Topical Collection "Health Behaviors, Risk Factors, NCDs and Health Promotion"

Editor

Prof. Dr. Stefano Campostrini
E-Mail Website
Collection Editor
Department of Economics, Universita Ca' Foscari Venezia, Venice, Italy
Interests: health statistics; social statistics; evaluation; public health; health systems; health promotion; social innovation

Topical Collection Information

Dear Colleagues,

As clearly shown in the literature and remarked by international organizations, Non Communicable Diseases (NCDs) account for 70 to more than 90% of deaths in almost any country in the world, and, even more, for years of living with disability. As pointed out in the recent report “TIME TO DELIVER” of the WHO Independent High-Level Commission on Noncommunicable Diseases, action is needed at all levels to increase global health and avoid premature mortality. Despite the fact that this need has been shared globally, not only by WHO but also in the UN General Assembly Declarations (2011), little improvements have been seen in this field, and the shared global targets, such as a 25% reduction in premature NCD mortality by 2025, seem too far to reach.

Much undergoing research is studying the relationship between risk factors at individual and community level and NCDs, as well as trying to identify “what works” in reducing the risk factors’ prevalence. Smoking, physical inactivity, unhealthy diet, and alcohol are the main areas of action and study, together with some other more specific fields.

This Topical Collection is open to the subject area of health behaviors, risk factors, and NCDs, with a specific interest in the analysis of public health actions and health promotion programs. The keywords listed below provide an outline of some of the possible areas of interest.

Prof. Dr. Stefano Campostrini
Collection Editor

Manuscript Submission Information

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Keywords

  • Risk factors
  • Risk factors and NCDs among specific populations (migrants, etc.)
  • Health behaviors
  • Health promotion
  • Evaluation
  • Surveillance
  • Premature mortality
  • NCDs and primary care
  • Universal care
  • Smoking
  • Physical inactivity
  • Unhealthy diet
  • Alcohol
  • Obesity

Published Papers (68 papers)

2021

Jump to: 2020, 2019, 2018

Open AccessArticle
Is 25-Hydroxyvitamin D Associated with Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus in Saudi Arabia? A Population Based Study
Int. J. Environ. Res. Public Health 2021, 18(6), 2805; https://doi.org/10.3390/ijerph18062805 - 10 Mar 2021
Viewed by 417
Abstract
Background: Saudi Arabia has a high burden of diabetes mellitus and vitamin D deficiency. The objective of this study was to explore the association between glycosylated hemoglobin and 25-hydroxyvitamin D in patients with type 2 diabetes mellitus (T2DM) in Riyadh, Saudi Arabia. Methods: [...] Read more.
Background: Saudi Arabia has a high burden of diabetes mellitus and vitamin D deficiency. The objective of this study was to explore the association between glycosylated hemoglobin and 25-hydroxyvitamin D in patients with type 2 diabetes mellitus (T2DM) in Riyadh, Saudi Arabia. Methods: An interview based cross-sectional study was conducted on 606 patients with type 2 diabetes, aged 30–75 years, visiting primary health care centers. Blood samples were collected for measuring HbA1c, 25(OH)D and bone and lipid markers. Multivariable linear regression analysis was conducted to explore the association between HbA1c and 25(OH)D. Results: The mean (±SD) levels for HbA1c and 25(OH) D were 7.69 (±1.77) and 44.28 (±23.06), respectively. Around 55% of patients had uncontrolled HbA1c (>7.0), whereas vitamin D deficiency (<50 nmol/L) was found in 52.3% (=317). Multiple linear regression analysis found that a unit increase in vitamin D levels and parathyroid hormone levels was associated with −0.17 (−0.02, −0.01, p < 0.001) and −0.20 (−2.66, −1.18, p < 0.001) unit decrease in levels of HbA1c, respectively. Similarly, increasing age was associated with −0.15 (−0.01, −0.04, p = 0.002) unit decrease in HbA1c levels, whereas unit increases in serum alkaline phosphatase, calcium and diabetes duration were associated with 0.22 (0.01, 0.02, p < 0.001), 0.14 (1.03, 3.88, p = 0.001) and 0.26 (0.42, 0.78, p < 0.001) unit increase in HbA1c levels, respectively. Conclusion: HbA1c levels are associated with 25-hydroxyvitamin D levels. For better control of HbA1c levels, it is important to maintain 25-hydroxyvitamin D level and bone markers within normal range. Full article
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Open AccessReview
A Systematic Scoping Review of Media Campaigns to Develop a Typology to Evaluate Their Collective Impact on Promoting Healthy Hydration Behaviors and Reducing Sugary Beverage Health Risks
Int. J. Environ. Res. Public Health 2021, 18(3), 1040; https://doi.org/10.3390/ijerph18031040 - 25 Jan 2021
Viewed by 1240
Abstract
Interventions to discourage sugary beverages and encourage water consumption have produced modest and unsustainable behavioral changes to reduce obesity and noncommunicable disease risks. This systematic scoping review examined media campaigns to develop a typology to support healthy hydration nonalcoholic beverage behaviors. Our three-step [...] Read more.
Interventions to discourage sugary beverages and encourage water consumption have produced modest and unsustainable behavioral changes to reduce obesity and noncommunicable disease risks. This systematic scoping review examined media campaigns to develop a typology to support healthy hydration nonalcoholic beverage behaviors. Our three-step methodology included the following: (1) review and summarize expert-recommended healthy beverage guidelines; (2) review six English-language electronic databases guided by PRISMA to describe existing campaign types by issue, goal and underlying theory; and (3) develop a media campaign typology to support policies, systems and environments to encourage healthy hydration behaviors. Results showed no international consensus for healthy beverage guidelines, though we describe expert-recommended healthy beverage guidelines for the United States. Of 909 records identified, we included 24 articles describing distinct media campaigns and nine sources that defined models, schemes or taxonomies. The final media campaign typology included: (1) corporate advertising, marketing or entertainment; (2) corporate social responsibility, public relations/cause marketing; (3) social marketing; (4) public information, awareness, education/ health promotion; (5) media advocacy/countermarketing; and (6) political or public policy. This proof-of-concept media campaign typology can be used to evaluate their collective impact and support for a social change movement to reduce sugary beverage health risks and to encourage healthy hydration behaviors. Full article
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Open AccessArticle
As the Pandemic Progresses, How Does Willingness to Vaccinate against COVID-19 Evolve?
Int. J. Environ. Res. Public Health 2021, 18(2), 797; https://doi.org/10.3390/ijerph18020797 - 19 Jan 2021
Cited by 9 | Viewed by 1675
Abstract
Controversy around the safety and efficacy of COVID-19 vaccines may lead to low vaccination rates. Survey data were collected in April and August 2020 from a total of 2343 Australian adults. A quarter (n = 575, 24%) completed both surveys. A generalized [...] Read more.
Controversy around the safety and efficacy of COVID-19 vaccines may lead to low vaccination rates. Survey data were collected in April and August 2020 from a total of 2343 Australian adults. A quarter (n = 575, 24%) completed both surveys. A generalized linear mixed model analysis was conducted to determine whether willingness to vaccinate changed in the repeated sample, and a multinominal logistic regression was conducted in all participants to determine whether willingness to vaccinate was associated with demographics, chronic disease, or media use. Willingness to vaccinate slightly decreased between April (87%) and August (85%) but this was not significant. Willingness to vaccinate was lower in people with a certificate or diploma (79%) compared to those with a Bachelor degree (87%), p < 0.01 and lower in infrequent users of traditional media (78%) compared to frequent users of traditional media (89%), p < 0.001. Women were more likely to be unsure if they would be willing to vaccinate (10%) compared to men (7%), p < 0.01. There were no associations between willingness to vaccinate and age, chronic disease, or social media use. Promotion of a COVID-19 vaccine should consider targeting women, and people with a certificate or diploma, via non-traditional media channels. Full article

2020

Jump to: 2021, 2019, 2018

Open AccessArticle
High Variability in Implementation of Selective-Prevention Services for Cardiometabolic Diseases in Five European Primary Care Settings
Int. J. Environ. Res. Public Health 2020, 17(23), 9080; https://doi.org/10.3390/ijerph17239080 - 04 Dec 2020
Viewed by 579
Abstract
(1) Background: Cardiometabolic diseases are the most common cause of death worldwide. As part of a collaborative European study, this paper aims to explore the implementation of primary care selective-prevention services in five European countries. We assessed the implementation process of the selective-prevention [...] Read more.
(1) Background: Cardiometabolic diseases are the most common cause of death worldwide. As part of a collaborative European study, this paper aims to explore the implementation of primary care selective-prevention services in five European countries. We assessed the implementation process of the selective-prevention services, participants’ cardiometabolic profile and risk and participants’ evaluation of the services, in terms of feasibility and impact in promoting a healthy lifestyle. (2) Methods: Eligible participants were primary care patients, 40–65 years of age, without any diagnosis of cardiometabolic disease. Two hundred patients were invited to participate per country. The extent to which participants adopted and completed the implementation of selective-prevention services was recorded. Patient demographics, lifestyle-related cardiometabolic risk factors and opinions on the implementation’s feasibility were also collected. (3) Results: Acceptance rates varied from 19.5% (n = 39/200) in Sweden to 100% (n = 200/200) in the Czech Republic. Risk assessment completion rates ranged from 65.4% (n = 70/107) in Greece to 100% (n = 39/39) in Sweden. On a ten-point scale, the median (25–75% quartile) of participant-reported implementation feasibility ranged from 7.4 (6.9–7.8) in Greece to 9.2 (8.2–9.9) in Sweden. Willingness to change lifestyle exceeded 80% in all countries. (4) Conclusions: A substantial variation in the implementation of selective-prevention receptiveness and patient risk profile was observed among countries. Our findings suggest that the design and implementation of behavior change cardiometabolic programmes in each country should be informed by the local context and provide some background evidence towards this direction, which can be even more relevant during the current pandemic period. Full article
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Open AccessReview
Quality of Life After Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2020, 17(22), 8439; https://doi.org/10.3390/ijerph17228439 - 14 Nov 2020
Viewed by 717
Abstract
Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of [...] Read more.
Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of sufferers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, differences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed. Full article
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Open AccessArticle
A Randomised Controlled Trial to Evaluate the Administration of the Health Improvement Card as a Health Promotion Tool: A Physiotherapist-Led Community-Based Initiative
Int. J. Environ. Res. Public Health 2020, 17(21), 8065; https://doi.org/10.3390/ijerph17218065 - 02 Nov 2020
Viewed by 755
Abstract
A randomised controlled trial was conducted to evaluate the administration of the Health Improvement Card (HIC) on lifestyle practices and biometric variables in community-dwelling Chinese participants. Adults living in Shanghai were randomly assigned to either the HIC-intervention or control group. Measurements/assessments were conducted [...] Read more.
A randomised controlled trial was conducted to evaluate the administration of the Health Improvement Card (HIC) on lifestyle practices and biometric variables in community-dwelling Chinese participants. Adults living in Shanghai were randomly assigned to either the HIC-intervention or control group. Measurements/assessments were conducted at baseline and three-month follow-up. Supervised physiotherapy students administered the HIC and four standardised questionnaires related to health and wellbeing. Both groups received a health promotion education pamphlet. Based on participants’ HIC biometric and lifestyle scores, students prescribed lifestyle, and exercise advice to the HIC-intervention group. 171 individuals (39 men, 132 women) (mean age 68.4 ± 9.7 y) participated. At follow-up, body mass index (BMI) and waist circumference decreased significantly in the HIC-intervention group. Furthermore, the number of participants in the HIC-intervention group categorised as low risk regarding their physical activity and dietary practices, increased by 32.2% and 20%, respectively. Changes in standardised questionnaire scores did not meet minimum clinically importance differences in either group. This is the first study to demonstrate that HIC-informed health promotion education can improve people’s lifestyle practices, thereby, objective biometric variables. Evaluation of the effect of HIC-informed lifestyle education on some biometric parameters (blood pressure and BMI) may warrant a longer timeframe. Full article
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Open AccessArticle
Voluntary Smoke-Free Home Rules and Exposure to Secondhand Smoke in Poland: A National Cross-Sectional Survey
Int. J. Environ. Res. Public Health 2020, 17(20), 7502; https://doi.org/10.3390/ijerph17207502 - 15 Oct 2020
Viewed by 615
Abstract
Smoke-free policies have been shown to significantly reduce secondhand smoke (SHS) exposure in private and public places. The objectives of this study were to: (1) to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland; and (2) assess the association [...] Read more.
Smoke-free policies have been shown to significantly reduce secondhand smoke (SHS) exposure in private and public places. The objectives of this study were to: (1) to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland; and (2) assess the association of smoke-free rules with self-reported SHS exposure in private homes. A cross-sectional survey was conducted in September 2019 with a nationally representative sample of 1011 individuals aged 15 and over. Nationally, 66.1% of individuals had a 100% smoke-free home rule (78.9% of non-smokers and 18.6% of smokers; p < 0.001), while a further 24.6% had adopted a partial home smoking rule. SHS exposure in the home during past month was reported by 6.1% of respondents (11.5% of smokers and 4.5% of non-smokers; p < 0.001). The lowest level of SHS exposure (1.8%) was observed among respondents who had implemented a full smoke-free home rule. Non-smokers had higher odds of having adopted a total smoke-free home rule compared with smokers (aOR: 19.17; 95% CI: 12.89–28.50). Moreover, non-smokers had lower odds (aOR: 0.35; 95% CI: 0.20–0.61; p < 0.001) of self-reporting SHS smoke exposure at home. Although two-thirds of the Polish population have adopted a full smoke-free home rule in their homes, smokers continue to lag in adoption rates relative to non-smokers. Full article
Open AccessArticle
Individual Capital Structure and Health Behaviors among Chinese Middle-Aged and Older Adults: A Cross-Sectional Analysis Using Bourdieu’s Theory of Capitals
Int. J. Environ. Res. Public Health 2020, 17(20), 7369; https://doi.org/10.3390/ijerph17207369 - 09 Oct 2020
Viewed by 646
Abstract
This study draws on Bourdieu’s theory of capitals to analyze the relative importance of economic, cultural, and social capital on health behaviors in Chinese middle-aged and older adults. Based on data from the China Family Panel Studies of 2016 (N = 15,147), we [...] Read more.
This study draws on Bourdieu’s theory of capitals to analyze the relative importance of economic, cultural, and social capital on health behaviors in Chinese middle-aged and older adults. Based on data from the China Family Panel Studies of 2016 (N = 15,147), we first harnessed a binary logistic regression model to discuss the associations between the three capitals and four types of health behaviors (i.e., physical exercise, smoking, binge drinking and stay-up). Using the sheaf coefficients technique, we then compared the relative effects of three of the capitals on health behaviors. The results suggest that cultural capital is the most influential one, which would significantly increase physical exercise and stay-up behaviors, and reduce smoking and binge drinking behaviors. Economic capital is also an important predictor, that may reduce smoking behavior but increase binge drinking and stay-up behaviors. Social capital has shown the least importance, although it would still be saliently associated with physical exercise, smoking and stay-up behaviors. In addition, some significant group disparities are also identified. This article is one of the first to explain health behavior inequalities through a Bourdieusian capital-based approach in Chinese contexts. Full article
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Open AccessArticle
Health Behaviors and Health Status among Middle-Aged and Older Adults with Chronic Diseases in Taiwan
Int. J. Environ. Res. Public Health 2020, 17(19), 7196; https://doi.org/10.3390/ijerph17197196 - 01 Oct 2020
Viewed by 651
Abstract
Changes in lifestyle behaviors may effectively maintain or improve the health status of individuals with chronic diseases. However, such health behaviors adopted by individuals are unlikely to demonstrate similar patterns. This study analyzed the relationship between the heterogeneous latent classes of health behavior [...] Read more.
Changes in lifestyle behaviors may effectively maintain or improve the health status of individuals with chronic diseases. However, such health behaviors adopted by individuals are unlikely to demonstrate similar patterns. This study analyzed the relationship between the heterogeneous latent classes of health behavior and health statuses among middle-aged and older adults with hypertension, diabetes, or hyperlipidemia in Taiwan. After selecting 2103 individuals from the 2005 and 2009 Taiwan National Health Interview Survey (NHIS), we first identified heterogeneous groups of health behaviors through latent class analysis (LCA). We further explored the relationship between each latent class of health behavior and health status through ordered logit regression. We identified the following five distinct health behavior classes: the all-controlled, exercise and relaxation, healthy diet and reduced smoking or drinking, healthy diet, and least-controlled classes. Regression results indicated that individuals in classes other than the all-controlled class all reported poor health statuses. We also found great magnitude of the coefficient estimates for individuals who reported their health status to be poor or very poor for the least-controlled class. Therefore, health authorities and medical providers may develop targeted policies and interventions that address multiple modifiable health behaviors in each distinct latent class of health behavior. Full article
Open AccessArticle
Prognostic Factors for Staying at Work for Partially Sick-Listed Workers with Subjective Health Complaints: A Prospective Cohort Study.
Int. J. Environ. Res. Public Health 2020, 17(19), 7184; https://doi.org/10.3390/ijerph17197184 - 30 Sep 2020
Viewed by 671
Abstract
Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders. We used data of [...] Read more.
Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders. We used data of 86 partially sick-listed workers with SHC (57 females, 29 males, mean age 47.1 years) and 433 with other disorders (227 females, 206 males, mean age 50.9 years), from an existing prospective cohort study consisting of 2593 workers aged 18–65 years and registered as sick-listed with different health complaints or disorders for at least 84 weeks in the database of the Dutch Social Security Institute. We performed univariable logistic regression analyses (p 0.157) for all independent variables with the dependent variable staying at work for the workers with SHC. We then performed multivariable logistic regression analyses with forward selection (p ≤ 0.157) and combined the remaining factors in a final, multivariable model (p 0.05), which we also used for logistic regression analysis in the workers with other disorders. The following factors were significant prognostic factors for staying at work for workers with SHC: full work disability benefits (odds ratio (OR) 0.07, 95% confidence interval (95% CI) 0.01–0.64), good mental health (OR 1.08, 95% CI 1.02–1.14), positive expectations for staying at work (OR 6.49, 95% CI 2.00–21.09), previous absenteeism for the same health complaint (OR 0.31, 95% CI 0.10–0.96) and good coping strategies (OR 1.13, 95% CI 1.04–1.23). For workers with other disorders, full work disability benefits, good mental health and positive expectations for staying at work were also prognostic factors for staying at work. Individual and policy factors seem to be important for staying at work of sick-listed workers with SHC and those with other disorders alike, but several biopsychosocial factors are particularly important for workers with SHC. Full article
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Open AccessArticle
Factors Affecting Onset and Persistence of Metabolic Syndrome in Korean Breast Cancer Survivors: A Prospective Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6814; https://doi.org/10.3390/ijerph17186814 - 18 Sep 2020
Viewed by 580
Abstract
This study aimed to investigate the onset and persistence of metabolic syndrome in breast cancer survivors in a community setting. The study included 329 female breast cancer survivors from 39 community health examination centers located in 14 urban areas in Korea. After an [...] Read more.
This study aimed to investigate the onset and persistence of metabolic syndrome in breast cancer survivors in a community setting. The study included 329 female breast cancer survivors from 39 community health examination centers located in 14 urban areas in Korea. After an average of 4.6 years of follow-up, based on the presence of metabolic syndrome at baseline and follow-up, the subjects were assigned to three groups: Non-metabolic syndrome (n = 249), onset (n = 32), and persistent (n = 48). Factors associated with the metabolic syndrome were analyzed and presented as odds ratios (ORs). Older age, postmenopausal status, lower education, and lower-income level were associated with an increased prevalence of metabolic syndrome in the onset Mets and persistent Mets group. In particular, when the breast cancer survivor was obese (≥25 kg/m2), the probability of developing metabolic syndrome was 3.33 times higher than normal-weight subjects (<23 kg/m2) and the probability of metabolic syndrome persisting was 16.34 times. When breast cancer survivors were in their 60s or older, the probability of metabolic syndrome persisting was 4.27 times higher than those in their 40s. To prevent the onset and persistence of metabolic syndrome in breast cancer survivors, health-care providers should identify risk factors. Obesity, in particular, should be controlled. Full article
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Open AccessArticle
XGBoost-Based Framework for Smoking-Induced Noncommunicable Disease Prediction
Int. J. Environ. Res. Public Health 2020, 17(18), 6513; https://doi.org/10.3390/ijerph17186513 - 07 Sep 2020
Cited by 3 | Viewed by 894
Abstract
Smoking-induced noncommunicable diseases (SiNCDs) have become a significant threat to public health and cause of death globally. In the last decade, numerous studies have been proposed using artificial intelligence techniques to predict the risk of developing SiNCDs. However, determining the most significant features [...] Read more.
Smoking-induced noncommunicable diseases (SiNCDs) have become a significant threat to public health and cause of death globally. In the last decade, numerous studies have been proposed using artificial intelligence techniques to predict the risk of developing SiNCDs. However, determining the most significant features and developing interpretable models are rather challenging in such systems. In this study, we propose an efficient extreme gradient boosting (XGBoost) based framework incorporated with the hybrid feature selection (HFS) method for SiNCDs prediction among the general population in South Korea and the United States. Initially, HFS is performed in three stages: (I) significant features are selected by t-test and chi-square test; (II) multicollinearity analysis serves to obtain dissimilar features; (III) final selection of best representative features is done based on least absolute shrinkage and selection operator (LASSO). Then, selected features are fed into the XGBoost predictive model. The experimental results show that our proposed model outperforms several existing baseline models. In addition, the proposed model also provides important features in order to enhance the interpretability of the SiNCDs prediction model. Consequently, the XGBoost based framework is expected to contribute for early diagnosis and prevention of the SiNCDs in public health concerns. Full article
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Open AccessArticle
Effect of a Graduated Walking Program on the Severity of Obstructive Sleep Apnea Syndrome. A Randomized Clinical Trial
Int. J. Environ. Res. Public Health 2020, 17(17), 6334; https://doi.org/10.3390/ijerph17176334 - 31 Aug 2020
Viewed by 692
Abstract
Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled [...] Read more.
Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled clinical trial with a two-arm parallel in three tertiary hospitals was carried out with seventy sedentary patients with moderate to severe OSAS. Twenty-nine subjects in each arm were analyzed by protocol. The control group received usual care, while usual care and an exercise program based on progressive walks without direct supervision for 6 months were offered to the intervention group. Results: The apnea–hypopnea index decreased by six points in the intervention group, and improvements in oxygen desaturation index, total cholesterol, and Low-Density Lipoprotein of Cholesterol (LDL-c) were observed. A higher decrease in sleep apnea–hypopnea index (45 ± 20.6 vs. 34 ± 26.3/h; p = 0.002) was found in patients with severe vs. moderate OSAS, as well as in oxygen desaturation index from baseline values (43.3 vs. 34.3/h; p = 0.046). Besides, High-Density Lipoprotein of Cholesterol (HDL-c) values showed a higher increase in the intervention group (45.3 vs. 49.5 mg/dL; p = 0.009) and also, a higher decrease in LDL-c was found in this group (141.2 vs. 127.5 mg/dL; p = 0.038). Conclusion: A home physical exercise program is a useful and viable therapeutic measure for the management of OSAS. Full article
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Open AccessArticle
Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(16), 5963; https://doi.org/10.3390/ijerph17165963 - 17 Aug 2020
Viewed by 585
Abstract
Excess healthcare utilization is rapidly rising in rural China. This study focused on excess outpatient demand (EOD) and aimed to measure its performance and sociodemographic determinants among China’s rural residents. A total of 1290 residents from four counties in central China were enrolled [...] Read more.
Excess healthcare utilization is rapidly rising in rural China. This study focused on excess outpatient demand (EOD) and aimed to measure its performance and sociodemographic determinants among China’s rural residents. A total of 1290 residents from four counties in central China were enrolled via multistage cluster random sampling. EOD is the condition in which the level of hospital a patient chooses is higher than the indicated level in the governmental guide. A multilevel logistic regression was used to examine the sociodemographic determinants of EOD. Residents with EOD accounted for 85.83%. The risk of EOD was 51.17% and value was 5.69. The value of EOD in diseases was higher than that in symptoms (t = −21.498, p < 0.001). Age (OR = 0.489), educational level (OR = 1.986) and hospital distance difference (OR = 0.259) were the main sociodemographic determinants of EOD. Excess outpatient demand was evident in rural China, but extreme conditions were rare. Results revealed that age, educational level and hospital distance were the main sociodemographic determinants of EOD. The capacity of primary healthcare institutions, universality of common disease judgement and understanding of institution’s scope of disease curing capabilities of residents should be improved to reduce EOD. Full article
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Open AccessCommentary
The Social Determinants of Health: Time to Re-Think?
Int. J. Environ. Res. Public Health 2020, 17(16), 5856; https://doi.org/10.3390/ijerph17165856 - 12 Aug 2020
Cited by 2 | Viewed by 1335
Abstract
Twelve years have now passed since the influential WHO Report on the Social Determinants of Health (SDoH) in 2008. A group of senior international public health scholars and decision-makers met in Italy in mid-2019 to review the legacy of the SDoH conceptual framework [...] Read more.
Twelve years have now passed since the influential WHO Report on the Social Determinants of Health (SDoH) in 2008. A group of senior international public health scholars and decision-makers met in Italy in mid-2019 to review the legacy of the SDoH conceptual framework and its adequacy for the many challenges facing our field as we enter the 2020s. Four major categories of challenges were identified: emerging “exogenous” challenges to global health equity, challenges related to weak policy and practice implementation, more fundamental challenges related to SDoH theory and research, and broader issues around modern research in general. Each of these categories is discussed, and potential solutions offered. We conclude that although the SDoH framework is still a worthy core platform for public health research, policy, and practice, the time is ripe for significant evolution. Full article
Open AccessArticle
Nutrition Labeling Usage Influences Blood Markers in Body-Size Self-Conscious Individuals: The Korean National Health and Nutrition Examination Survey (KNHANES) 2013–2018
Int. J. Environ. Res. Public Health 2020, 17(16), 5769; https://doi.org/10.3390/ijerph17165769 - 10 Aug 2020
Viewed by 574
Abstract
This study analyzed the effects of nutrition labeling and examined whether nutrition labeling usage influences the levels of blood markers, such as high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) in body-size self-conscious individuals. The dependent variables were HDL-C and TG; the independent variables [...] Read more.
This study analyzed the effects of nutrition labeling and examined whether nutrition labeling usage influences the levels of blood markers, such as high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) in body-size self-conscious individuals. The dependent variables were HDL-C and TG; the independent variables were the respondents’ awareness of nutrition labeling use, sociodemographic factors, perceived health status, stress, lifestyle, frequency of eating out, family history of hyperlipidemia, survey year, body mass index, total energy intake, and cholesterol levels. Body-size perception was assessed by matching body mass index with subjective body-shape recognition using data from the Korean National Health and Nutrition Examination Survey (2013–2018). Differences were observed in HDL-C and TG levels according to nutrition labeling usage and body-image perception. The group that recognized body image correctly showed high HDL-C and low TG levels when they actively used nutrition labeling, whereas the group that recognized body image incorrectly showed no significant changes in HDL-C and TG levels even when actively using nutrition labeling. The standard nutritional information, which does not consider individual body-size perceptions, has a restrictive effect. Policies should be developed towards tailored intervention strategies considering individual body-size perception. Full article
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Open AccessArticle
Knowledge and Practices Related to Salt Intake among Saudi Adults
Int. J. Environ. Res. Public Health 2020, 17(16), 5749; https://doi.org/10.3390/ijerph17165749 - 09 Aug 2020
Cited by 1 | Viewed by 830
Abstract
In Saudi Arabia, data regarding salt-related knowledge and practices are still lacking. This cross-sectional study aimed to investigate salt-related knowledge and practices and associated factors in Saudi adults. Data on the following variables were collected from 467 participants living in Madinah or Jeddah [...] Read more.
In Saudi Arabia, data regarding salt-related knowledge and practices are still lacking. This cross-sectional study aimed to investigate salt-related knowledge and practices and associated factors in Saudi adults. Data on the following variables were collected from 467 participants living in Madinah or Jeddah via face-to-face interviews: demographics, anthropometrics (height and weight), blood pressure (assessed using a digital sphygmomanometer), salt-related knowledge, and practices related to salt intake. Salt-related knowledge and practices were limited among the study participants; however, they were not correlated (rs = 0.10). Multiple linear regression analysis revealed that salt-related practices were negatively associated with sodium intake and positively associated with body mass index (BMI) (p < 0.001 and p = 0.001, respectively), whereas salt-related knowledge was not associated with sodium intake, blood pressure, or BMI. Salt-related knowledge is limited and not linked to practices related to salt intake in Saudi adults. Interventions are needed to increase the accessibility of low-sodium food options and improve practices limiting sodium intake to prevent the occurrence of salt-related diseases among adults in Saudi Arabia. Full article
Open AccessReview
Breast Cancer Primary Prevention and Diet: An Umbrella Review
Int. J. Environ. Res. Public Health 2020, 17(13), 4731; https://doi.org/10.3390/ijerph17134731 - 01 Jul 2020
Cited by 2 | Viewed by 1681
Abstract
Introduction: Many studies have been published, but none have pooled the useful evidence available in the literature to produce guidelines and health policies promoting healthy eating styles to prevent breast cancer (BC). The present study aimed to summarize the evidence produced to date, [...] Read more.
Introduction: Many studies have been published, but none have pooled the useful evidence available in the literature to produce guidelines and health policies promoting healthy eating styles to prevent breast cancer (BC). The present study aimed to summarize the evidence produced to date, taking a judicious, critical approach to the quality of the studies analyzed. Methods: An umbrella review method was adopted, which is a systematic review of second-level studies, meta-analyses and literature reviews. Results: In all, 48 studies were considered: 32 meta-analyses, 4 pooled analyses, 5 systematic reviews, and 7 qualitative reviews. A higher intake of total meat, or red or processed meats, or foods with a high glycemic index, or eggs would seem to be associated with a higher risk of BC. Some foods, such as vegetables, would seem instead to have an inverse association with BC risk. One meta-analysis revealed an inverse association between citrus fruit and mushroom consumption and BC. Some nutrients, such as calcium, folate, vitamin D, lignans and carotenoids, also seem to be inversely associated with BC risk. The evidence is still conflicting as concerns exposure to other dietary elements (e.g., polyunsaturated fatty acids, dairy foods). Conclusion: Nutrition is one of the most modifiable aspects of people’s lifestyles and dietary choices can affect health and the risk of cancer. Overall, adhering to a healthy eating style may be associated with a significant reduction in the risk of BC. Full article
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Open AccessArticle
Effects of Gender and Age on Dietary Intake and Body Mass Index in Hypertensive Patients: Analysis of the Korea National Health and Nutrition Examination
Int. J. Environ. Res. Public Health 2020, 17(12), 4482; https://doi.org/10.3390/ijerph17124482 - 22 Jun 2020
Cited by 1 | Viewed by 734
Abstract
Controlling weight and dietary intake are important for hypertensive patients to manage their blood pressure. However, the interaction effect of gender and age on weight and dietary intake is not well known. The aim of this study was to examine the main and [...] Read more.
Controlling weight and dietary intake are important for hypertensive patients to manage their blood pressure. However, the interaction effect of gender and age on weight and dietary intake is not well known. The aim of this study was to examine the main and interaction effects of age and gender on body mass index (BMI) and dietary intake in hypertensive patients. We analyzed data from 4287 participants with hypertension (1600 participants 45–64 years old and 2687 participants 65 years or older) who participated in the Korea National Health and Nutrition Examination Survey (2013–2016). Two-way ANOVAs were conducted to examine the main and interaction effects of age and gender on BMI and dietary intake. Gender and age had significant main effects on BMI, intake of energy, cholesterol, sodium, and potassium. However, both gender and age illustrated interaction effects on BMI (F = 8.398, p = 0.004), energy intake (F = 12.882, p < 0.001), and cholesterol intake (F = 6.107, p = 0.014), while not showing any significant interaction effects on sodium (F = 3.547, p = 0.060) and potassium (F = 3.396, p = 0.066). Compared to the middle-aged group, BMI, energy intake, and cholesterol intake decreased in the older-aged group. However, the declines were steeper in men than in women. Therefore, both gender and age need to be considered for weight and dietary intake management for hypertensive patients. Full article
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Open AccessArticle
Prevalence of Overweight and Obesity among People Aged 18 Years and Over between 2013 and 2018 in Hunan, China
Int. J. Environ. Res. Public Health 2020, 17(11), 4048; https://doi.org/10.3390/ijerph17114048 - 05 Jun 2020
Cited by 2 | Viewed by 1063
Abstract
Background: Recent overweight and obesity prevalence data are lacking for China. Methods: Data were from provincially representative surveys conducted in 2013 and 2018 in Hunan Province, China. Overweight and obesity were defined according to the Chinese standard. Complex sampling weights were considered in [...] Read more.
Background: Recent overweight and obesity prevalence data are lacking for China. Methods: Data were from provincially representative surveys conducted in 2013 and 2018 in Hunan Province, China. Overweight and obesity were defined according to the Chinese standard. Complex sampling weights were considered in statistical analyses. 95% confidence interval (95% CI) of rate was calculated. Results: The overall prevalence rate between 2013 and 2018 significantly increased from 20.81% (95% CI: 17.68–23.95) to 26.97% (95% CI: 23.48–30.45) for overweight and from 4.09% (95% CI: 3.21–4.96) to 7.13% (95% CI: 5.10–9.15) for obesity in Hunan Province of China, respectively. Urban residents and males had higher crude prevalence rates of overweight and obesity than rural residents and females in 2013 and in 2018. Notably, the peak age groups of overweight and obesity both became younger between 2013 and 2018. After controlling for Engel coefficient, level of education and frequency of physical exercise per week, the overweight prevalence significantly increased in urban males aged 65+ (adjusted OR: 1.52) and rural males aged 45–54 years (adjusted OR: 1.52) and 65+ (adjusted OR: 1.88) and the obesity prevalence rate rose significantly in many groups (urban males: 18–24 years, 25–34 years, 35–44 years and 55–64 years; urban females: 25–34 years, 35–44 years, 45–54 years; rural males: 18–24 years, 25–34 years; rural females: 35–44 years, 55–64 years), with adjusted OR varying from 1.56 to 5.52. Conclusion: The adult prevalence rates of overweight and obesity significantly increased between 2013 and 2018 in Hunan Province, China. The increasing prevalence rates and varying prevalence changes across groups warrantee further research and policy interventions. Full article
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Open AccessArticle
Social Support and User Characteristics in Online Diabetes Communities: An In-Depth Survey of a Large-Scale Chinese Population
Int. J. Environ. Res. Public Health 2020, 17(8), 2806; https://doi.org/10.3390/ijerph17082806 - 18 Apr 2020
Cited by 2 | Viewed by 926
Abstract
Objective: To determine the characteristics of members of online diabetes communities as well as those factors affecting the provision and acceptance of social support. Methods: A cross-sectional STAR questionnaire survey was conducted among patients with diabetes who were members of online [...] Read more.
Objective: To determine the characteristics of members of online diabetes communities as well as those factors affecting the provision and acceptance of social support. Methods: A cross-sectional STAR questionnaire survey was conducted among patients with diabetes who were members of online diabetes groups. Univariate and multivariate binary logistic regression analysis were adopted to explore the relative analysis of providing and accepting social support compared with the characteristics of members in virtual diabetics’ groups. Results: A total of 1297 respondents were collected. The map distribution of patients in China was mainly located in the Guangdong, Jiangsu, Shandong, Henan, and Hebei provinces. As for their demographic characteristics, respondents had diabetes or prediabetes and were between the ages of 21 and 50 years (Median age was 35.0 (interquartile range from 28.0 to 44.0)). Most respondents were married and lived in cities. The education level of patients was mainly distributed throughout junior high, technical secondary, high school, junior college, and undergraduate levels. Age, marital status, and education level varied by gender, and the total score of the patients aged 41 to 50 for social support had a statistical significance between male and female. In addition, when group members were in junior high school or below, or were undergraduate students, their total social support scores varied by gender. Binary logistic regression showed that in 21 independent variables the total score and the total score grade of relationship intensity in the online group and reorganize of age were significant. The patients’ social support acceptance of the map of respondents score grading of relationship intensity in the online group was 5.420 times higher than that of the lower score grading of relationship intensity in the group. At the same time, the patients’ social support acceptance of the patients at the age of less than or equal to 31 years old was 19.608 times higher than that of group members aged more than 31 years old. Conclusion: Age and education background of the patients affects scores of social supports between males and females. The higher the total score and the score grade of relationship intensity in the online group, the higher the patients’ social support acceptance. The younger patients had a better utilization of social support. Full article
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Open AccessArticle
To Vaccinate or Not: The Relative Impact of Attitudes toward Autism Spectrum Disorders and the Ability to Interpret Scientific Information on Vaccination Decisions
Int. J. Environ. Res. Public Health 2020, 17(7), 2542; https://doi.org/10.3390/ijerph17072542 - 08 Apr 2020
Viewed by 1624
Abstract
Background. This pilot study investigated vaccine decision making, i.e., the relationships between knowledge and attitudes towards autism spectrum disorders (ASD), scientific literacy, attitudes toward the (MMR) vaccine, and children’s MMR vaccination status. Methods. A sample of 132 parents and expectant parents (mean age [...] Read more.
Background. This pilot study investigated vaccine decision making, i.e., the relationships between knowledge and attitudes towards autism spectrum disorders (ASD), scientific literacy, attitudes toward the (MMR) vaccine, and children’s MMR vaccination status. Methods. A sample of 132 parents and expectant parents (mean age 38.40 years; >60% with university education) participated in a survey where they were asked about their knowledge of ASD, attitudes towards ASD and MMR, and their children’s MMR vaccine status. The participants also completed a standardized science test (The American College Test) to test their scientific literacy. Results. Knowledge of ASD was positively correlated with attitudes towards ASD. Attitudes towards ASD were positively correlated with scientific literacy and attitudes towards MMR. Attitudes towards MMR were positively correlated with MMR vaccine status (i.e., vaccination decision). Discussion. Factors other than scientific literacy seem to contribute towards children’s MMR vaccine status such as attitudes towards MMR. However, these are preliminary findings and need to be interpreted with caution. Full article
Open AccessArticle
The Associations Among Health-Promoting Lifestyle, eHealth Literacy, and Cognitive Health in Older Chinese Adults: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(7), 2263; https://doi.org/10.3390/ijerph17072263 - 27 Mar 2020
Cited by 2 | Viewed by 1140
Abstract
Background: Healthy lifestyles and health literacy are strongly associated with cognitive health in older adults, however, it is unclear whether this relationship can be generalized to health-promoting lifestyles and eHealth literacy. To date, no research has examined the interactive effect of health-promoting lifestyles [...] Read more.
Background: Healthy lifestyles and health literacy are strongly associated with cognitive health in older adults, however, it is unclear whether this relationship can be generalized to health-promoting lifestyles and eHealth literacy. To date, no research has examined the interactive effect of health-promoting lifestyles and eHealth literacy on cognitive health. Objective: To examine the associations among health-promoting lifestyles, eHealth literacy, and cognitive health in older adults. Methods: Using a stratified cluster sampling method, we conducted a survey with older adults in four districts and two counties in Jinan (China). Older adults (n = 1201; age ≥ 60 years) completed our survey. We assessed health-promoting lifestyles, eHealth literacy, and cognitive health, and collected participants’ sociodemographic information. Results: Health-promoting lifestyles and eHealth literacy were significantly and positively associated with cognitive health (both p < 0.01). In addition, eHealth literacy was positively associated with health-promoting lifestyles. Moreover, the interaction of health-promoting lifestyle and eHealth literacy negatively predicted cognitive health (β = −0.465, p < 0.01). Conclusions: Health-promoting lifestyles and eHealth literacy were associated with the cognitive health of Chinese older adults, both independently and interactively. Further, eHealth literacy was associated with health-promoting lifestyles in older adults. Therefore, interventions regarding healthy lifestyles and eHealth literacy would benefit older adults. Full article
Open AccessArticle
The Associations between Individual Factors, eHealth Literacy, and Health Behaviors among College Students
Int. J. Environ. Res. Public Health 2020, 17(6), 2108; https://doi.org/10.3390/ijerph17062108 - 22 Mar 2020
Cited by 2 | Viewed by 1264
Abstract
Background: This study aimed to investigate the associations between individual factors, electronic health (eHealth) literacy, dietary behaviors, and exercise habits in college students, as well as the moderating effect of gender on the above target behaviors. Methods: A pen-and-paper questionnaire with a stratified [...] Read more.
Background: This study aimed to investigate the associations between individual factors, electronic health (eHealth) literacy, dietary behaviors, and exercise habits in college students, as well as the moderating effect of gender on the above target behaviors. Methods: A pen-and-paper questionnaire with a stratified sampling method was used to collect data, and at least 100 students from each stratum were determined to be used for the official sample in this study. Finally, 674 students completed the survey. Results and Conclusions: Chi-square test results demonstrated that genders had dissimilar dietary supplement use and subjective health status. Further analyses indicated females had a higher likelihood of taking dietary supplements and poorer subjective health statuses. The t-test results indicated that the functional eHealth literacy, dietary behaviors, and exercise habits of genders were different, and the mean scores showed that males had higher functional eHealth literacy, healthier dietary behaviors, and higher exercise involvement than females. Regression analyses showed that students who were male, took dietary supplements, placed the utmost importance on health, and had high critical eHealth literacy tended to possess healthy dietary behaviors. Students who were male and had good subjective health statuses tended to have higher exercise involvement. Specifically, the critical eHealth literacy changed dietary behaviors less effectively for women than for men, and the subjective health status changed exercise habits less effectively for women than for men. Therefore, when designing the diet and exercise intervention programs, gender-specific programs rather than generic programs should be given priority to develop. Full article
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Open AccessArticle
Association between Physician-Diagnosed Asthma and Weight Status among Chinese Children: The Roles of Lifestyle Factors
Int. J. Environ. Res. Public Health 2020, 17(5), 1599; https://doi.org/10.3390/ijerph17051599 - 02 Mar 2020
Cited by 4 | Viewed by 1026
Abstract
Childhood asthma and obesity have posed a parallel epidemic over the past few decades. However, whether asthma diagnosis is associated with obesity, and what the roles of lifestyle factors play in this relationship, remained unclarified. This study aimed to investigate the association between [...] Read more.
Childhood asthma and obesity have posed a parallel epidemic over the past few decades. However, whether asthma diagnosis is associated with obesity, and what the roles of lifestyle factors play in this relationship, remained unclarified. This study aimed to investigate the association between asthma and weight status in Chinese children and explore the potential mediating and/or modifying roles of lifestyle factors in the association. In this cross-sectional study, 16,837 children aged 6–12 years were recruited from Guangzhou, China. Participants’ information on physician-diagnosed asthma was collected from parents, and data on physical activity, screen time, and sleeping were reported in a validated questionnaire. Height and weight were objectively measured, and weight status was classified by body mass index (BMI). Multiple logistic regression analysis and mediation analysis were used. Results showed that asthmatic children were at significantly higher risk of obesity (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.03, 2.21) compared with non-asthmatic children. More importantly, this increased risk was even greater in children with moderate-to-vigorous physical activity <60 min/d and children with screen time >2 h/d (both Pinteraction < 0.05). Also, a positive relationship of asthma with overweight was found in children with screen time >2 h/d (OR 3.92, 95% CI 1.56, 9.88), while a negative association was observed between asthma and underweight in children aged 9–12 years (OR 0.23, 95% CI 0.06, 0.92). Mediation analysis indicated that these associations were not mediated by physical activity, screen time, or sleeping. The findings suggested that physician-diagnosed asthma was associated with higher risks of overweight and obesity, and these risks might be exacerbated by insufficient physical activity and prolonged screen time. Full article
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Open AccessArticle
Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital
Int. J. Environ. Res. Public Health 2020, 17(3), 980; https://doi.org/10.3390/ijerph17030980 - 04 Feb 2020
Cited by 2 | Viewed by 1197
Abstract
Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used [...] Read more.
Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs). Full article
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Open AccessArticle
Dietary Knowledge among Adults with Type 2 Diabetes—Kingdom of Saudi Arabia
Int. J. Environ. Res. Public Health 2020, 17(3), 858; https://doi.org/10.3390/ijerph17030858 - 30 Jan 2020
Cited by 3 | Viewed by 1252
Abstract
Dietary management is considered as a major step in assessing a patient’s knowledge related to nutritional aspects, treatment, and complications of diabetes. Diabetes patients frequently face difficulty in identifying the recommended diet, including its quality and quantity. In the Kingdom of Saudi Arabia [...] Read more.
Dietary management is considered as a major step in assessing a patient’s knowledge related to nutritional aspects, treatment, and complications of diabetes. Diabetes patients frequently face difficulty in identifying the recommended diet, including its quality and quantity. In the Kingdom of Saudi Arabia (KSA), sedentary lifestyle, along with food choices and portion sizes, have increased considerably and this has resulted in the soaring risk of diabetes. In addition, there is paucity of literature focusing on the Dietary Knowledge (DK) of type 2 diabetics in KSA. The study aimed to assess and evaluate the DK of type 2 diabetics. An analytical cross-sectional study was conducted among 350 type 2 diabetics using a valid and reliable self-prepared questionnaire comprising of 21 questions. Results showed that type 2 diabetics had an overall poor DK (28.57%). Sub-group analysis further revealed that diabetes patients had poor knowledge related to the consumption of carbohydrates and food choices, whereas they had good knowledge related to lipids and fats, proteins and food types. The role of diet in controlling of diabetes is considered imperative, but still, diabetes patients are unaware how they should approach this issue. The patient empowerment approach can be used to counsel patients with a poor DK. Primary care physicians and dietitians should work together and carry out individualized, tailored and patient-centered dietary education sessions. Full article

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Open AccessArticle
The Prevalence of Tobacco and E-Cigarette Use in Poland: A 2019 Nationwide Cross-Sectional Survey
Int. J. Environ. Res. Public Health 2019, 16(23), 4820; https://doi.org/10.3390/ijerph16234820 - 30 Nov 2019
Cited by 9 | Viewed by 1481
Abstract
Monitoring of tobacco use is one of the key tobacco control activities. This study aimed to assess the current prevalence and patterns of tobacco and e-cigarette in Poland as well as to investigate socioeconomic factors associated with cigarette smoking and e-cigarette use. This [...] Read more.
Monitoring of tobacco use is one of the key tobacco control activities. This study aimed to assess the current prevalence and patterns of tobacco and e-cigarette in Poland as well as to investigate socioeconomic factors associated with cigarette smoking and e-cigarette use. This cross-sectional study was carried out in 2019, on a representative nationwide sample of 1011 individuals aged 15+ in Poland. Daily tobacco smoking was declared by 21.0% of participants; 1.3% of participants were occasional tobacco smokers, and 10.7% were former tobacco smokers. Heated tobacco was used by 0.4% of participants. Ever e-cigarette use was declared by 4.0% of participants and 1.4% were current e-cigarette users. A higher proportion of daily smokers was observed among men than women (24.4% vs. 18.0%; p < 0.0001). The age group 30 to 49 years, of a lower educational level and living in a medium-sized city (between 20,000 and 500,000 residents), was significantly associated with current daily smoking. This is the most up-to-date study on the prevalence of smoking in Poland. Further tobacco control activities are needed to reduce tobacco use in Poland. Full article
Open AccessArticle
Hepatitis C Virus Treatment Status and Barriers among Patients in Methadone Maintenance Treatment Clinics in Guangdong Province, China: A Cross-Sectional, Observational Study
Int. J. Environ. Res. Public Health 2019, 16(22), 4436; https://doi.org/10.3390/ijerph16224436 - 12 Nov 2019
Viewed by 1121
Abstract
We aimed to evaluate the status and barriers related to hepatitis C virus (HCV) treatment among Chinese methadone maintenance treatment (MMT) clients, and the willingness and barriers of patients to accept directly observed treatment (DOT) service and oral direct-acting antivirals (DAAs). We conducted [...] Read more.
We aimed to evaluate the status and barriers related to hepatitis C virus (HCV) treatment among Chinese methadone maintenance treatment (MMT) clients, and the willingness and barriers of patients to accept directly observed treatment (DOT) service and oral direct-acting antivirals (DAAs). We conducted a cross-sectional survey from July to October 2017 in Guangdong Province, China, involving 678 HCV antibody-positive MMT patients. If they reported being infected with HCV, then their HCV treatment experience, willingness to use DOT and DAAs, along with any barriers, were collected. Logistic regression analysis was used to identify the correlates of initiating HCV treatment. Among those reporting HCV infection (54%, 366/678), 39% (144/366) initiated treatment; however, 38% (55/144) interrupted and 55% (79/135) delayed treatment for 15 months. Seventy-five percent (273/366) and 53% (195/366) were willing to use DOT and DAAs, respectively. Unaffordable medical costs and insignificant symptoms were the major barriers to HCV treatment and accepting DOT or DAAs. The lack of a stable residence, being a woman, and having ever injected drugs were all associated with a low probability of initiating treatment (p < 0.05). This study highlights a limited uptake of HCV treatment among MMT patients, and a need to strengthen the popularity of DOT and DAAs and integrate them into Chinese MMT clinics. Full article
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Open AccessArticle
Analyzing Awareness on Risk Factors, Barriers and Prevention of Cervical Cancer among Pairs of Nepali High School Students and Their Mothers
Int. J. Environ. Res. Public Health 2019, 16(22), 4382; https://doi.org/10.3390/ijerph16224382 - 09 Nov 2019
Cited by 3 | Viewed by 1667
Abstract
Providing information on increased cancer risks associated with certain behaviors might encourage adolescents to initiate protective behaviors. This study firstly determined the knowledge of risk factors and prevention of cervical cancer. Secondly, it checked an association between mothers’ screening practice and student’s knowledge. [...] Read more.
Providing information on increased cancer risks associated with certain behaviors might encourage adolescents to initiate protective behaviors. This study firstly determined the knowledge of risk factors and prevention of cervical cancer. Secondly, it checked an association between mothers’ screening practice and student’s knowledge. A descriptive, cross sectional study was conducted among 253 pairs of high school students and their mothers. Knowledge on cervical cancer was significantly lower among students and mothers. While cancer screening tests, maintenance of hygiene were considered as major preventive measures for cervical cancer, human papilloma vaccine was the least considered preventive measure. Students who were female, attended discussions on cancer and had a healthy diet had better awareness of cancer. Mothers of female students had better knowledge about cervical cancer than mothers of male students. Less perceived susceptibility and lack of knowledge were major obstacles among mothers, limiting cervical cancer screening to 15%. Although association between knowledge of students and screening practice of mothers was not clear, it was observed that cancer communication increased awareness of cervical cancer in both groups. Our findings showed a strong need for school-based cancer education program to address the issues of human papillomavirus vaccinations, cervical cancer risk and screening. Full article
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Open AccessArticle
Cigarette and E-Cigarette Use and Smoking Cessation Practices among Physicians in Poland
Int. J. Environ. Res. Public Health 2019, 16(19), 3595; https://doi.org/10.3390/ijerph16193595 - 25 Sep 2019
Cited by 9 | Viewed by 1601
Abstract
Physicians play a key role in combating tobacco use. This study aims to evaluate the knowledge, attitude, and behaviors toward smoking cessation and vaping cessation interventions among physicians in Poland; to identify factors shaping physicians’ behaviors toward smoking and vaping cessation interventions; and [...] Read more.
Physicians play a key role in combating tobacco use. This study aims to evaluate the knowledge, attitude, and behaviors toward smoking cessation and vaping cessation interventions among physicians in Poland; to identify factors shaping physicians’ behaviors toward smoking and vaping cessation interventions; and to assess differences in the tobacco cessation interventions recommended for cigarette smokers and users of electronic cigarettes (e-cigarettes). A questionnaire-based survey was conducted in 2018 among physicians attending mandatory public health training courses delivered at the School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland. The questionnaire included 25 questions related to tobacco product use and smoking cessation interventions. Data were obtained from 423 physicians (64.3% female; mean age 32.0 ± 5.8 years) with response rate of 84.6%. Current cigarette smoking was declared by 7.8% of participants; 1.9% of participants were e-cigarette users and 1.9% used heated tobacco. Smoking cessation interventions were offered more often to patients who smoked cigarettes than those who used e-cigarettes (p < 0.001). Physicians’ behaviors toward smoking cessation and vaping cessation interventions were associated with (p < 0.05) physicians’ smoking status and self-declared knowledge about smoking cessation methods. Among physicians in Poland, discussion of smoking cessation was not common behavior and limited mainly to identification of smoking status. Full article
Open AccessArticle
Trends in Diabetes Prevalence, Awareness, Treatment and Control in Yangon Region, Myanmar, Between 2004 and 2014, Two Cross-Sectional Studies
Int. J. Environ. Res. Public Health 2019, 16(18), 3461; https://doi.org/10.3390/ijerph16183461 - 18 Sep 2019
Cited by 2 | Viewed by 1313
Abstract
Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the [...] Read more.
Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25–74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5–10.6) in 2004 and 10.2% (7.6–13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7–18.1) to 31.9% (21.1–45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9–75.2) (p < 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8–63.1) to 68.6% (61.5–74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26–0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed. Full article
Open AccessArticle
Metabolic Unhealthiness Increases the Likelihood of Having Metabolic Syndrome Components in Normoweight Young Adults
Int. J. Environ. Res. Public Health 2019, 16(18), 3258; https://doi.org/10.3390/ijerph16183258 - 05 Sep 2019
Cited by 2 | Viewed by 1158
Abstract
Findings on risk detection for having metabolic syndrome (MetS) components, each of which may individually increase the risk of disease and mortality, are limited in young adults. In this study, we aimed to calculate the likelihood of having ≥1 MetS component in normoweight [...] Read more.
Findings on risk detection for having metabolic syndrome (MetS) components, each of which may individually increase the risk of disease and mortality, are limited in young adults. In this study, we aimed to calculate the likelihood of having ≥1 MetS component in normoweight young adults using two different metabolic health criteria. We recruited 1182 normoweight young adults from the Taiwan Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia and the National Health Interview Survey (aged 16–45 years, 39% male, body mass index = 18.5–22.99, all without MetS) and followed them for 5 years. Metabolic health criteria were derived from the Harmonized criteria (unhealthy if showing abnormality in one or two MetS components) and the triglyceride-glucose index (TyG-i; unhealthy if TyG-i was in the >75th percentile). Odds ratio (OR) and 95% confidence interval (CI) estimations for having ≥1 MetS component and for having each MetS component in 5 years were assessed using multivariable-adjusted logistic regression. We observed a significantly increased likelihood of the presence of ≥1 MetS component in the unhealthy group by using the Harmonized criteria and TyG-i (adjusted OR (aOR); 95%CI: 2.64; 2.02-3.45 and 2.1; 1.57–2.82, respectively). The areas under the receiver-operating characteristics curves were 0.679 and 0.652 for the final models using Harmonized and TyG-i criteria, respectively. These findings support the recommendation of treating any metabolic component abnormality, even in young adults without a MetS diagnosis. Full article
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Open AccessArticle
Long-Term Trends of Liver Cancer Incidence and Mortality in China 1990–2017: A Joinpoint and Age–Period–Cohort Analysis
Int. J. Environ. Res. Public Health 2019, 16(16), 2878; https://doi.org/10.3390/ijerph16162878 - 12 Aug 2019
Cited by 7 | Viewed by 1865
Abstract
Liver cancer (LC) is one of the most common causes of cancer-related deaths: this study aims to present the long-term trends and age–period–cohort effects of the incidence of and mortality from LC in China during 1990–2017. Incidence and mortality data were obtained from [...] Read more.
Liver cancer (LC) is one of the most common causes of cancer-related deaths: this study aims to present the long-term trends and age–period–cohort effects of the incidence of and mortality from LC in China during 1990–2017. Incidence and mortality data were obtained from the Global Burden of Disease Study 2017. We determined trends in the age-standardized incidence rate (ASIR) and mortality rate (ASMR) using Joinpoint regression. An age–period–cohort (APC) analysis was performed to describe the long-term trends with intrinsic estimator methods. The ASMR decreased markedly before 2013 and increased thereafter, with overall average annual percent change (AAPC) values of −0.5% (95% confidence interval (CI): −0.6%, −0.3%) for men and −1.3% (−1.6%, −1.0%) for women during 1990–2017. The ASIR significantly increased by 0.2% (0.1%, 0.3%) in men and decreased by 1.1% (−1.2%, −1.0%) in women from 1990 to 2017. The risks of LC incidence and mortality increased with age in both genders. The period effect risk ratios (RRs) of incidence and mortality displayed similar monotonic increasing trends in men and remained stable in women. The cohort effect showed an overall downward trend and almost overlapping incidence and mortality in both genders, and later birth cohorts experienced lower RRs than previous birth cohorts. Older age, recent period, and birth before 1923 were associated with a higher risk of liver cancer incidence and mortality. The net age and period effects showed an increasing trend, while the cohort effects presented a decreasing trend in incidence and mortality risk. As China’s population aging worsens and with the popularization of unhealthy lifestyles, the burden caused by liver cancer will remain a huge challenge in China’s future. Full article
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Open AccessArticle
Analysis of Factors Affecting the High Subjective Well-Being of Chinese Residents Based on the 2014 China Family Panel Study
Int. J. Environ. Res. Public Health 2019, 16(14), 2566; https://doi.org/10.3390/ijerph16142566 - 18 Jul 2019
Cited by 5 | Viewed by 1328
Abstract
(1) Purpose: The purpose of our research is to understand the subjective well-being (SWB) of Chinese adult residents and its influencing factors and to identify the key groups and areas to provide a basis for the formulation of relevant policies to improve residents’ [...] Read more.
(1) Purpose: The purpose of our research is to understand the subjective well-being (SWB) of Chinese adult residents and its influencing factors and to identify the key groups and areas to provide a basis for the formulation of relevant policies to improve residents’ happiness. (2) Methods: In this study, we analyzed the influencing factors of SWB of individuals older than 16 years of age, according to the 2014 China Family Panel Study (CFPS). We weighted 27,706 samples in the database to achieve the purpose of representing the whole country. Finally, descriptive statistics were used for the population distribution, chi-square tests were used for univariable analysis, and binary logistic models were used for multivariable analysis. (3) Results: The response rate of SWB was 74.58%. Of the respondents, 71.2% had high SWB (7–10), with a U-shaped distribution between age and SWB. Females are more likely than males to rate themselves as happy. There is a positive ratio between years of education and SWB. Residents who have better self-evaluated income, self-rated health (SRH), psychological well-being (PWB), Body Mass Index (BMI), social trust, social relationships, and physical exercise have higher SWB. (4) Conclusion: The results of the present study indicate that to improve residents’ SWB, we should focus more attention on middle-aged and low-income groups, particularly men in agriculture. The promotion of SWB should be facilitated by improvements in residents’ education, health status, and social support as well as by the promotion of smoking bans and physical exercise. Full article
Open AccessArticle
Inhibitory Risks Affecting the Maintenance of Healthy Lifestyle Habits—A Study Based on Demographic Factors and Personality Traits
Int. J. Environ. Res. Public Health 2019, 16(13), 2322; https://doi.org/10.3390/ijerph16132322 - 30 Jun 2019
Viewed by 1114
Abstract
People with different personal attributes, both intrinsic (personality traits) and extrinsic (demographic factors), perceive different inhibitions in the maintenance of a healthy lifestyle. This study examines the correlation between inhabitants’ personal attributes, internal and external, and their perception of risk factors in the [...] Read more.
People with different personal attributes, both intrinsic (personality traits) and extrinsic (demographic factors), perceive different inhibitions in the maintenance of a healthy lifestyle. This study examines the correlation between inhabitants’ personal attributes, internal and external, and their perception of risk factors in the maintenance of a healthy lifestyle. Results show that (1) residents prone to ‘challenge’ and ‘commitment’ are more sensitive to the inhibitory risks. (2) Inhabitants under 65 years old with ‘challenge’ in their personality are more likely to report ‘time’ as a constraining factor. (3) Regarding walking habits, residents are not only impacted by the living environment but also restricted by the demographic factors of economics and time. Full article
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Open AccessArticle
The Prevalence of Cigarette and E-cigarette Smoking Among Students in Central and Eastern Europe—Results of the YUPESS Study
Int. J. Environ. Res. Public Health 2019, 16(13), 2297; https://doi.org/10.3390/ijerph16132297 - 28 Jun 2019
Cited by 20 | Viewed by 2387
Abstract
Electronic cigarettes (e-cigarettes) are an alternative to traditional tobacco cigarette smoking. The aim of this study was to assess the prevalence of cigarette smoking and e-cigarette use among university students from Central and Eastern Europe and to investigate personal characteristics associated with cigarette [...] Read more.
Electronic cigarettes (e-cigarettes) are an alternative to traditional tobacco cigarette smoking. The aim of this study was to assess the prevalence of cigarette smoking and e-cigarette use among university students from Central and Eastern Europe and to investigate personal characteristics associated with cigarette and e-cigarette smoking. A questionnaire-based cross-sectional survey was performed between 2017–2018 among university students in five European countries: Belarus, Lithuania, Poland, Russia, and Slovakia. The questionnaire included 46 questions related to the frequency and habits of traditional cigarettes and e-cigarettes use. Completed questionnaires were obtained from 14,352 students (8800 medical; aged 20.9 ± 2.4 years) with an overall response rate of 72.2%. Two-thirds of the respondents had smoked a traditional tobacco cigarette and 43.7% had used an e-cigarette. Overall current smoking status included 12.3% traditional cigarette smokers, 1.1% e-cigarette users, and 1.8% were dual users with the remainder being non-smokers. Smoking status differed between the research centres (p < 0.001). Females were less likely to try either cigarettes (OR = 0.83) or e-cigarettes (OR = 0.62) and were less likely to be current cigarette (OR = 0.64), e-cigarette (OR = 0.34), or dual users (OR = 0.33) than males. Perception of e-cigarettes significantly differed between smokers and non-smokers (p < 0.001). Among university students, cigarettes are more popular than e-cigarettes. Full article
Open AccessArticle
The Influence of Social Support and Care Burden on Depression among Caregivers of Patients with Severe Mental Illness in Rural Areas of Sichuan, China
Int. J. Environ. Res. Public Health 2019, 16(11), 1961; https://doi.org/10.3390/ijerph16111961 - 02 Jun 2019
Cited by 8 | Viewed by 1348
Abstract
Depression is one of the most common psychological consequences of caregiving. Caring for patients with severe mental illness (SMI) adds significant challenges to family caregivers’ mental health. The purpose of this study was to describe the prevalence of depression among caregivers of SMI [...] Read more.
Depression is one of the most common psychological consequences of caregiving. Caring for patients with severe mental illness (SMI) adds significant challenges to family caregivers’ mental health. The purpose of this study was to describe the prevalence of depression among caregivers of SMI patients in rural areas of Sichuan province of China, to examine the influence of social support and care burden on depression, and to explore the intermediary effect of care burden between social support and depression among caregivers of SMI patients. Data were collected from 256 primary caregivers of SMI patients in rural Sichuan Province in China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. We found that a total of 53.5% of caregivers had depression. Both care burden (β = 0.599, 95%CI: 0.392–0.776) and social support (β = −0.307, 95%CI: (−0.494)–(−0.115)) were directly related to depression, while social support had a direct association with care burden (β = −0.506, 95%CI: (−0.672)–(−0.341)). Care burden mediated the relationship between social support and depression. For the socio-demographic variables, gender, education level and per capita annual income of household had significant correlations with depression (p < 0.05). The results strongly demonstrated that social support and care burden were predictors of depression, especially social support. Policymakers should fully recognize the role of primary family caregivers in caring for SMI patients and promote interventions to decrease care burden and reduce caregivers’ depression by improving social support and network. More attention should be given to female caregivers and caregivers with lower education and lower household income levels. Full article
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Open AccessArticle
Parent’s Cardiorespiratory Fitness, Body Mass, and Chronic Disease Status Is Associated with Metabolic Syndrome in Young Adults: A Preliminary Study
Int. J. Environ. Res. Public Health 2019, 16(10), 1768; https://doi.org/10.3390/ijerph16101768 - 19 May 2019
Cited by 1 | Viewed by 1420
Abstract
We sought to determine if there was an intergenerational association between parental weight, cardiorespiratory fitness (CRF), and disease status, with the prevalence of metabolic syndrome (MetSyn) in their young adult offspring. Young adults (n = 270, 21 ± 1 years, 53.3% female) [...] Read more.
We sought to determine if there was an intergenerational association between parental weight, cardiorespiratory fitness (CRF), and disease status, with the prevalence of metabolic syndrome (MetSyn) in their young adult offspring. Young adults (n = 270, 21 ± 1 years, 53.3% female) were assessed for MetSyn and self-reported parent’s CRF, body mass status, and disease status. MetSyn was present in 11.9% of participants, 27.4% had one or two components, and 58.5% had no components. A significantly higher percentage (93.9%) of young adults with MetSyn identified at least one parent as being overweight or obese, 84.8% reported low parental CRF and 87.9% reported a parent with disease (all p < 0.017). MetSyn in offspring is more likely when parents are perceived to have low CRF, increased body mass, and a diagnosis of disease. Evaluating the offspring of people with low CRF, elevated body mass, or who have a history of cardiovascular disease (CVD) or diabetes should be considered to promote early identification and treatment of young adults to reduce future premature CVD in these at-risk individuals. Full article
Open AccessArticle
Relationship between Community or Home Gardening and Health of the Elderly: A Web-Based Cross-Sectional Survey in Japan
Int. J. Environ. Res. Public Health 2019, 16(8), 1389; https://doi.org/10.3390/ijerph16081389 - 17 Apr 2019
Cited by 8 | Viewed by 1929
Abstract
There have been many reports indicating the relationship between gardening and health or healthy lifestyles among adults in developed countries all over the world. However, Japanese evidence is lacking. The aim of this study was to clarify the relationship between community or home [...] Read more.
There have been many reports indicating the relationship between gardening and health or healthy lifestyles among adults in developed countries all over the world. However, Japanese evidence is lacking. The aim of this study was to clarify the relationship between community or home gardening and health status or a healthy lifestyle using a web-based survey with Japanese elderly living in the community. A survey was conducted to gather data from 500 gardeners and 500 nongardeners aged 60 to 69. As a result, significant relationships were shown between community gardening and exercise habits, physical activity, eating vegetables, and connections with neighbors. Moreover, the significant relationships between home gardening and the following items were indicated: Subjective happiness, exercise habits, physical activity, sitting time, eating breakfast, eating vegetables, eating balanced meals, and connections with neighbors. No item demonstrated a significant relationship with gardening frequency. A significant relationship was demonstrated between gardening duration and health problems affecting everyday life. Further significant relationships were shown between gardening with others and subjective happiness, having a reason for living. In conclusion, promising positive relationships between community or home gardening and health or healthy lifestyles were indicated. Full article
Open AccessArticle
Compliance with Multiple Health Behaviour Recommendations: A Cross-Sectional Comparison between Female Cancer Survivors and Those with no Cancer History
Int. J. Environ. Res. Public Health 2019, 16(8), 1345; https://doi.org/10.3390/ijerph16081345 - 15 Apr 2019
Cited by 3 | Viewed by 1385
Abstract
Lifestyle behaviours have an important role in preventing cancer, reducing treatment side effects, and improving survival and quality of life for cancer survivors. This study investigated adherence to multiple lifestyle behaviours among women with and without a cancer history. From the Australian Longitudinal [...] Read more.
Lifestyle behaviours have an important role in preventing cancer, reducing treatment side effects, and improving survival and quality of life for cancer survivors. This study investigated adherence to multiple lifestyle behaviours among women with and without a cancer history. From the Australian Longitudinal Study on Women’s Health (ALSWH) surveys, 2407 cancer survivors and 3896 controls (cancer free population) were identified. Based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations, adherence to six health behaviours (smoking, physical activity, fruit and vegetable intake, alcohol consumption, sugary drink intake, and Body Mass Index [BMI]) were assessed. Overall adherence was low, and there were no differences between survivors and controls on adherence to any of the six individual health behaviours. However, both recent and long-term cancer survivors were more likely than controls to adhere to multiple health behaviours (p < 0.05). When participants with melanoma or non-melanoma skin cancer were excluded, adherence was less likely (but not significant) in the cancer group than controls. Higher education (p < 0.01), being married (p < 0.01), and lower comorbidity of chronic illnesses (p < 0.01) were significantly associated with adherence to multiple lifestyle behaviours. Overall, the findings suggest that a cancer diagnosis may result in increased compliance with multiple health behaviour guidelines. Full article
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Open AccessArticle
Contemporary Trends and Habits in the Consumption of Sugar and Sweeteners—A Questionnaire Survey among Poles
Int. J. Environ. Res. Public Health 2019, 16(7), 1164; https://doi.org/10.3390/ijerph16071164 - 01 Apr 2019
Cited by 6 | Viewed by 1661
Abstract
The purpose of the paper was a cross sectional study to evaluate the use of sugars and selected sweeteners by Polish consumers in their diet. The survey was conducted using the direct interview method on the group of 2000 adults declaring the consumption [...] Read more.
The purpose of the paper was a cross sectional study to evaluate the use of sugars and selected sweeteners by Polish consumers in their diet. The survey was conducted using the direct interview method on the group of 2000 adults declaring the consumption of sugar or sweeteners. The ANOVA test and multi-dimensional cluster analysis was used to the data interpretation (p < 0.05). It was stated that the consumption of sugar among consumers remained at a high level. Respondents declared taking up the activities towards reducing sugar intake in their diet mostly due to health-related reasons. It was emphasized in particular by women taking part in the survey. The most frequent way to limit the amount of sugar in the diet consisted in choosing sweeteners, mainly stevia and xylitol. However, the knowledge concerning steviol glycosides among the consumers was not extensive. Results are the source of up-to-date information concerning the consumption of sugar and sweeteners. Consumers to whom nutrition campaigns on the necessity to limit the content of sugar in the diet are worth addressing were identified. A hypothesis, that consumers are currently more aware of the negative influence of increased sugar consumption on their health and they aim at limiting the content of added sugar in their diet, was confirmed. Full article
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Open AccessArticle
Salt-Related Knowledge, Attitudes, and Behaviors on Efate Island, Vanuatu
Int. J. Environ. Res. Public Health 2019, 16(6), 1027; https://doi.org/10.3390/ijerph16061027 - 21 Mar 2019
Cited by 2 | Viewed by 1585
Abstract
In Vanuatu, mean salt intake exceeds the recommended maximum daily intake, and contributes to the high proportion of deaths attributable to cardiovascular diseases. Understanding salt-related knowledge, attitudes, and behaviors of the Vanuatu population can inform appropriate interventions. This cross-sectional study was conducted as [...] Read more.
In Vanuatu, mean salt intake exceeds the recommended maximum daily intake, and contributes to the high proportion of deaths attributable to cardiovascular diseases. Understanding salt-related knowledge, attitudes, and behaviors of the Vanuatu population can inform appropriate interventions. This cross-sectional study was conducted as part of the 2016–2017 Vanuatu Salt Survey. In total, 753 participants aged between 18 and 69 years from rural and urban communities on the Island of Efate were included. Demographic and clinical data were collected and a salt-related knowledge, attitudes, and behaviors survey was administered. Knowledge relating to the need to reduce salt consumption was high, but reported behaviors did not reflect this knowledge. A total of 83% of participants agreed that too much salt could cause health problems, and 86% reported that it was “very important” to lower the amount of salt in the diet. However, more than two-thirds of the population reported always/often adding salt to food during cooking/meal preparation and at the table, and always/often consuming processed foods high in salt. Strategic, targeted, and sustained behavior change programs in parallel with interventions to change the food environment to facilitate healthier choices should be key components of a salt reduction program. Actions should implemented as part of a comprehensive strategy to prevent and control non-communicable diseases in Vanuatu. Full article
Open AccessArticle
Prediction of Physical Activity Intensity with Accelerometry in Young Children
Int. J. Environ. Res. Public Health 2019, 16(6), 931; https://doi.org/10.3390/ijerph16060931 - 15 Mar 2019
Cited by 3 | Viewed by 1416
Abstract
Background: An algorithm for the classification of ambulatory and non-ambulatory activities using the ratio of unfiltered to filtered synthetic acceleration measured with a triaxial accelerometer and predictive models for physical activity intensity (METs) in adults and in elementary school children has been [...] Read more.
Background: An algorithm for the classification of ambulatory and non-ambulatory activities using the ratio of unfiltered to filtered synthetic acceleration measured with a triaxial accelerometer and predictive models for physical activity intensity (METs) in adults and in elementary school children has been developed. The purpose of the present study was to derive predictive equations for METs with a similar algorithm in young children. Methods: Thirty-seven healthy Japanese children (four- to six-years old) participated in this study. The five non-ambulatory activities including low-intensity activities, and five ambulatory activities were selected. The raw accelerations using a triaxial accelerometer and energy expenditure by indirect calorimetry using the Douglas bag method during each activity were collected. Results: For non-ambulatory activities, especially light-intensity non-ambulatory activities, linear regression equations with a predetermined intercept (0.9) or quadratic equations were a better fit than the linear regression. The equations were different from those for adults and elementary school children. On the other hand, the ratios of unfiltered to filtered synthetic acceleration in non-ambulatory activities were different from those in ambulatory activities, as in adults and elementary school children. Conclusions: Our calibration model for young children could accurately predict intensity of physical activity including low-intensity non-ambulatory activities. Full article
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Open AccessArticle
Influence of Living Arrangements and Eating Behavior on the Risk of Metabolic Syndrome: A National Cross-Sectional Study in South Korea
Int. J. Environ. Res. Public Health 2019, 16(6), 919; https://doi.org/10.3390/ijerph16060919 - 14 Mar 2019
Cited by 3 | Viewed by 1171
Abstract
Studies on the relationships between health, different living arrangements, and eating behaviors across age groups are limited. Therefore, we investigated these associations, focusing on metabolic syndrome, among 16,015 South Koreans aged ≥19 years who completed the Korean National Health and Nutrition Examination Survey [...] Read more.
Studies on the relationships between health, different living arrangements, and eating behaviors across age groups are limited. Therefore, we investigated these associations, focusing on metabolic syndrome, among 16,015 South Koreans aged ≥19 years who completed the Korean National Health and Nutrition Examination Survey (2013–2016). Multivariate logistic regression revealed that younger adults (<65 years) who lived and ate alone consumed more carbohydrates than those who lived and ate with others (p < 0.01). The odds of metabolic syndrome in younger adults increased with eating alone (adjusted odds ratio (aOR) 2.11, 95% confidence interval (CI) 1.10–4.02) and living and eating alone (2.39, 1.25–4.58). Older adults (≥65 years) did not differ in dietary intake or prevalence of metabolic syndrome according to their living and eating situations. Younger adults living and eating alone may benefit from customized nutrition and health management programs to reduce their risk of metabolic syndrome. Full article
Open AccessArticle
Protective Behavioral Strategies and Alcohol Consumption: The Moderating Role of Drinking-Group Gender Composition
Int. J. Environ. Res. Public Health 2019, 16(5), 900; https://doi.org/10.3390/ijerph16050900 - 12 Mar 2019
Cited by 2 | Viewed by 1492
Abstract
Background. There is international concern about the negative consequences for health related to young people’s alcohol consumption. Peer relationships can play a positive and protective role to cope with risky behaviors associated with alcohol consumption. Objective. This study investigated the influence [...] Read more.
Background. There is international concern about the negative consequences for health related to young people’s alcohol consumption. Peer relationships can play a positive and protective role to cope with risky behaviors associated with alcohol consumption. Objective. This study investigated the influence of protective behavioral strategies (PBS) on alcohol consumption and the moderating role of drinking-group gender composition and drinking-group size. Methods. The sample comprised 286 youths (mean age = 23.49; SD = 2.78; 67.5% female). Participants reported their protective behavioral strategies, their alcohol consumption and the size (overall mean = 7.44; SD = 3.83) and gender composition (62.58% mixed; 19.93% all-female; 9.8% all-male) of their social drinking groups. The mean sizes of mixed, all-female, and all-male groups were 8.27, 5.34, and 6.2, respectively. Results. Data showed that women consume less alcohol and use more protective strategies than men, particularly those strategies directed at avoiding negative consequences. Furthermore, the number of men in a group influences protective strategies and consumption, therefore drinking-group gender composition moderates the relationship between protective strategies and alcohol consumption. The more protective strategies that young adults use, the lower their alcohol consumption. This relationship is moderated by the size of the group. Conclusion. Strategies to prevent risky drinking behavior should focus on both PBS shared by drinking-group members and the training in individual PBS associated with drinking behavior. Finally, taking into account the relationship between drinking-group gender composition and protective behavioral strategies for alcohol consumption, a positive protector role for individual and group habits in relation to alcohol consumption is discussed. Full article
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Open AccessArticle
Prevention of Cardiovascular Disease and Cancer Mortality by Achieving Healthy Dietary Goals for the Swedish Population: A Macro-Simulation Modelling Study
Int. J. Environ. Res. Public Health 2019, 16(5), 890; https://doi.org/10.3390/ijerph16050890 - 12 Mar 2019
Cited by 6 | Viewed by 4516
Abstract
The objective is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in Sweden if adults adhere to the official dietary recommendations. We used an age-group and sex-specific epidemiological macro-simulation model to estimate [...] Read more.
The objective is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in Sweden if adults adhere to the official dietary recommendations. We used an age-group and sex-specific epidemiological macro-simulation model to estimate preventable deaths due to the discrepancies between actual intake and recommended intake of changes in food components. Data included in the model are a baseline scenario (actual dietary intake), a counterfactual scenario (recommended intake) and age- and sex-specific mortality for cardiovascular and diet-related cancer diseases together compared with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations was performed to produce the 95% uncertainty intervals (UI). The model predicts that 6405 (95% UI: 5086–7086) deaths could be prevented or delayed if the Swedish population could adhere to official dietary recommendations in a year. More deaths would be saved for men than women. The recommendations for fruits and vegetables could have saved 47% of the deaths, followed by fiber intake (32%). For men, fruits and vegetables could have saved more compared to other dietary components, while for women dietary fiber was the prominent factor. Public health policies should consider ensuring healthy eating practices for the Swedish population. Full article
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Open AccessArticle
Health-Associated Nutrition and Exercise Behaviors in Relation to Metabolic Risk Factors Stratified by Body Mass Index
Int. J. Environ. Res. Public Health 2019, 16(5), 869; https://doi.org/10.3390/ijerph16050869 - 09 Mar 2019
Cited by 1 | Viewed by 1487
Abstract
This study aimed to investigate the relationships of nutrition and exercise behaviors on metabolic risk factors (MRF) when body mass index (BMI) was considered. Health-associated nutrition and exercise behaviors were assessed by a questionnaire, anthropometric values, blood pressure and biochemical determinations that were [...] Read more.
This study aimed to investigate the relationships of nutrition and exercise behaviors on metabolic risk factors (MRF) when body mass index (BMI) was considered. Health-associated nutrition and exercise behaviors were assessed by a questionnaire, anthropometric values, blood pressure and biochemical determinations that were obtained from 4017 workers. The nutrition score was negatively associated with triglycerides in the overweight subgroup and with systolic blood pressure (SBP) in the obese subgroup. The exercise score was negatively associated with triglycerides and waist circumference (WC) and positively associated with SBP and high-density lipoprotein cholesterol (HDL-C) in the ideal weight subgroup as well as being negatively associated with WC and positively associated with HDL-C in the overweight subgroup. Similarly, the exercise score was negatively associated with WC and positively associated with SBP in the obese subgroup. However, no significant association was found between nutrition or exercise behavior and MRF in the underweight subgroup. In conclusion, the relationships of exercise and nutrition behaviors on MRF varied for different levels of BMI. Exercise showed a significant association with lower WC. Moreover, its effect showed a gradient trend in accordance with the levels of BMI. For ameliorating MRF, exercise seemed to have better effects than nutrition behavior, especially in the ideal weight subgroup. Full article
Open AccessArticle
Barriers and Enabling Factors Affecting Satisfaction and Safety Perception with Use of Bicycle Roads in Seoul, South Korea
Int. J. Environ. Res. Public Health 2019, 16(5), 773; https://doi.org/10.3390/ijerph16050773 - 04 Mar 2019
Cited by 1 | Viewed by 1573
Abstract
Cycling has proven to be an important strategy in decreasing the risk of non-communicable diseases. This study aimed to discover barriers and enabling factors influencing satisfaction and safety perceptions towards the use of bicycle roads in the Seoul metropolitan area, South Korea. A [...] Read more.
Cycling has proven to be an important strategy in decreasing the risk of non-communicable diseases. This study aimed to discover barriers and enabling factors influencing satisfaction and safety perceptions towards the use of bicycle roads in the Seoul metropolitan area, South Korea. A cross-sectional survey of 190 youth and adult individuals was conducted. Sex, age, purpose of bicycle use, perceived safety, availability of facilities, road gradient, road width, and traffic on the bicycle road were associated with cycling regularity. Multivariate regression analysis showed that the sufficiency of bicycle parking space, moderate slope, and enough bicycle signs were significant enabling factors for satisfaction with the use of bicycle roads. Narrow bicycle roads were found to be a barrier to satisfaction with the use of bicycle roads. Moderate slope, enough bicycle signs, and enough maintenance facilities around bike roads were found to be enabling factors in the perceived safety of the use of bicycle roads, whereas traffic on the side of the bicycle road was found to be a barrier to perceived safety. Based on these findings, we conclude that healthy cities should promote cycling behavior encouraging enabling factors and initiating attempts to improve the factors that act as barriers through urban planning. Full article
Open AccessArticle
A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea
Int. J. Environ. Res. Public Health 2019, 16(5), 721; https://doi.org/10.3390/ijerph16050721 - 28 Feb 2019
Cited by 3 | Viewed by 2031
Abstract
The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based [...] Read more.
The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases. Full article
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Chronic Diseases & Employment: An Overview of Existing Training Tools for Employers
Int. J. Environ. Res. Public Health 2019, 16(5), 718; https://doi.org/10.3390/ijerph16050718 - 28 Feb 2019
Cited by 4 | Viewed by 1440
Abstract
Background: The number of people living with one or more chronic diseases (e.g., neurological, musculoskeletal, cardiovascular, respiratory, metabolic disorders) has dramatically increased in recent decades, affecting all sectors, including the social and economic aspects of the work sector. In the frame of [...] Read more.
Background: The number of people living with one or more chronic diseases (e.g., neurological, musculoskeletal, cardiovascular, respiratory, metabolic disorders) has dramatically increased in recent decades, affecting all sectors, including the social and economic aspects of the work sector. In the frame of the European Union (EU) Joint Action “Chrodis Plus: Implementing good practices for chronic diseases”, a review has been performed in order to identify and analyze existing training tools for employers, including managers and Human Resources Staff (HRs), which aimed at creating and fostering inclusive and supportive workplaces for workers with chronic conditions and to avoid absenteeism, presenteeism, and early retirement. Methods: The training tools were identified through a revision of online published materials through Google Scholar and internet searches, published since 2006, in English, Italian, and Spanish. Results: The mapping of existing training tools highlighted the existence of two types of training tools: the first type includes those implemented by Social and Institutional Organizations (e.g., Patients’ Associations, Ministries, Unions), external to the company; the second involves those implemented by Large Multinational Enterprises. Conclusions: to promote an effective and concrete inclusion and participation of employees that are affected by chronic diseases in the labor market is necessary to involve employers and managers in training programs. Full article
Open AccessArticle
Assessing Heavy Episodic Drinking: A Random Survey of 18 to 34-Year-Olds in Four Cities in Four Different Continents
Int. J. Environ. Res. Public Health 2019, 16(5), 706; https://doi.org/10.3390/ijerph16050706 - 27 Feb 2019
Cited by 1 | Viewed by 1061
Abstract
Background: Heavy episodic drinking (HED) can have health and social consequences. This study assesses the associations between HED and demographic, socioeconomic, motivation and effects indicators for people aged 18–34 years old living in four cities in different regions of the world. Method: Multistage [...] Read more.
Background: Heavy episodic drinking (HED) can have health and social consequences. This study assesses the associations between HED and demographic, socioeconomic, motivation and effects indicators for people aged 18–34 years old living in four cities in different regions of the world. Method: Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward/back translated and face-to-face interviewing was undertaken. A total of 6235 interviews were undertaken in 2014. Separate univariable and multivariable modelling was undertaken to determine the best predictors of HED. Results: HED prevalence was 9.0%. The best predictors differed for each city. The higher probability of HED in the final models included beliefs that they have reached adulthood, feeling relaxed as an effect of drinking alcohol, and forgetting problems as an effect of drinking alcohol. Lower probability of HED was associated with not being interested in alcohol as a reason for limiting alcohol, and the belief that drinking alcohol is too expensive or a waste of money. Conclusion: Although some indicators were common across the four cities, the variables included in the final models predominantly differed from city to city. The need for country-specific prevention and early intervention programs are warranted. Full article
Open AccessArticle
Mujeres Fuertes y Corazones Saludables, a Culturally Tailored Physical Activity and Nutrition Program for Rural Latinas: Findings from a Pilot Study
Int. J. Environ. Res. Public Health 2019, 16(4), 630; https://doi.org/10.3390/ijerph16040630 - 21 Feb 2019
Cited by 3 | Viewed by 1468
Abstract
In the United States, Latino adults, compared with non-Hispanic white adults, are less likely to meet physical activity and dietary recommendations, and have higher rates of obesity. There is an urgent need for culturally adapted health promotion programs that meet the needs of [...] Read more.
In the United States, Latino adults, compared with non-Hispanic white adults, are less likely to meet physical activity and dietary recommendations, and have higher rates of obesity. There is an urgent need for culturally adapted health promotion programs that meet the needs of the growing Latino population in the United States. We systematically adapted StrongWomen—Healthy Hearts, an evidence-based physical activity and nutrition program, for rural Latinas. This paper reports results from a pilot study of the adapted program. We used mixed methods to assess the feasibility and efficacy of the adapted program, Mujeres Fuertes y Corazones Saludables, in a nonprofit community organization serving rural Latinos. The intervention consisted of sixty-minute classes held twice weekly for 12 weeks and included 30 minutes of physical activity and 30 minutes of nutrition education. To assess efficacy, we used a one-group, pre–post design with overweight/obese, sedentary, middle-aged or older, Spanish-speaking rural Latinas (n = 15). Outcome measures included weight, height, body mass index (BMI), waist circumference, cardiorespiratory fitness, physical activity, dietary behavior, and self-efficacy for diet and physical activity. Process outcomes included attendance, end of class surveys, mid-program evaluation survey, and a post-program focus group. We calculated means and standard deviations, paproired t-tests, and Cohen’s D effect size. Qualitative data were analyzed using qualitative description. Significant changes pre- to post-program included weight (−1.5 kg; p = 0.009), BMI (−0.6; p = 0.005), waist circumference (−3.0 cm; p = 0.008), 6-minute walk test (69.7 m; p < 0.001), frequency of sugar-added drink consumption (−0.7 servings; p = 0.008), fruit and vegetable intake (1.3 servings; p = 0.035), and physical activity self-efficacy (0.9 points; p = 0.022). Participants found the program motivating and enjoyable, and on average participants attended 62% of classes and fidelity was maintained. This pilot study suggests that this culturally adapted physical activity and nutrition program for rural Latinas shows promise in improving physical activity, diet, and obesity. Full article
Open AccessArticle
Participation in Organized Sports and Self-Organized Physical Activity: Associations with Developmental Factors
Int. J. Environ. Res. Public Health 2019, 16(4), 585; https://doi.org/10.3390/ijerph16040585 - 18 Feb 2019
Cited by 9 | Viewed by 1708
Abstract
Engagement in organized sports is associated with developmental factors, such as, healthy growth, cognitive abilities, psychological well-being and lower substance use. Research also suggest that the spontaneous free play that characterises self-organized physical activity (PA) provides young people with opportunities to learn social [...] Read more.
Engagement in organized sports is associated with developmental factors, such as, healthy growth, cognitive abilities, psychological well-being and lower substance use. Research also suggest that the spontaneous free play that characterises self-organized physical activity (PA) provides young people with opportunities to learn social skills, such as self-regulation and conflict-resolution skills. We assessed associations between participation in the two activity types and several demographics along with developmental factors (e.g., body mass index (BMI)). Data was from a representative sample of 2060 students attending 38 schools in Norway (mean age (Mage) = 15.29, standard deviation (SD) = 1.51; 52% females). Results indicated that while engagement in organized sports was more related to developmental factors, relative to self-organized PA, engaging concurrently in both activities for at least an hour a week was more developmentally beneficial than engaging only in one for the same amount of time. Thus, PA programmes for students will enhance their effectiveness if they focus on structured activities but also self-organized activities where students can coordinate themselves. Full article
Open AccessArticle
Does Eating-Away-from-Home Increase the Risk of a Metabolic Syndrome Diagnosis?
Int. J. Environ. Res. Public Health 2019, 16(4), 575; https://doi.org/10.3390/ijerph16040575 - 16 Feb 2019
Viewed by 1459
Abstract
Rising frequency of eating-away-from-home (EAFH) is suspected to be correlated with several non-communicable diseases. This study adopted the Chinese Health and Nutrition Survey (CHNS) 2009 data to investigate the association between being diagnosed with the metabolic syndrome (MetS) and EAFH at different ages. [...] Read more.
Rising frequency of eating-away-from-home (EAFH) is suspected to be correlated with several non-communicable diseases. This study adopted the Chinese Health and Nutrition Survey (CHNS) 2009 data to investigate the association between being diagnosed with the metabolic syndrome (MetS) and EAFH at different ages. Results showed that the association between EAFH and MetS varied at different ages and differed for males and females. EAFH was positively associated with a higher risk of getting MetS for males, especially for those aged between 45 and 60; while it was negatively associated with the risk of getting MetS for young females (<45) (all p < 0.05). In particular, EAFH was associated with a lower risk of getting high serum triglycerides (TGs), abdominal adiposity, elevated blood pressure, and impaired fasting blood glucose for young females, while higher risk of high serum TGs, abdominal adiposity, elevated blood pressure, and impaired fasting blood glucose for middle-aged males (all p < 0.05). In addition, a higher frequency of EAFH was associated with a higher risk of abdominal adiposity and elevated blood pressure for older women, and a lower risk of elevated blood pressure, and impaired fasting blood glucose for younger men (all p < 0.05). Our study implies that heterogeneous target strategies for preventing MetS in different subpopulation should be considered. Full article
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Open AccessArticle
Effectiveness of a Large, Nation-Wide Smoking Abstinence Campaign in the Netherlands: A Longitudinal Study
Int. J. Environ. Res. Public Health 2019, 16(3), 378; https://doi.org/10.3390/ijerph16030378 - 29 Jan 2019
Cited by 4 | Viewed by 1755
Abstract
From 2014, the 28-day smoking abstinence campaign ‘Stoptober’ is held in the Netherlands. Each year, more than 50,000 people participate in what has become a nation-wide collective cessation attempt. This study aims to determine the short-term effects of ‘Stoptober’ on participants’ smoking behavior [...] Read more.
From 2014, the 28-day smoking abstinence campaign ‘Stoptober’ is held in the Netherlands. Each year, more than 50,000 people participate in what has become a nation-wide collective cessation attempt. This study aims to determine the short-term effects of ‘Stoptober’ on participants’ smoking behavior and behavioral determinants. Stoptober participants completed online surveys before the start of the campaign (n = 6856) and three months later (n = 1127). Descriptive statistics and t-tests were performed to determine changes in smoking and behavioral determinants. Logistic regression analyses were used to identify differences between subgroups. After three months, 71.8% of respondents had quit smoking and consumption was reduced among sustained smokers. Cessation rates were similar for subgroups by age, sex and educational level. Cessation was positively associated with confidence and self-efficacy at baseline and negatively associated with past year quit attempts and addiction level at baseline. For quitters, we found favorable changes in attitude towards cessation related stress, social norms, social pressure to smoke, self-efficacy to quit, smoking habit strength and smoker identity. For sustained smokers, we found favorable changes in attitude towards cessation related stress, self-efficacy and smoking habit strength. These results suggest that an abstinence campaign with a wide reach in a national population may be effective in decreasing smoking prevalence and cigarette consumption among a broad range of participants. Full article
Open AccessArticle
Sex-Specific Lifestyle and Biomedical Risk Factors for Chronic Disease among Early-Middle, Middle and Older Aged Australian Adults
Int. J. Environ. Res. Public Health 2019, 16(2), 224; https://doi.org/10.3390/ijerph16020224 - 15 Jan 2019
Cited by 4 | Viewed by 1742
Abstract
Evidence suggests age and sex differences in risk factors for chronic disease. This study examined lifestyle and biomedical risk factors among men (m) and women (w) in early-middle (25–51 years), middle (52–64) and older (65+) adulthood. Cross-sectional data from the 2011–2012 Australian Health [...] Read more.
Evidence suggests age and sex differences in risk factors for chronic disease. This study examined lifestyle and biomedical risk factors among men (m) and women (w) in early-middle (25–51 years), middle (52–64) and older (65+) adulthood. Cross-sectional data from the 2011–2012 Australian Health Survey (n = 3024) were analysed. Self-reported dietary, activity, sleep behaviours and collected biomedical data were analysed. Early-middle adults failed to meet fruit, vegetable (95.3%) and sugar-sweetened beverage (SSB, 34.9%) recommendations. Older adults had higher prevalence of overweight/obesity (70%), high blood pressure (38.0%) and fewer met physical activity guidelines (36.3%). Prior to older adulthood, more men consumed SSBs (early-middle m 45.6%, w 24.4%; middle m 26.0%, w 19.3%), and fewer met sedentary behaviour recommendations (early-middle m 43.2%, w 62.1%; middle m 46.4%, w 63.9%). Differences in overweight/obese women in early-middle (44.8%) to middle adulthood (64.7%) were significant. Biomedical risk was greatest in middle age; abnormal cholesterol/lipids increased specifically for women (total cholesterol early-middle 24.9% middle 56.4%; abnormal LDL-cholesterol early-middle 23.1% middle 53.9%). Adherence to lifestyle guidelines was low; particularly among men. While men exhibited greater clinical risk overall, this significantly increased among women in middle-adulthood. Public health strategies to improve lifestyle, monitor and intervene among middle-aged women are warranted. Full article
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Open AccessArticle
Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina
Int. J. Environ. Res. Public Health 2019, 16(2), 213; https://doi.org/10.3390/ijerph16020213 - 14 Jan 2019
Cited by 2 | Viewed by 2104
Abstract
Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We [...] Read more.
Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators. Full article
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Open AccessArticle
Are Sedentary Behaviors Associated with Sleep Duration? A Cross-Sectional Case from Croatia
Int. J. Environ. Res. Public Health 2019, 16(2), 200; https://doi.org/10.3390/ijerph16020200 - 12 Jan 2019
Cited by 5 | Viewed by 1635
Abstract
Although both sedentary behavior and sleep duration are risk factors for obesity, little evidence is provided regarding their mutual associations in young adults, who are at extreme risk of spending more time sitting and having irregular sleeping hygiene. Thus, the main purpose of [...] Read more.
Although both sedentary behavior and sleep duration are risk factors for obesity, little evidence is provided regarding their mutual associations in young adults, who are at extreme risk of spending more time sitting and having irregular sleeping hygiene. Thus, the main purpose of the present study was to explore the associations between different sedentary behaviors and sleep duration. In this cross-sectional study, we recruited 2100 university students from the city of Zagreb. To assess sedentary behaviors and sleep duration, we used validated questionnaires. The associations between sedentary behaviors and sleep duration were analyzed using logistic regression analyses and were adjusted for sex, body-mass index, self-rated health, socioeconomic status, smoking status, binge drinking, psychological distress and chronic disease/s. Participants being in the third (OR = 1.45; 95% CI 1.05 to 2.01) and fourth (OR = 1.82; 95% CI 1.26 to 2.61) quartile of the screen-time, in the third (OR = 1.49; 95% CI 1.05 to 2.13) and fourth (OR = 1.72; 95% CI 1.22 to 2.42) quartile of the leisure-time sedentary behavior and in the fourth (OR = 1.45; 95% CI 1.04 to 2.02) quartile of the total sedentary behavior were more likely to be ‘short’ sleepers (<7 h). Also, participants being in the third (OR = 1.63; 95% CI 1.16 to 2.30) and fourth (OR = 1.93; 95% CI 1.33 to 2.81) quartile of the screen-time and in the fourth (OR = 1.45; 95% CI 1.05 to 2.00) quartile of the total sedentary behavior were more likely to be ‘long’ sleepers (>9 h). Our study shows that sedentary behavior in screen-time and total sedentary behavior are associated with both ‘short’ and ‘long’ sleep duration. Full article
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Open AccessArticle
Metabolic Syndrome Knowledge among Adults with Cardiometabolic Risk Factors: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2019, 16(1), 159; https://doi.org/10.3390/ijerph16010159 - 08 Jan 2019
Cited by 4 | Viewed by 1954
Abstract
Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors. Many people may be unaware of their risk for MetS. A cross-sectional, descriptive study was conducted among hospitalized patients with at least one cardiometabolic risk factor in Mainland China. This study assessed the [...] Read more.
Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors. Many people may be unaware of their risk for MetS. A cross-sectional, descriptive study was conducted among hospitalized patients with at least one cardiometabolic risk factor in Mainland China. This study assessed the MetS knowledgelevel(through MetS Knowledge Scale, MSKS) and examined the potential predictors by regression analysis. A total of 204 patients aged 58.5 ± 10.1 years (55% males) participated in this study. The majority of participants had no history of hypertension (54%), dyslipidemia (79%), or diabetes (85%). However, 56% of these participants had at least three cardiometabolic risk factors, indicating the presence of MetS. The average MSKS was very low (mean = 36.7±18.8, possible range = 0–100), indicating the urgent needs of MetS education in current practice. Predictors of better MetS knowledge included higher educational level, history of dyslipidemia, and normal high-density lipoprotein cholesterol (F (8, 195) = 9.39, adjusted R2 = 0.192, p< 0.001). In conclusion, adults with cardiometabolic risk factors are at risk of developing MetS, but with a low level of knowledge. Specific health education on MetS should be provided, particularly for those with limited formal education or inadequate lipid management. Full article

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Open AccessArticle
Prevalence of Alcohol and Tobacco Use among Men and Women in Namibia
Int. J. Environ. Res. Public Health 2019, 16(1), 59; https://doi.org/10.3390/ijerph16010059 - 26 Dec 2018
Cited by 8 | Viewed by 2069
Abstract
Namibia is known to have a high prevalence of tobacco smoking and alcohol consumption. Individuals who smoke are more likely to drink, and vice versa. It was reported that the individual rewarding effect of drinking and smoking were reported to be higher than [...] Read more.
Namibia is known to have a high prevalence of tobacco smoking and alcohol consumption. Individuals who smoke are more likely to drink, and vice versa. It was reported that the individual rewarding effect of drinking and smoking were reported to be higher than when they are used at the same time. In this study our objective was to examine the individual and combined prevalence of drinking and smoking and investigate their sociodemographic correlates among adolescent and adult men and women in Namibia. This study was based on data from Namibia Demographic and Health Survey (NDHS 2013). Sample population were 14,185 men and women aged between 15 and 64 years. Self-reported tobacco smoking and alcohol consumption patterns were the outcome variables. Data were analysed using complex sampling techniques to account for survey design. Bivariate and multivariate techniques were used to measure the association between drinking and smoking with the sociodemographic factors. The prevalence of alcohol and tobacco use was, respectively, 53.1% (51.5–54.6) and 8.8% (8.1–9.5), and that of both drinking and smoking was 6.9% (6.3–7.6). In the regression analysis, several sociodemographic factors were found to be significantly associated with alcohol and tobacco use including age, area of residence, religion and educational status. Overall, women had higher rates of drinking alcohol; however, men had higher rates of engaging in high risk drinking. Men and women who reported drinking alcohol had, respectively, 2.57 and 4.60 times higher odds of smoking. Findings suggest that the prevalence of drinking was higher than that of smoking, with men having higher prevalence of high risk drinking. Men and women who drink alcohol were more likely to be smokers. The prevalence of both alcohol and tobacco use showed important sociodemographic patterns which need to be taken into consideration in designing prevention and intervention programs. Strategic tobacco control and smoking cessation approaches should pay particular attention to alcohol users. Full article
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Open AccessArticle
Epidemiology of Self-Reported Diabetes Mellitus in the State of Maranhão, Northeastern Brazil: Results of the National Health Survey, 2013
Int. J. Environ. Res. Public Health 2019, 16(1), 47; https://doi.org/10.3390/ijerph16010047 - 25 Dec 2018
Cited by 2 | Viewed by 1742
Abstract
Objective: To estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in adults from the State of Maranhão, Northeastern Brazil. Methods: A cross-sectional study was carried out with 1774 individuals aged ≥18 years participating in the National Health Survey [...] Read more.
Objective: To estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in adults from the State of Maranhão, Northeastern Brazil. Methods: A cross-sectional study was carried out with 1774 individuals aged ≥18 years participating in the National Health Survey of 2013 in Maranhão. The adults were selected by probabilistic sampling and interviewed face-to-face by in-home visits. The Poisson regression model was used to verify the factors associated with DM. Results: The prevalence of DM was 5.39% (95% confidence interval [95% CI]: 3.73–7.73). After adjustment of the regression model for age, gender, smoking, education, hypertension, and hypercholesterolemia, DM was statistically associated with age ≥60 years, female sex, low educational level, and self-report hypertension. Conclusion: The present study found the prevalence of self-reported DM similar to that estimated in the general population of Brazil. Public policies for prevention and control should intensify control, especially in the subgroups most vulnerable to DM. Full article
Open AccessArticle
OPENCRONIC Study. Knowledge and Experiences of Spanish Patients and Carers about Chronic Disease
Int. J. Environ. Res. Public Health 2019, 16(1), 39; https://doi.org/10.3390/ijerph16010039 - 24 Dec 2018
Viewed by 1701
Abstract
Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods [...] Read more.
Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods: Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results: Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions: Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases. Full article
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Open AccessReview
Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2018, 15(12), 2805; https://doi.org/10.3390/ijerph15122805 - 10 Dec 2018
Cited by 21 | Viewed by 2971
Abstract
Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our [...] Read more.
Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA. Respect to a previous a meta-analysis we added the funnel plot to examine the effect sizes estimated from individual studies as measure of their precision; sensitivity analysis to check the stability of study findings and estimate how the overall effect size would be modified by removal of one study; cumulative analysis to evaluate the trend between studies in relation to publication year. Abdominal aortic aneurysm prevalence is higher in smokers and in males. On the other hand, while diabetes is a risk factor for many cardiovascular diseases, it is not a risk factor for AAA. In addition, it is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It could avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening. Full article
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Open AccessArticle
Types of Milk and/or Its Substitutes Given to Children (6–36 Months) in Nurseries in Poland: Data from the Research and Education Project “Eating Healthy, Growing Healthy”
Int. J. Environ. Res. Public Health 2018, 15(12), 2789; https://doi.org/10.3390/ijerph15122789 - 09 Dec 2018
Cited by 1 | Viewed by 1265
Abstract
The purpose of the study was to evaluate the types of milk and/or its substitutes given to children (aged 6–36 months) in nurseries in Poland. Methods: The study was conducted in 211 nurseries across Poland. The supply of milk and its substitutes [...] Read more.
The purpose of the study was to evaluate the types of milk and/or its substitutes given to children (aged 6–36 months) in nurseries in Poland. Methods: The study was conducted in 211 nurseries across Poland. The supply of milk and its substitutes was checked in ten-day menus and inventory documents. In total, 211 ten-day menus and 2110 daily inventory reports were analyzed. Additionally, data were obtained by interviews with day-care center (DCC) directors and/or staff responsible for nutrition. Results: Compared to non-public nurseries, public ones were characterized by a higher average number of children, most often maintained their own kitchens, and charged a lower financial fee. Public DCCs also more often employed dietitians. The type of milk and its substitutes offered to children in nurseries was dependent on the age of the children and type of DCC. In a larger percentage of public DCCs infants received a milk formula, and in smaller percentage they received breast milk. This regularity also occurred in older children’s diets (13–36 months). In toddlers’ diets in public nurseries, cow’s milk was more common. The share of other milk substitutes in the nutrition of children from both age groups was negligible. Conclusion: The types of milk given to children in nurseries in Poland varied and depended on the age of children and the type of DCCs. It is necessary to provide education to DCC staff regarding the type of milk recommended for children under one year of age. Full article
Open AccessArticle
Association between Colorectal Adenoma and Carotid Atherosclerosis in Korean Adults
Int. J. Environ. Res. Public Health 2018, 15(12), 2762; https://doi.org/10.3390/ijerph15122762 - 06 Dec 2018
Cited by 2 | Viewed by 1205
Abstract
Background: Colorectal neoplasm, including colorectal adenoma, is associated with old age, cigarette smoking, and the presence of metabolic syndromes. These are also risk factors for cardiovascular disease. Carotid ultrasonography is a noninvasive test that can predict the risk of cardiovascular disease and may [...] Read more.
Background: Colorectal neoplasm, including colorectal adenoma, is associated with old age, cigarette smoking, and the presence of metabolic syndromes. These are also risk factors for cardiovascular disease. Carotid ultrasonography is a noninvasive test that can predict the risk of cardiovascular disease and may be another test that may provide indications of these risk factors. This study aimed to investigate the association between colorectal adenomatous polyps and carotid atherosclerosis. Methods: This study included 548 adults who underwent colonoscopy and carotid ultrasonography for a health examination between March 2013 and December 2017 at a university hospital in South Korea. Abnormal carotid sonography findings included either increased carotid intima-media thickness or presence of carotid plaques. Results: The proportion of subjects with overall colorectal adenomatous polyps was 31.0% (170/548). Colorectal adenoma was more prevalent in the presence of abnormal carotid ultrasonography findings (38.6% vs. 27.6%, p = 0.013). Colorectal adenomatous polyp was significantly associated with abnormal carotid ultrasonography findings (OR = 1.65; 95% CI, 1.12–2.42, p = 0.011) in a multivariate analysis after adjusting for age, sex, cigarette smoking, alcohol consumption, and presence of metabolic syndrome. Conclusion: Colorectal adenoma is significantly associated with carotid atherosclerosis. Full article
Open AccessArticle
The Peer Context of Dieting: The Relationship between Young Adults’ Dieting Frequency and Their Friends’ Weight-Related Characteristics
Int. J. Environ. Res. Public Health 2018, 15(12), 2744; https://doi.org/10.3390/ijerph15122744 - 05 Dec 2018
Cited by 1 | Viewed by 1983
Abstract
Previous research found that weight-related behaviors and body weight tends to be similar between individuals and peers. Rather little is known how different domains of weight-related behaviors co-evolve in peer networks. Hence, this study explores how young adults’ self-reported dieting relates to perceived [...] Read more.
Previous research found that weight-related behaviors and body weight tends to be similar between individuals and peers. Rather little is known how different domains of weight-related behaviors co-evolve in peer networks. Hence, this study explores how young adults’ self-reported dieting relates to perceived body weight and weight control behaviors of their peers. A Swedish two-wave panel survey with ego-centric network data was analyzed with negative binomial regression models. Nineteen-year-old men and women in the first wave, and 23-year-olds in the follow-up sample were examined. Men at age 19 showed an increased dieting propensity when being exposed to underweight peers. Compared to men, women’s dieting at age 19 was more strongly related to their own body image concerns, and peers’ weight-related behaviors like physical exercising and unhealthy eating. The associations between dieting and peers’ weight-related characteristics for men and women deteriorated from age 19 to age 23. The findings suggest that women’s dieting—in comparison to dieting in men—is more strongly related to the peer context. The decrease in associations between men’s and women’s dieting and peers’ weight-related characteristics from age 19 to age 23 may reflect a weakened importance of the peer context in early adulthood. Full article
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Open AccessArticle
Physical Activity Programming Advertised on Websites of U.S. Islamic Centers: A Content Analysis
Int. J. Environ. Res. Public Health 2018, 15(11), 2581; https://doi.org/10.3390/ijerph15112581 - 18 Nov 2018
Viewed by 1559
Abstract
Previous research has found churches to be effective at delivering physical activity (PA) programs to their congregants. Mosques, however, have not been extensively studied. Therefore, we quantified U.S. Islamic centers’ advertisement of PA programming and examined their programming characteristics. We conducted a content [...] Read more.
Previous research has found churches to be effective at delivering physical activity (PA) programs to their congregants. Mosques, however, have not been extensively studied. Therefore, we quantified U.S. Islamic centers’ advertisement of PA programming and examined their programming characteristics. We conducted a content analysis of the websites of 773 eligible Islamic centers of which 206 centers in 32 states advertised PA programming. We categorized PA by program type: camping, fitness classes, sports, youth programs, and irregular offerings. We calculated descriptive statistics by program type for specific activity, frequency/duration/volume, participant/instructor sex, and instructor religion. Youth group (44%) and sports (23%) programs were most and least frequently advertised, respectively. Most centers (66%) that posted information on PA programming advertised only one program type. Men and Muslims taught most activities. Most activities—except for fitness classes—were advertised to a male audience. Islamic centers should offer and advertise additional PA programming—especially for women—and better utilize their websites for promoting such programming. Individual Islamic centers and Islamic- and non-religion based public health agencies can utilize our findings to fashion future PA offerings. Full article
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