This study aims to examine the symptom level associations among multiple health-related behaviors, insomnia, and depression in urban LBA. Data on a sample of urban LBA aged 11-19 (N = 3,601) from the Adolescent Mental Health Survey in Shenzhen, China, were used. Health-related behaviors (i.e., Internet use, physical inactivity, social jetlag, smoking, and alcohol consumption), insomnia, and depressive symptoms were assessed using a self-administered questionnaire. Graphical Gaussian Model (GGM) was used to describe key bridging nodes in an undirected network. Directed Acyclic Graph (DAG) was used to construct a directed network and estimate the most likely causal associations among behaviors/symptoms. In the undirected network, Internet use was identified as the key bridging node most strongly associated with insomnia and depression. Two other key bridging nodes include difficulty initiating sleep and appetite change. In the directed network, anhedonia emerged as the most pivotal symptom, which could cause insomnia symptoms and behavioral changes, either directly, or through triggering other depressive symptoms, such as low energy and appetite change. These findings have implications for understanding the occurrence and maintenance process of health-related behaviors, insomnia, and depression in urban LBA. In practice, Internet use should be considered a priority in targeting multiple health behavior interventions. Meanwhile, early screening and treatment for anhedonia are of great significance as well.

Cross-Sectional Examination of Physical Abuse Victimization Differences Between Lesbian, Gay, Bisexual, and Heterosexual Service Members in the U.S. Military, 2018.

Purpose: The primary objective was to analyze the association between sexual orientation and physical abuse victimization using a representative sample from the U.S. active-duty military population. The secondary objective was to determine if differences exist by sexual orientation in perceived barriers (e.g., stigma) to mental health care utilization among physical abuse victimization survivors. Methods: The 2018 Department of Defense Health Related Behaviors Survey (HRBS) (n = 17,166 active-duty respondents) was used for analysis. Weighted logistic regressions and Poisson regressions were used for multivariable analyses, controlling for demographic and military variables. Results: Approximately 93.7% of respondents identified as heterosexual or straight, 2.3% identified as gay or lesbian, and 4% as bisexual. Bisexual active-duty service members had 1.5-fold greater odds of reporting any form of physical abuse victimization (adjusted odds ratio: 1.50 and 95% confidence interval: 1.07-2.10). However, there was no difference observed between gay/lesbian and heterosexual service members for physical abuse victimization. Among survivors of physical abuse victimization, bisexual (p = 0.0038) and gay (p < 0.0001) service members were more likely to report more than one mental health care barrier compared to their heterosexual counterparts. Conclusions: Bisexual service members were more likely to experience physical abuse victimization when compared to their heterosexual counterparts. In addition, gay and bisexual survivors of physical abuse were more likely to experience barriers to mental health care. Tailored interventions should explore strategies to prevent victimization and disparities in mental health care utilization by sexual orientation.

Religious service attendance and mortality: A population-based prospective cohort study in southern Sweden.

Aims: The aim is to investigate associations between attendance in religious service during the past year and all-cause, cardiovascular (CVD), cancer and other cause mortality. Study design: Prospective cohort study. Methods: A public health survey with three reminders was sent to a stratified random sample of the adult 18-80 population in southernmost Sweden in 2008. The response rate was 54.1%, and 24,855 participants were included in this study. The cross-sectional baseline survey was connected to mortality data with 8.3-year follow-up. Analyses were conducted in Cox regression models. Results: 13.9% had attended religious service at least once during the past year, and 86.1% had not attended. The group with religious attendance contained significantly higher proportions of women, high and medium position non-manual employees, participants born abroad, never alcohol consumers, respondents with high trust in others and respondents with high social participation. It also contained significantly lower proportions with low leisure-time physical activity (LTPA) and daily smokers. Religious service attendance during the past year was significantly associated with lower hazard rate ratios (HRRs) of all-cause mortality compared to non-attendance until social participation items were introduced in the final model. HRRs of CVD mortality were significantly lower for religious attendance in the multiple models until BMI and health-related behaviors were introduced. No significant results were observed for cancer and other cause mortality. Conclusions: The results suggest that religious service attendance in a highly secularized country such as Sweden is significantly associated with lower all-cause mortality, which may be explained by a social network pathway in this highly secularized population.

Association between long working hours and cigarette smoking, leisure-time physical activity, and risky alcohol use: Findings from the Korea National Health and Nutrition Examination Survey (2014-2021).

BACKGROUND: Long working hours cause adverse health outcomes; however, the precise mechanisms underlying this relationship remain unknown. We examined the association between long working hours and health behaviors, as well as gender differences in this association. METHODS: A nationally representative sample of 26,385 Korean workers was analyzed. The exposure variable was self-reported weekly working hours. The outcomes examined were cigarette smoking, high-level physical activity (defined as engaging in ≥150 min/week of moderate-to-vigorous leisure-time physical activity), and risky alcohol use (defined as consuming seven glasses for men or five glasses for women of alcohol in a single sitting, twice or more per week). Logistic regression models were utilized, and gender differences were examined by incorporating interaction terms into the regression models. RESULTS: Among 26,385 workers, 4,109 (16%) worked ≥55 h/week. The prevalence of cigarette smoking, high-level physical activity, and risky alcohol use was 19%, 18%, and 14%, respectively. The odds ratio (OR) (95% confidence interval [CI]) of the association between working ≥55 h/week and outcomes was 1.26 (1.12-1.43) for cigarette smoking, 0.73 (0.65-0.83) for high-level physical activity, and 0.95 (0.83-1.08) for risky alcohol use compared to working 35-40 h/week. A moderating effect of gender on the association between long working hours and risky alcohol use was observed. The OR (95% CI) of the association between working ≥55 h/week was 0.88 (0.76-1.02) in men and 1.51 (1.12-2.05) in women. CONCLUSION: Our findings emphasize the need for policy interventions aimed at reducing excessive working hours and fostering healthy lifestyle behaviors among individuals engaged in long working hours.

Health-related behaviors and weight-related outcomes within sibling pairs: A systematic review.

BACKGROUND: Siblings reciprocally contribute to mutual social and physical development. The aim of this review was to examine the health-related behaviors and weight-related outcomes within child-sibling pairs and to determine how these factors vary by sibling composition. METHODS: Following the PRISMA guidelines, a systematic review of studies published since 2000 obtained from MEDLINE, CINAHL, PubMed, Cochrane Reviews, Web of Science, PsycINFO, Health and Wellness, and Science Direct was performed. The eligibility criteria for inclusion were: 1) peer-reviewed and published in English; 2) included children ages 2 to 20 and their siblings; and 3) explored health-related behaviors (i.e., diet) and/or weight-related outcomes (i.e., body weight) within child-sibling dyads. RESULTS: A total of 13 studies were included in the review. The study findings are summarized according to three major themes: 1) sibling concordance in health-related behaviors and weight-related outcomes, 2) differences in health-related behaviors within weight-concordant/weight-discordant sibling dyads, and 3) influence of sibling composition on health-related behaviors and weight-related outcomes. CONCLUSIONS: Family-based interventions for childhood obesity may benefit from including siblings as key family members in promoting children's health-related behaviors and preventing excessive weight gain. Future studies should explore variable sibling dynamics (e.g., adoptive siblings) in more culturally/racially diverse families to further explore the role of a sibling in a child's health. IMPLICATIONS TO PRACTICE: The findings of this study may help healthcare providers in developing effective family-based obesity interventions for families with more than one child in their household.

The Association Between Health-Related Behaviors and Traditional Chinese Medicine Syndromes in Type 2 Diabetes Mellitus Patients.

Background: Traditional Chinese medicine (TCM) has certain advantages in treating diabetes via TCM syndromes differentiation, and health-related behaviors can regulate TCM syndromes. This study aimed to identify the clusters of TCM syndromes in type 2 diabetes mellitus (T2DM) patients and to explore the association between health-related behaviors and those TCM syndromes clusters. Methods: This was a cross-sectional study of 1761 T2DM patients from the Ningxia Province. The TCM syndromes (11 TCM syndromes in total) scale was used to collect the syndrome information. Health-related behaviors, including smoking, alcohol use, tea drinking, the intensity of physical activity, sleep quality, and sleep duration, were collected via a face-to-face interview questionnaire. Latent profile analysis was employed to identify clusters of 11 TCM syndromes. Multinomial logistic regression was employed to examine the relationships between health-related behaviors and clusters of TCM syndromes. Results: TCM syndromes in T2DM patients were classified into three profiles using latent profile analysis: light, moderate, and heavy. Participants with poor health-related behaviors were more likely to have heavy 1.49 (95% CI: 1.12, 1.99) or moderate 1.75 (95% CI: 1.10, 2.79) profiles than those with good health-related habits. Smokers, tea drinkers, and those with poor sleep quality were more likely to have a moderate profile and heavy profile than a light profile. Compared with heavy physical activity, moderate activity 0.24 (95% CI: 0.07, 0.88) was negatively associated with a heavy profile. Conclusion: Results showed that most participants had light or moderate levels of TCM syndromes, and those with poor health-related behaviors were more likely to have heavy or moderate profiles. In the context of precision medicine, these results have important implications for understanding the prevention and treatment of diabetes via changing lifestyles and behaviors to regulate TCM syndromes.

The impact of COVID-19 on cancer screening and treatment in older adults: The Multiethnic Cohort Study.

Background: The Coronavirus Disease of 2019 (COVID-19) has impacted the health and day-to-day life of individuals, especially the elderly and people with certain pre-existing medical conditions, including cancer. The purpose of this study was to investigate how COVID-19 impacted access to cancer screenings and treatment, by studying the participants in the Multiethnic Cohort (MEC) study. Methods: The MEC has been following over 215,000 residents of Hawai'i and Los Angeles for the development of cancer and other chronic diseases since 1993-1996. It includes men and women of five racial and ethnic groups: African American, Japanese American, Latino, Native Hawaiian, and White. In 2020, surviving participants were sent an invitation to complete an online survey on the impact of COVID-19 on their daily life activities, including adherence to cancer screening and treatment. Approximately 7,000 MEC participants responded. A cross-sectional analysis was performed to investigate the relationships between the postponement of regular health care visits and cancer screening procedures or treatment with race and ethnicity, age, education, and comorbidity. Results: Women with more education, women with lung disease, COPD, or asthma, and women and men diagnosed with cancer in the past 5 years were more likely to postpone any cancer screening test/procedure due to the COVID-19 pandemic. Groups less likely to postpone cancer screening included older women compared to younger women and Japanese American men and women compared to White men and women. Conclusions: This study revealed specific associations of race/ethnicity, age, education level, and comorbidities with the cancer-related screening and healthcare of MEC participants during the COVID-19 pandemic. Increased monitoring of patients in high-risk groups for cancer and other diseases is of the utmost importance as the chance of undiagnosed cases or poor prognosis is increased as a result of delayed screening and treatment. Funding: This research was partially supported by the Omidyar 'Ohana Foundation and grant U01 CA164973 from the National Cancer Institute.