Search Results (20)

Objective: This study assessed the influence of a highly publicized influenza-related death event on caregivers’ influenza vaccination intention for kindergarten and primary school children in Zhejiang, China, and identified associated factors. Methods: A cross-sectional survey was conducted from March to April 2025 using a multi-stage, stratified cluster sampling method across 10 districts/counties. Caregivers completed electronic questionnaires covering sociodemographics, event awareness, vaccination history, hesitancy, and cognitive attitudes. Factors associated with vaccination intention were analyzed using chi-square tests and logistic regression. Results: Among 2153 caregivers, overall vaccination intention for the 2025 season was 60.10%, markedly higher than the 2024 season’s actual rate (27.45%). Caregiver awareness of this event was 91.92%, primarily via social media (92.02%). In univariate analyses, event-related characteristics were significantly associated with vaccination intention: perceived “completely objective” coverage showed the highest willingness (79.68%, χ² = 79.92, p < 0.001), whereas the “exaggerated risk” (52.44%) and “unaware” (51.15%) groups showed lower willingness. Exposure frequency also correlated positively: low exposure (0–2 times) had 53.39% willingness, moderate (3–5) 61.11%, and high (≥6) 66.10% (χ² = 27.75, p < 0.001). However, stronger vaccination intention was independently associated with factors such as no prior vaccination refusal [aOR(95% CI) = 2.74(2.03,3.72)] or hesitancy history [1.47(1.13,1.92)], greater information need (aOR = 6.42–8.83), and disbelief in influenza’s spontaneous resolution [1.39(1.08,1.77)]. Weaker intention was associated with poorer child health status [0.19(0.04,0.74)], no influenza vaccination in 2024 [0.41(0.30,0.55)], no influenza illness in 2024 [0.73(0.56,0.95)], belief in vaccine protection [0.60(0.46,0.79)], and the perception that most parents have their children vaccinated [0.70(0.53,0.93)]. Conclusions: Following a highly publicized celebrity influenza death, vaccination intention was primarily driven by caregivers’ cognitive, psychological, and behavioral experience factors. Caregivers who perceived event coverage as completely objective showed higher vaccination intention, while prior vaccination behavior exhibited inertia. Targeted interventions should enhance information credibility and focus on previously unvaccinated and vaccine-hesitant groups to improve coverage. Full article

Background: Most individuals develop smoking habits in adolescence, highlighting the need for a smoking prevention program targeted at this age group. The use of “Implementation Intentions” (If-Then plans) about how to refuse a cigarette combined with anti-smoking messages has been shown to be effective in the UK. However, there is a scarcity of data regarding school-based smoking prevention interventions among adolescents available to countries with high tobacco consumption rates, like Greece. Objectives: To describe the cultural adaptation procedure and the evaluation protocol for the school-based “Implementation Intentions” program aimed at reducing tobacco use susceptibility among Greek adolescents aged 13–16 in school settings. Methods: The present study is part of the EU-funded FRESHAIR4Life Program. We will use a mixed-methods approach with a pre- and post-intervention design in six conveniently selected secondary schools in Heraklion, Crete, Greece, to measure the intervention’s Reach, Effectiveness, Adoption, Implementation, and Maintenance using the RE-AIM framework. The study plans to involve three Master Trainers (MTs), 20–25 school teachers (to be trained by the MTs), and approximately 480 students. Participating schools will receive the “Implementation Intentions” intervention, which is based on a goal-setting technique where individuals commit to perform a particular behavior when a specific context arises. The study will consist of five sequential phases: Phase I involves training three Master Trainers (MTs) using the International Primary Care Respiratory Group (IPCRG’s) Teach-the-Teacher (TtT) curriculum, specifically focused on the implementation of our intervention. In Phase II, workshops will be held to co-create and culturally adapt the intervention. Phase III will involve teachers trained by MTs on delivering the intervention. In Phase IV, teachers will deliver the intervention among students in their schools. Data will be collected pre- and post-intervention through surveys, session logs, fidelity observations, feedback forms, and follow-up interviews or focus groups (Phase V). Quantitative data will be analyzed descriptively and by using paired t-tests and multiple linear regression analyses, while qualitative data will undergo thematic analysis. Discussion: The study protocol’s potential benefits extend beyond educating Greek adolescents on the risks associated with smoking. Active participation will empower and motivate young people to make informed, healthy choices. We expect the results could help create more effective, context-specific interventions, support policy changes aimed at decreasing the prevalence of adolescent smoking in Crete, Greece, and potentially be used by other countries as well. Full article

Background/Objectives: Schools, as structured social environments, are important settings for shaping lifelong eating habits, and teachers play a mediating role in nutrition education. This study aimed to assess nutrition knowledge among public school teachers, examine their perceptions of the school food environment, and identify factors associated with knowledge scores. Methods: A stratified cross-sectional survey was conducted among 736 teachers from 12 public schools during the fall of 2025. A structured questionnaire based on the Knowledge–Attitudes–Practice model was used to evaluate nutrition knowledge, teaching practices, perceived school food environment, and teachers’ observations of student food-related behaviors. Group differences were examined using t-tests and ANOVA, and multivariable logistic regression was applied to identify factors associated with low nutrition knowledge. Results: The mean knowledge score was 6.26 ± 2.64 out of 12, with 23.6% of teachers classified as having low knowledge, 59.9% satisfactory, and 16.4% good. Primary school teachers scored significantly higher than subject teachers (7.27 vs. 5.64; p < 0.001). Regular conduct of nutrition classes was associated with lower odds of low knowledge (adjusted OR 0.10, 95% CI 0.05–0.23, p < 0.001). A sensitivity analysis using continuous knowledge scores confirmed this pattern, with the absence of nutrition teaching predicting a 1.40-point reduction in scores (95% CI −1.86 to −0.94, p < 0.001). Teachers rated school meal quality moderately high, and frequently observed student refusal of canteen food and purchase of sweets or fast food outside school. Conclusions: This study found that public school teachers in Karaganda, Kazakhstan showed satisfactory overall nutrition knowledge, with gaps in applied understanding and common dietary myths. Primary teachers and those actively teaching nutrition had higher knowledge scores, indicating an association between pedagogical engagement and content knowledge. To help optimize the school food environment, educational policies would benefit from the development of cross-curricular instructional materials fitted specifically for secondary school subject teachers. Full article

Background/Objectives: Children with developmental disabilities (DD) may experience feeding problems that increase their risk of malnourishment. However, data concerning factors linked to feeding problems in children with DD are lacking. The present study aimed to investigate feeding problems and their associated factors in children with DD who are fed orally. This cross-sectional study included data from 160 children with DD aged 2–18 years, recruited from 9 disability centers and schools located in Madinah, Saudi Arabia. Methods: A total of 666 envelopes were distributed randomly to children to take home. Caregivers were asked to provide sociodemographic, health, and nutrition information. Feeding problems were assessed using a validated screening tool for eating/feeding problems (STEP-AR), which included 17 items divided into 5 subdomains (Aspiration risk, Food refusal, Food selectivity, Nutrition behaviors, and Skill). Phone interviews were conducted with caregivers within two weeks of data collection for dietary assessment. Results: The most frequently reported feeding problems involved feeding skills and food selectivity, with 39.3% unable to feed themselves, 33.1% showing overeating behavior, and 31.2% exhibiting pica-like behavior. Chewing difficulties (28.7%), limited food intake (25.6%), and swallowing challenges (21.2%) were moderately reported, while aspiration-related problems were less common. Multiple linear regression analysis revealed significant positive associations between feeding problems and caregiver education level, family income, caregiver’s relationship to the child, and the child’s living arrangement. Dietary intake was not associated with feeding problems. Conclusions: The findings of this study indicate a range of feeding problems and key sociodemographic factors associated with feeding problems in children with DD. These results highlight the need for targeted interventions such as behavioral support and caregiver education to effectively address and manage feeding challenges in children. Full article

Background: Childhood obesity is a persistent global health challenge, often rooted in early-life dietary patterns shaped within the home environment. Objective: To investigate the association between parents’ culinary skills, children’s eating behavior, and the degree of child involvement in family culinary practices. Methods: A cross-sectional, analytical study. In the public and private schools in southern Brazil. A total of 205 families with children aged 3 to 13 years participated. Parents or caregivers answered a structured questionnaire on culinary skills and sociodemographic variables. Children’s eating behavior was assessed through the validated Brazilian version of the Children’s Eating Behaviour Questionnaire (CEBQ). Student’s T test was used to compare means, and Pearson’s chi-square or Fisher’s exact test to compare proportions. Multivariate linear regression was applied to control for potential confounders. Analyses were conducted using SPSS version 27.0 and R software. Results: Most parents (90.7%) reported cooking regularly, and 65.9% involved children in cooking activities. The predominant culinary profile (40%) was classified as “convenience cooking,” marked by frequent use of processed ingredients. Healthier parental cooking practices were positively associated with adaptive eating behaviors in children, reflected by lower food fussiness, satiety responsiveness, food responsiveness and food refusal scores and higher enjoyment of food scores domains of the CEBQ. Conclusions: Despite the high prevalence of routine cooking, convenience-oriented practices remain dominant, reflecting broader sociocultural patterns. Engagement in healthier cooking practices was positively associated with more favorable eating behaviors in children. These findings underscore the importance of promoting culinary education and parental involvement in cooking as strategies to support healthy childhood eating behaviors. Full article

Background: Drinking alcohol of adolescents is an important issue in Taiwan. The purpose of the research is to determine how drinking expectancy and drinking refusal self-efficacy influence drinking behavior among Taiwanese adolescents based on a cognitive model of alcohol consumption. Methods: In this cross-sectional study, a total of 908 students, selected from 10th to 12th grade of six high schools in Taiwan, were stratified randomly. Pearson correlation, and multiple regression analyses were conducted to examine the relationships among drinking expectancy, refusal self-efficacy, and alcohol use, including drinking frequency and drunkenness frequency. Results: There was significant positive relationship between drinking expectancies, and drinking and drunkenness frequency; and negative correlation between drinking refusal self-efficacy, and drinking and drunkenness frequency. Multiple regression analysis revealed that (1) tension reduction, sexual enhancement, social pressure, emotional relief, and opportunity to drink significant predicted drinking frequency (Adjusted R² = 0.352, p < 0.001) and (2) tension reduction, increased confidence, cognitive enhancement, and social pressure significant predicted drunkenness frequency (Adjusted R² = 0.226, p < 0.001). Conclusions: Adolescents have positive outcome expectancies regarding increased drinking frequency. Under the pressure of social interaction, drinking was the most difficult to refuse. Alcohol expectancy and drinking refusal self-efficacy have both shown notable influences on Taiwanese adolescents. Full article

School refusal behavior, defined as a child’s prolonged voluntary absence from school for reasons unrelated to illness and/or economic hardship, is a growing concern in Japan. The COVID-19 pandemic has worsened this issue by disrupting children’s lives. This review summarizes the prevalence, contributing factors, and health implications of school refusal, particularly in the context of COVID-19. A literature review of government reports and PubMed-indexed studies indicates that school refusal in Japan has been rising for eleven years, reaching a record 340,000 cases in 2023. Middle school students (6.7%) were the most affected, followed by elementary school students (2.1%). The pandemic intensified school-related, family-related, and child-related risk factors. School closures disrupted routines, reduced peer interactions, and increased social isolation, contributing to higher rates of anxiety and depression. Reports of suicides and mental health disorders among children have also surged. Family stressors, including economic hardship and parental mental health struggles, further exacerbate school refusal. Additionally, remote learning has widened socioeconomic disparities in access to education, leaving vulnerable children at greater risk. Addressing school refusal requires a multifaceted approach involving schools, families, healthcare providers, and policymakers. School-based interventions, mental health approach, and flexible educational programs would be essential. The Japanese government’s “COCOLO Plan” represents progress toward a more inclusive education system, and a comprehensive, interdisciplinary strategy is needed. Ensuring all children receive the necessary support to reengage with education is critical to overcoming the long-term challenges posed by school refusal. Full article

Studies have shown that the school atmosphere perceived by students can play a key role in promoting their well-being and success in school. No study to date has analyzed whether the students’ perceived school atmosphere might contribute to school refusal (SR), which in turn might reduce students’ engagement and promote underachievement. A cross-sectional study was conducted with 528 Italian high school students (M_age = 16.08, SD = 1.38; 50.8% males, 47% females, and 2.3% not declared), with the aim of assessing the role of the mediation of SR (Anxious Anticipation, Difficult Transition, Interpersonal Discomfort, and School Avoidance) in the association between students’ perceived school atmosphere (Student Relations, Student–Teacher Relations, Educational Climate, Sense of Belonging, and Interpersonal Justice) and school engagement and underachievement. Data were collected using validated instruments, including the SChool REfusal EvaluatioN for school refusal, the Multidimensional School Climate Questionnaire for school atmosphere, and the Utrecht Work Engagement Scale for school engagement. To evaluate the association between variables, we performed structural equation modeling with latent variables. Mediation analysis indicated that Difficult Transition fully mediates the association between Sense of Belonging and school engagement (β = 0.20, p ≤ 0.05). This study extends the knowledge of school refusal behavior. Full article

Background: Risky sexual behaviors remain common among adolescents regardless of those with comprehensive knowledge of safer sex practices. Self-efficacy has been shown to have a positive relationship with safer sex practices. Thus, investigating self-efficacy, and enhancing it to agency is important. The current study explores the predictors of self-efficacy for avoiding risky sexual behaviors and what limits agency among sexually active adolescents (15–19 years) in Northern Uganda. Methods: The study consisted of a sub-sample of 396 sexually active adolescents (145 in school, 251 out of school) interviewed as part of a household survey for the program on Advancing Sexual Reproductive Health and Rights in Northern Uganda. Poisson and Poisson regression models with survey weights were implemented in Stata. Results: A total of 94% of male and 64% of female adolescents reported self-efficacy to avoid unsafe sex, including using condoms and avoiding multiple sexual partnerships or transactional sex. At multivariable analysis, a higher proportion of adolescents who listened to a radio or television program about sexual and reproductive health within the past 12 months had self-efficacy as compared to others (PR = 1.13, p-value = 0.002). Similarly, higher proportions of adolescents who knew all the sexual and reproductive health (SRH) rights (PR = 1.33, p-value = 0.007) and who had comprehensive knowledge about pregnancy, prevention of sexual transmission infections, and sources of SRH services (PR = 1.24, p-value = 0.013) had self-efficacy as compared to others. However, among those who reported self-efficacy, 42% of the girls and 53% of the boys could not uphold their self-efficacy in actual sexual encounters in the past 12 months. Partner’s refusal or girls’ fear to ask their sexual partner to use a condom were commonly cited reasons. Alcohol consumption was associated with failure to act on one’s self-efficacy (RR = 0.74, p-value = 0.048). Conclusions: Programs should target self-efficacy beliefs and attempt to enhance them into agency by increasing positive and decreasing negative expectations associated with risky sexual behavior. Full article

In this work, we suggest that children’s social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori). Full article

Background: Vaccine hesitancy was defined by the World Health Organization (WHO) in 2019 as a major threat to global health. In Italy, reluctance to receive vaccines is a widespread phenomenon that was amplified during the COVID-19 pandemic by fear and mistrust in government. This study aims to depict different profiles and characteristics of people reluctant to vaccinate, focusing on the drivers of those who are in favor of and those who are opposed to receiving the COVID-19 vaccine. Methods: A sample of 10,000 Italian residents was collected. A survey on COVID-19 vaccination behavior and possible determinants of vaccine uptake, delay, and refusal was administered to participants through a computer-assisted web interviewing method. Results: In our sample, 83.2% stated that they were vaccinated as soon as possible (“vaccinators”), 8.0% delayed vaccination (“delayers”), and 6.7% refused to be vaccinated (“no-vaccinators”). In general, the results show that being female, aged between 25 and 64, with an education level less than a high school diploma or above a master’s degree, and coming from a rural area were characteristics significantly associated with delaying or refusing COVID-19 vaccination. In addition, it was found that having minimal trust in science and/or government (i.e., 1 or 2 points on a scale from 1 to 10), using alternative medicine as the main source of treatment, and intention to vote for certain parties were characteristics associated with profiles of “delayers” or “no-vaccinators”. Finally, the main reported motivation for delaying or not accepting vaccination was fear of vaccine side effects (55.0% among delayers, 55.6% among no-vaccinators). Conclusion: In this study, three main profiles of those who chose to be vaccinated are described. Since those who are in favor of vaccines and those who are not usually cluster in similar sociodemographic categories, we argue that findings from this study might be useful to policy makers when shaping vaccine strategies and choosing policy instruments. Full article

Background: Despite the availability of different health care initiatives and interventions, young people are still faced with barriers in accessing reproductive health care services; thus, they are exposed to health-related issues such as sexually transmitted infections. Aim: To determine the awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in primary health facilities in the Tshwane district, Gauteng Province, South Africa. Methods: The study employed a quantitative, cross-sectional descriptive survey with a sample size of 219 to determine the level of awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in Tshwane district. Results: Out-of-school-youth between the ages of 18–24 years participated in the study. Most of the participants (90.8%, n = 199) were female. Service utilization was high in females compared to their male counterparts. There is availability of youth-friendly services in primary health care facilities, however, the level of service utilization among young people is still a challenge evidenced by 12.1% (n = 74) of participants who never sought treatment for STIs, although they had STI symptoms. Furthermore, 52.0% reported that they were not happy with the health services they received when they had STIs. These findings clearly indicate a gap in service delivery for young people regarding reproductive health issues; thus, the low health care seeking behavior among the youth. Condom use was 69.1% and/or inconsistently used among the youth; about 80% of the participants had low perceptions of the risk of contracting STIs. The self-reported risks of HIV and AIDS was 46.8%. Approximately 20% reported that they would not refuse to have sex if their partner did not want to use condoms. These findings showed risky behavior among the participants, and shows that the level of awareness about the risk of contracting STIs is still poor. Conclusions: Irrespective of facilities with youth-friendly services, out-of-school-youth still display poor perceptions about sexually transmitted infections services due to health care providers’ attitudes, limited resources, and working hours. Furthermore, the level of awareness regarding sexually transmitted infections is poor, hence the display of risky sexual behaviors. Full article

Educational achievement is an essential component of the development indicator of a country. The phrase ‘education for all’ covers all levels of life, including indigenous students (ISs). Commonly, education among indigenous people (IP) is not very encouraging. Many previous studies have highlighted the factors involved in ISs’ refusal to attend school and how to solve this problem. However, there are only a few studies on the relationship between the importance of obtaining literacy information in schools and managing knowledge for a guaranteed future. Previous studies found that a lack of information literacy skills, low motivation, cultural background, and learning environment contributed to supporting teaching and learning among ISs. Therefore, this paper proposes a conceptual framework to examine the relationship between student behavior, the sociocultural learning environment, and information literacy in managing IK among ISs in Malaysia. This future research will be carried out among indigenous primary school students aged 10 to 12 years. This proposed research framework will later adopt a quantitative research approach and use an appropriate questionnaire based on the level of education, age, and background after being reviewed by an expert. The expected contribution is the proposed new framework, since literature about ISs is lacking in Malaysia. It is expected that instruments will be developed and used for research, perhaps for indigenous secondary students in Malaysia. Full article

Objectives: The present study aimed to investigate parents’ willingness to vaccinate their children under the age of 18 with a COVID-19 vaccine. Methods: This cross-sectional study was conducted in Saudi Arabia from January 2021 to March 2021. The univariate analysis using Mann–Whitney U-test, t-test, and chi-squared/Fisher’s exact test was performed to identify sociodemographic factors associated with the acceptance of COVID-19 vaccine in children. Factors with statistical significance (p < 0.05) were analyzed using multivariate regression analysis to determine the variables affecting parents’ decisions to vaccinate children. Results: Overall, 44% (167) of parents reported that they would accept vaccinating their children with a COVID-19 vaccine. Young (86; 22.7%), married (135; 35.6%), and Saudi (114; 30%) parents seemed to be more concerned about their children being infected. Parents who intended to vaccinate themselves (OR: 0.599, 95% CI: 0.367–0.980) and who trust the healthcare system (OR: 0.527, 95% CI: 0.327–0.848) reported greater acceptance of children’s vaccination. Among parents, the most frequent (40.9%) reason for vaccinating children was to prevent infection in other family members. What may underlie this result is that some parents understand that children can carry pathogens from persons in school to thoseat home. The most frequent (22.2%) reason for refusing vaccination was concerns about the side effects of the vaccine. Conclusions: Parents have differing opinions on frequencies and risks of coronavirus disease transmission and medical complications and of effectiveness and adverse effects of a vaccine. These results could be of use in designing public health information campaigns and health promotion programs based on perceived parental behavior and positive attitudes. Full article

It is the patient who consults, often at the last minute, the one you sigh over when you see his or her name on your list, the one who makes you feel powerless, and whom you would like to refer to a colleague. Every practicing physician has experienced being involved in a dialog of the deaf, with a patient refusing physicians’ recommendations, in a therapeutic dead end. Faced with such patients, the physician tries to convey scientific evidence to untangle the situation. When it does not work, he looks for other arguments, raises his voice, and avoids looking the patient in the eyes. When he is out of resources, trying to sound professional, he uses a sentence such as “I understand and respect your beliefs, but I am telling you what I learned in medical school!”. At the same time, his non-verbal behavior betrays more than a hint of irritation. Far from being caricatures, such situations generally result in the physician diagnosing or labeling the patient as “difficult.” This label is affixed on more than one patient in ten, and for all sorts of reasons. How, then, do you re-establish a relationship of trust? Or, even better, how do you avoid such labeling? Full article