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437 KiB

Open AccessArticle

Prospective Cohort Study to Elucidate the Correlation between Occupational Stress and Hypertension Risk in Oil Workers from Kelamayi City in the Xinjiang Uygur Autonomous Region of China

by Rong Li, Xiaoyan Gao, Bo Liu, Hua Ge, Li Ning, Junling Zhao and Jiwen Liu

Int. J. Environ. Res. Public Health 2017, 14(1), 1; https://doi.org/10.3390/ijerph14010001 - 22 Dec 2016

Cited by 51 | Viewed by 6306

Abstract

The purpose of this study was to assess the major risk factors for hypertension in oil workers, and investigate the effect of occupational stress on the incidence of hypertension after controlling for other risk factors. A prospective cohort approach was used following enrollment [...] Read more.

The purpose of this study was to assess the major risk factors for hypertension in oil workers, and investigate the effect of occupational stress on the incidence of hypertension after controlling for other risk factors. A prospective cohort approach was used following enrollment of 1354 oil workers. The occupational stress experienced by oil workers was higher than for the general population in China. By the end of the cohort study, 231 new cases of hypertension among the oil workers had been diagnosed. The cumulative incidence of hypertension was 17.06%. There were 44, 112, and 75 workers who developed hypertension in the low, intermediate, and high occupational stress groups, which represented a 12.0%, 15.6%, and 20.3% cumulative incidence, respectively (chi-square value = 9.812, p < 0.01). Multivariate Cox proportional hazard model analysis showed that type of work, cigarette smoking, excess body weight, and obesity were risk factors for hypertension (p < 0.05). After risk factors such as type of work, cigarette smoking, alcohol consumption, and body mass index (BMI) were controlled, the hypertension risk (hazard ratio, HR) in the high occupational stress group was 1.549 (1.072–2.236) compared to the low exposure group, and 2.337 (1.191–4.585) in female subjects. Our study indicated that an increase in occupational stress was associated with an increased risk of hypertension after other factors were adjusted. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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438 KiB

Open AccessArticle

Knowledge, Attitude, and Behaviors Related to Eating Out among University Students in China

by Ping Hu, Wenjie Huang, Ruixue Bai, Fan Zhang, Manoj Sharma, Zumin Shi, Xiaoqiu Xiao, Abu S. Abdullah and Yong Zhao

Int. J. Environ. Res. Public Health 2016, 13(7), 696; https://doi.org/10.3390/ijerph13070696 - 12 Jul 2016

Cited by 20 | Viewed by 7213

Abstract

In many countries the frequency of eating out has steadily increased over the last few decades, and this behavioris often associated with unhealthy dietary patterns. This study aimed to describe the levels of knowledge, attitude, and behaviors (KAB) related to eating out among [...] Read more.

In many countries the frequency of eating out has steadily increased over the last few decades, and this behavioris often associated with unhealthy dietary patterns. This study aimed to describe the levels of knowledge, attitude, and behaviors (KAB) related to eating out among university students. A cross-sectional study was conducted in the college town in Chongqing, China with a total of 1634 participants. The mean eating out related KAB scores were: knowledge 11.5 ± 2.9, attitude 17.0 ± 2.8, and behaviors 24.2 ± 4.8 (possible total scores: 20, 24, 40 respectively). As the level of knowledge increased, the percentage of highly satisfactory attitude and behaviors increased. Only 10% of the participants did not eat out for lunch and dinner during weekends in the last month. Gender, ethnicity, mother’s education, monthly boarding expenses, living place during the study, and the frequency of eating out for breakfast were statistically associated with the scores of KAB. In conclusion, Chinese junior students had poor knowledge of and behaviors towards eating out and ate out frequently. Educational interventionsto improve knowledge related eating out are needed in order to promote healthy eating out behaviors among Chinese university students. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Migrant Sexual Health Help-Seeking and Experiences of Stigmatization and Discrimination in Perth, Western Australia: Exploring Barriers and Enablers

by Josephine Agu, Roanna Lobo, Gemma Crawford and Bethwyn Chigwada

Int. J. Environ. Res. Public Health 2016, 13(5), 485; https://doi.org/10.3390/ijerph13050485 - 11 May 2016

Cited by 53 | Viewed by 16622

Abstract

Increasing HIV notifications amongst migrant and mobile populations to Australia is a significant public health issue. Generalizations about migrant health needs and delayed or deterred help-seeking behaviors can result from disregarding the variation between and within cultures including factors, such as drivers for [...] Read more.

Increasing HIV notifications amongst migrant and mobile populations to Australia is a significant public health issue. Generalizations about migrant health needs and delayed or deterred help-seeking behaviors can result from disregarding the variation between and within cultures including factors, such as drivers for migration and country of birth. This study explored barriers and enablers to accessing sexual health services, including experiences of stigma and discrimination, within a purposive sample of sub-Saharan African, Southeast Asian, and East Asian migrants. A qualitative design was employed using key informant interviews and focus group discussions. A total of 45 people with ages ranging from 18 to 50 years, participated in focus group discussions. Common barriers and enablers to help seeking behaviors were sociocultural and religious influence, financial constraints, and knowledge dissemination to reduce stigma. Additionally, common experiences of stigma and discrimination were related to employment and the social and self-isolation of people living with HIV. Overcoming barriers to accessing sexual health services, imparting sexual health knowledge, recognizing variations within cultures, and a reduction in stigma and discrimination will simultaneously accelerate help-seeking and result in better sexual health outcomes in migrant populations. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Media Competition Implementation for the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD): Adoption and Reach

by Shaniece Criss, Lilian Cheung, Catherine Giles, Steven Gortmaker, Kasisomayajula Viswanath, Jo-Ann Kwass and Kirsten Davison

Int. J. Environ. Res. Public Health 2016, 13(4), 403; https://doi.org/10.3390/ijerph13040403 - 5 Apr 2016

Cited by 7 | Viewed by 5226

Abstract

The Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) was a multi-level, multi-sector community intervention with a media competition component to provide an overarching synergy and promote awareness of target behaviors to reduce childhood obesity. Students participating in the media competition were tasked with [...] Read more.

The Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) was a multi-level, multi-sector community intervention with a media competition component to provide an overarching synergy and promote awareness of target behaviors to reduce childhood obesity. Students participating in the media competition were tasked with developing videos, song/rap lyrics, and artwork that reflected the goals. The aim of this study is to document the process used to develop and implement the media competition along with its reach and adoption. An adapted version of Neta and colleagues’ 2015 framework on dissemination and implementation was used to summarize the process by which the media competition was developed and implemented. Adoption was defined by whether eligible schools or afterschool programs decided to implement the media competition. Reach was defined by student participation rates within schools/programs and the number of votes cast for the finalists on the coalition website and students’ paper ballots. A total of 595 students participated in the media competition from 18 school and afterschool programs in two communities. Adoption of the media competitions ranged from 22% to 100% in programs and reach ranged from 3% to 33% of the student population. The documentation of the implementation should contribute to the replication of the media competition. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Correlates of Insufficient Physical Activity among Junior High School Students: A Cross-Sectional Study in Xi’an, China

by Xiaoqin Wang, Zhaozhao Hui, Paul D. Terry, Mei Ma, Li Cheng, Fu Deng, Wei Gu and Bin Zhang

Int. J. Environ. Res. Public Health 2016, 13(4), 397; https://doi.org/10.3390/ijerph13040397 - 1 Apr 2016

Cited by 10 | Viewed by 5139

Abstract

Background: Physical activity plays an important role in individual health at all stages of life. However, evidence is lacking regarding the level of moderate to vigorous physical activity (MVPA) and the related factors to insufficient physical activity (IPA). Methods: A sample [...] Read more.

Background: Physical activity plays an important role in individual health at all stages of life. However, evidence is lacking regarding the level of moderate to vigorous physical activity (MVPA) and the related factors to insufficient physical activity (IPA). Methods: A sample of 1060 students aged 12–15 years from nine public junior high schools in China were invited to participate in this study. Physical activity was assessed by a modified version of the International Physical Activity Questionnaire. Logistic regression was used to assess the factors associated with IPA. Results: 30.1% boys and 43.0% girls in our sample did not engage in sufficient physical activity. Obesity (OR = 2.2, 95% CI: 1.5–2.9) and high socioeconomic status (SES) (OR = 2.4, 95% CI: 1.3–4.8) were positively associated with IPA, whereas male sex (OR = 0.7, 95% CI: 0.5–0.9), underweight status (OR = 0.5, 95% CI: 0.3–0.7), and high family support level for physical activity (OR = 0.7, 95% CI: 0.6–0.9) showed inverse associations. Age was not associated with IPA. Conclusions: IPA appears to be a considerable problem in this sample of Chinese youth. Effective interventions to increase physical activity are needed and may include improving family support level for physical activity, especially for girls, the obese and those with high SES. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Structural Factors Affecting Health Examination Behavioral Intention

by Hui-Ting Huang, Yu-Ming Kuo, Shiang-Ru Wang, Chia-Fen Wang and Chung-Hung Tsai

Int. J. Environ. Res. Public Health 2016, 13(4), 395; https://doi.org/10.3390/ijerph13040395 - 1 Apr 2016

Cited by 59 | Viewed by 10624

Abstract

Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, [...] Read more.

Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Association between the Hypertriglyceridemic Waist Phenotype, Prediabetes, and Diabetes Mellitus in Rural Chinese Population: A Cross-Sectional Study

by Shuang Chen, Xiaofan Guo, Shasha Yu, Guozhe Sun, Zhao Li and Yingxian Sun

Int. J. Environ. Res. Public Health 2016, 13(4), 368; https://doi.org/10.3390/ijerph13040368 - 25 Mar 2016

Cited by 19 | Viewed by 4537

Abstract

Background: The objective was to evaluate the association of the hypertriglyceridemic waist (HTGW) phenotype with prediabetes and diabetes (DM) in rural Chinese population. Methods: In a cross-sectional study, 11,579 adults (5361 men and 6218 women) aged 35 years or older were [...] Read more.

Background: The objective was to evaluate the association of the hypertriglyceridemic waist (HTGW) phenotype with prediabetes and diabetes (DM) in rural Chinese population. Methods: In a cross-sectional study, 11,579 adults (5361 men and 6218 women) aged 35 years or older were recruited from rural areas of China. Anthropometric measurements, laboratory examinations and self-reported information were collected by trained personnel. The HTGW phenotype was defined as elevated triglycerides and elevated waist circumference. We used logistic regression analysis to evaluate the associations of interest. Results: Adults with the HTGW phenotype had a significantly higher prevalence of prediabetes and diabetes than those without the HTGW phenotype. Compared with the normal waist-normal triglycerides (NWNT) group, those in the HTGW group had a higher adjusted odds ratio of diabetes (OR: 2.10; 95% CI: 1.62–2.73). The association for diabetes was stronger for men (OR: 2.27; 95% CI: 1.52–3.40) than for women (OR: 1.86; 95% CI: 1.32–2.63). However, multivariate analysis indicated that the HTGW phenotype was not associated with prediabetes. Conclusions: This study demonstrated that the HTGW phenotype was associated with diabetes in a large rural Chinese population, and suggested this phenotype as a simple screening tool to identify adults with cardiometabolic conditions. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Work-Recreation Balance, Health-Promoting Lifestyles and Suboptimal Health Status in Southern China: A Cross-Sectional Study

by Shengwei Wu, Zhengzheng Xuan, Fei Li, Wei Xiao, Xiuqiong Fu, Pingping Jiang, Jieyu Chen, Lei Xiang, Yanyan Liu, Xiaoli Nie, Ren Luo, Xiaomin Sun, Hiuyee Kwan and Xiaoshan Zhao

Int. J. Environ. Res. Public Health 2016, 13(3), 339; https://doi.org/10.3390/ijerph13030339 - 19 Mar 2016

Cited by 41 | Viewed by 7954

Abstract

Suboptimal health status (SHS)—an intermediate state between health and illness—refers to functional somatic symptoms that are medically undiagnosed. Although SHS has become a great challenge for global public health, very little about its etiology and mechanisms are known. Work-recreation balance is a part [...] Read more.

Suboptimal health status (SHS)—an intermediate state between health and illness—refers to functional somatic symptoms that are medically undiagnosed. Although SHS has become a great challenge for global public health, very little about its etiology and mechanisms are known. Work-recreation balance is a part of work−life balance, and is related to stress which greatly influences health status. We therefore carried out a cross-sectional investigation between 2012 and 2013 within a clustered sample of 24,475 individuals aged 15−60 years from a population in southern China. In so doing, we hoped to illuminate the associations between work-recreation balance conditions, healthy lifestyles, and SHS. Work-recreation balance conditions were categorically defined by frequency (“rarely, sometimes, or always”). Health-Promoting Lifestyle Profile (HPLP-II) was used to evaluate the level of healthy lifestyles, and the medical examination report and Sub-Health Measurement Scale V1.0 (SHMS V1.0) were both used to evaluate health status. The ratio of SHS (46.3%) is higher than health status (18.4%) or disease status (35.3%). Overall, 4.9% of respondents reported the lowest level of work-recreation balance, and they scored lower on both the HPLP-II and SHMS V1.0 compared with those who frequently maintained a work-recreation balance. Significant association was found between work-recreation balance behaviors and healthy lifestyles (p < 0.001) after demographic adjustment. In comparison with those reporting a frequent work-recreation balance, individuals whose work-recreation balance was categorically “rare” were 1.69 times as likely to develop SHS (odds ratio (OR): 1.69, 95% confidence interval (CI): 1.49–1.92), and those with infrequent work-recreation balance (“sometimes”) were 1.71 times more likely to develop SHS (OR: 1.71, 95% CI: 1.62–1.81). These findings suggest that work-recreation balance conditions are significantly associated with, and seem to be accurate behavioral indicia of a healthy lifestyle. Poor work-recreation balance is associated with increased risk for SHS; thus, a healthier lifestyle that maintains a work-recreation balance should be promoted in order to reduce the development of SHS or disease in southern China. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Exploring Associations between Problematic Internet Use, Depressive Symptoms and Sleep Disturbance among Southern Chinese Adolescents

by Yafei Tan, Ying Chen, Yaogui Lu and Liping Li

Int. J. Environ. Res. Public Health 2016, 13(3), 313; https://doi.org/10.3390/ijerph13030313 - 14 Mar 2016

Cited by 123 | Viewed by 12825

Abstract

The primary aim of this study was to examine associations between problematic Internet use, depression and sleep disturbance, and explore whether there were differential effects of problematic Internet use and depression on sleep disturbance. A total of 1772 adolescents who participated in the [...] Read more.

The primary aim of this study was to examine associations between problematic Internet use, depression and sleep disturbance, and explore whether there were differential effects of problematic Internet use and depression on sleep disturbance. A total of 1772 adolescents who participated in the Shantou Adolescent Mental Health Survey were recruited in 2012 in Shantou, China. The Chinese version of the Internet Addiction Test (IAT) was used to evaluate the prevalence and severity of Internet addiction. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI), a 10-item version of the Center for Epidemiologic Studies Depression Scale (CESD-10), and other socio-demographic measures were also completed. Multiple regression analysis was used to test the mediating effect of problematic Internet use and depression on sleep disturbance. Among the participants, 17.2% of adolescents met the criteria for problematic Internet use, 40.0% were also classified as suffering from sleep disturbance, and 54.4% of students had depressive symptoms. Problematic Internet use was significantly associated with depressive symptoms and sleep disturbance. The correlation between depressive symptoms and sleep disturbance was highly significant. Both problematic Internet use (β = 0.014; Sobel test Z = 12.7, p < 0.001) and depression (β = 0.232; Sobel test Z = 3.39, p < 0.001) had partially mediating effects on sleep disturbance and depression was of greater importance for sleep disturbance than problematic Internet use. There is a high prevalence of problematic Internet use, depression and sleep disturbance among high school students in southern China, and problematic Internet use and depressive symptoms are strongly associated with sleep disturbance. This study provides evidence that problematic Internet use and depression have partially mediating effects on sleep disturbance. These results are important for clinicians and policy makers with useful information for prevention and intervention efforts. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Leisure Time Physical Inactivity and Sedentary Behaviour and Lifestyle Correlates among Students Aged 13–15 in the Association of Southeast Asian Nations (ASEAN) Member States, 2007–2013

by Karl Peltzer and Supa Pengpid

Int. J. Environ. Res. Public Health 2016, 13(2), 217; https://doi.org/10.3390/ijerph13020217 - 15 Feb 2016

Cited by 66 | Viewed by 10227

Abstract

The aim of this study was to examine the relationship between self-reported leisure time physical inactivity frequency and sedentary behaviour and lifestyle correlates among school children in the Association of Southeast Asian Nations (ASEAN) region. The analysis included 30,284 school children aged 13–15 [...] Read more.

The aim of this study was to examine the relationship between self-reported leisure time physical inactivity frequency and sedentary behaviour and lifestyle correlates among school children in the Association of Southeast Asian Nations (ASEAN) region. The analysis included 30,284 school children aged 13–15 years from seven ASEAN countries that participated in the Global School-based Student Health Survey (GSHS) between 2007 and 2013. The measure asked about overall physical activity, walking or biking to school, and on time spent sitting. Overall, the prevalence of physical inactivity was 80.4%, ranging from 74.8% in Myanmar to 90.7% in Cambodia and sedentary behaviour 33.0%, ranging from 10.5% in Cambodia and Myanmar to 42.7% in Malaysia. In multivariate logistic regression, not walking or biking to school, not attending physical education classes, inadequate vegetable consumption and lack of protective factors (peer and parental or guardian support) were associated with physical inactivity, and older age (14 and 15 years old), coming from an upper middle income country, being overweight or obese, attending physical education classes, alcohol use, loneliness, peer support and lack of parental or guardian supervision were associated with sedentary behaviour. In boys, lower socioeconomic status (in the form of having experienced hunger) and coming from a low income or lower middle income country were additionally associated with physical inactivity, and in girls, higher socioeconomic status, not walking or biking to school and being bullied were additionally associated with sedentary behaviour. In conclusion, a very high prevalence of leisure physical inactivity and sedentary behaviour among school going adolescents in ASEAN was found and several factors identified that may inform physical activity promotion programmes in school-going adolescents in ASEAN. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Social and Physical Environments and Self-Rated Health in Urban and Rural Communities in Korea

by Jung-A Lee, Jong Heon Park and Myung Kim

Int. J. Environ. Res. Public Health 2015, 12(11), 14329-14341; https://doi.org/10.3390/ijerph121114329 - 12 Nov 2015

Cited by 39 | Viewed by 5926

Abstract

This study evaluated the associations between social and physical environments and self-rated health (SRH) for urban and rural Korean adults, using data from the Korean Community Health Survey (KCHS) of 199,790 participants (115,454 urban and 84,336 rural). The main dependent variable was SRH, [...] Read more.

This study evaluated the associations between social and physical environments and self-rated health (SRH) for urban and rural Korean adults, using data from the Korean Community Health Survey (KCHS) of 199,790 participants (115,454 urban and 84,336 rural). The main dependent variable was SRH, while the primary independent variables were social and physical characteristics. Urban residents reported better SRH than did rural residents. Five social environmental variables (trust of neighbors, residence in the area for over 20 years, exchanging help with neighbors, friend and fellowship activities, contact with relatives and neighbors over five times per month) were more prevalent among rural residents. Satisfaction with physical environment was more common among rural residents, but satisfaction with traffic and healthcare facilities was more common among urban areas. After adjusting for relevant factors, positive associations between SRH and trust of neighbors, exchanging help with neighbors, participation in social activities or organizations, and physical environment existed in both rural and urban populations. Also, in both areas, there was no demonstrated association between SRH and years of residence or frequency of contact with relatives. Our findings suggest the existence of an association between social and physical factors and perceived health status among the general population of Korea. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Growth Trajectories of Health Behaviors from Adolescence through Young Adulthood

by Nora Wiium, Kyrre Breivik and Bente Wold

Int. J. Environ. Res. Public Health 2015, 12(11), 13711-13729; https://doi.org/10.3390/ijerph121113711 - 28 Oct 2015

Cited by 49 | Viewed by 6940

Abstract

Based on nine waves of data collected during a period of 17 years (1990–2007), the present study explored different developmental trajectories of the following unhealthy behaviors: regular smoking, lack of regular exercise, lack of daily fruit intake, and drunkenness. A baseline sample of [...] Read more.

Based on nine waves of data collected during a period of 17 years (1990–2007), the present study explored different developmental trajectories of the following unhealthy behaviors: regular smoking, lack of regular exercise, lack of daily fruit intake, and drunkenness. A baseline sample of 1195 13-year-old pupils was from 22 randomly selected schools in the Hordaland County in western Norway. Latent class growth analysis revealed three developmental trajectories. The first trajectory was a conventional trajectory, comprising 36.3% of participants, who showed changes in smoking, physical exercise, fruit intake, and drunkenness consistent with the prevailing age specific norms of these behaviors in the Norwegian society at the time. The second trajectory was a passive trajectory, comprising 25.5% of participants, who reported low levels of both healthy and unhealthy behaviors during the 17-year period. The third trajectory was an unhealthy trajectory, comprising 38.2% of participants, who had high levels of unhealthy behaviors over time. Several covariates were examined, but only sex and mother’s and father’s educational levels were found to be significantly associated with the identified trajectories. While these findings need to be replicated in future studies, the identification of the different trajectories suggests the need to tailor intervention according to specific needs. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Prevalence and Determinants of Metabolic Health in Subjects with Obesity in Chinese Population

by Ruizhi Zheng, Min Yang, Yuqian Bao, Hong Li, Zhongyan Shan, Bo Zhang, Juan Liu, Qinguo Lv, Ou Wu, Yimin Zhu and Maode Lai

Int. J. Environ. Res. Public Health 2015, 12(11), 13662-13677; https://doi.org/10.3390/ijerph121113662 - 28 Oct 2015

Cited by 41 | Viewed by 7046

Abstract

Background: The study was to investigate the prevalence of metabolic health in subjects with obesity in the Chinese population and to identify the determinants related to metabolic abnormality in obese individuals. Methods: 5013 subjects were recruited from seven provincial capitals in [...] Read more.

Background: The study was to investigate the prevalence of metabolic health in subjects with obesity in the Chinese population and to identify the determinants related to metabolic abnormality in obese individuals. Methods: 5013 subjects were recruited from seven provincial capitals in China. The obesity and metabolic status were classified based on body mass index (BMI) and the number of abnormalities in common components of metabolic syndrome. Results: 27.9% of individuals with obesity were metabolically healthy. The prevalence of the metabolically healthy obese (MHO) phenotype was significantly decreased with age in women (p _trend < 0.001), but not significantly in men (p _trend = 0.349). Central obesity (odds ratio [OR] = 4.07, 95% confidence interval [CI] = 1.93–8.59), longer sedentary time (OR = 1.97, 95%CI = 1.27–3.06), and with a family history of obesity related diseases (hypertension, diabetes, dyslipidemia) (OR = 1.85, 95%CI = 1.26–2.71) were significantly associated with having metabolic abnormality in obese individuals. Higher levels of physical activity and more fruit/vegetable intake had decreased ORs of 0.67 (95%CI = 0.45–0.98) and 0.44 (95%CI = 0.28–0.70), respectively. Conclusion: 27.9% of obese participants are in metabolic health. Central obesity, physical activity, sedentary time, fruits/vegetables intake and family history of diseases are the determinants associated with metabolic status in obesity. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

The Association Between Physical Activity, Mental Status, and Social and Family Support with Five Major Non-Communicable Chronic Diseases Among Elderly People: A Cross-Sectional Study of a Rural Population in Southern China

by Xiang Huang, Huajie Yang, Harry H.X. Wang, Yongjun Qiu, Xiujuan Lai, Zhiheng Zhou, Fangjian Li, Liwei Zhang, Jiaji Wang and Jimin Lei

Int. J. Environ. Res. Public Health 2015, 12(10), 13209-13223; https://doi.org/10.3390/ijerph121013209 - 21 Oct 2015

Cited by 22 | Viewed by 8016

Abstract

Background: Non-communicable chronic diseases (NCDs) have become the top threat in China. This study aimed to estimate the prevalence of major NCDs among the elderly population in rural areas in southern China and explore its associated social determinants. Methods: A multistage [...] Read more.

Background: Non-communicable chronic diseases (NCDs) have become the top threat in China. This study aimed to estimate the prevalence of major NCDs among the elderly population in rural areas in southern China and explore its associated social determinants. Methods: A multistage cluster random sampling methodology was adopted to select a total of 9245 rural elderly people from 3860 rural households in Guangdong Province. Interviews and physical examinations were performed to collect patient information. Descriptive and logistic regression analyses were conducted to explore factors associated with the presence of major NCDs. Results: Over one-third (38.5%) of the study population suffered from five major NCDs. The grade of activities of daily living (ADL), mental status, and social relationship of elderly people without NCDs were better than those with NCDs. The major factors associated with the presence of NCDs among the elderly people included age (70–79 years group and 80–89 years group), education level (senior high/technical secondary school and junior college and above), mental status (concentration, enrichment and happy life and memory), relationship with neighbours, activities of daily living (ADL) (being able to climb three floors and bend over), physical activity, marital status (bereft), and living conditions (with offspring and family members). Conclusions: The study identified several social determinants associated with the presence of major NCDs. A higher level of family support and physical exercise might contribute to improved physical condition, mental status, and ADL among the elderly people in rural areas in southern China. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Relationships between Sleep Behaviors and Unintentional Injury in Southern Chinese School-Aged Children: A Population-Based Study

by Yafei Tan, Di Ma, Ying Chen, Fuyuan Cheng, Xiangxiang Liu and Liping Li

Int. J. Environ. Res. Public Health 2015, 12(10), 12999-13015; https://doi.org/10.3390/ijerph121012999 - 16 Oct 2015

Cited by 9 | Viewed by 5929

Abstract

The purpose of this study is to explore the relationships between sleep behaviors and injury occurrence among Chinese school-aged children. Data were collected with self-administered questionnaires of a cross-sectional survey which covered the school-aged children from southeastern Chinese urban and rural areas in [...] Read more.

The purpose of this study is to explore the relationships between sleep behaviors and injury occurrence among Chinese school-aged children. Data were collected with self-administered questionnaires of a cross-sectional survey which covered the school-aged children from southeastern Chinese urban and rural areas in April 2010. Information was collected on unintentional injury in the past year, sleep duration, napping and daytime fatigue, sleeping pill use, and social-demographic variables. Multivariable logistic regression analyses, controlling for confounding factors, were conducted to assess sleep-related variables that were associated with injuries. Students who slept for less than 8 h had a 30% increased risk of injury (OR: 1.30; 95%CI: 1.01–1.69) compared with those who slept for 8–9 h. Lack of napping, snoring and use of sleeping pills were significantly associated with injury. Among different genders, the slight difference in sleep behaviors predicted the occurrence of injury. Rural children displayed more sleep behaviors associated with injury than urban children. The sleep behaviors of primary school students were more negatively correlated with injury occurrence than junior/senior high school children. Consideration should be given to the prevention of problematic sleep behaviors as a potential risk factor in order to decrease injury rates and promote the health of school-aged children. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessCommunication

Are Total and Domain-Specific Sedentary Time Associated with Overweight in Older Taiwanese Adults?

by Ming-Chun Hsueh, Yung Liao and Shao-Hsi Chang

Int. J. Environ. Res. Public Health 2015, 12(10), 12697-12705; https://doi.org/10.3390/ijerph121012697 - 12 Oct 2015

Cited by 16 | Viewed by 4321

Abstract

This study investigated the associations between total and domain-specific sedentary time with the risk of overweight in older adults. A cross-sectional study was conducted by administering computer-assisted telephone interviews to 1046 Taiwanese older adults (aged ≥65 years) residing in two regions in Taiwan [...] Read more.

This study investigated the associations between total and domain-specific sedentary time with the risk of overweight in older adults. A cross-sectional study was conducted by administering computer-assisted telephone interviews to 1046 Taiwanese older adults (aged ≥65 years) residing in two regions in Taiwan in 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the associations between self-reported total and six domain-specific sedentary times and body mass index status (calculating by self-reported height and weight) by using logistic regression analyses. The results showed that compared with older women in the lowest quartile of the total sedentary time, those in the highest quartile were 1.87 (95% CI: 1.10–3.21) times more likely to be overweight, after adjustment for potential confounders. The total sedentary time was stratified into six specific domains, and only watching television more than 2 h per day was positively associated with overweight (OR, 1.55; 95% CI: 1.08–2.25) in older women, whereas no other sedentary time domains were associated with the risk of overweight. No significant associations were observed in older men. Further studies using prospective designs are required to confirm the presently observed effects of total and domain-specific sedentary behavior on the health of older adults. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Variability and Stability in Daily Moderate-to-Vigorous Physical Activity among 10 Year Old Children

by Sara Pereira, Thayse Natacha Gomes, Alessandra Borges, Daniel Santos, Michele Souza, Fernanda K. Dos Santos, Raquel N. Chaves, Peter T. Katzmarzyk and José A. R. Maia

Int. J. Environ. Res. Public Health 2015, 12(8), 9248-9263; https://doi.org/10.3390/ijerph120809248 - 7 Aug 2015

Cited by 14 | Viewed by 6156

Abstract

Day-to-day variability and stability of children’s physical activity levels across days of the week are not well understood. Our aims were to examine the day-to-day variability of moderate-to-vigorous physical activity (MVPA), to determine factors influencing the day-to-day variability of MVPA and to estimate [...] Read more.

Day-to-day variability and stability of children’s physical activity levels across days of the week are not well understood. Our aims were to examine the day-to-day variability of moderate-to-vigorous physical activity (MVPA), to determine factors influencing the day-to-day variability of MVPA and to estimate stability of MVPA in children. The sample comprises 686 Portuguese children (10 years of age). MVPA was assessed with an accelerometer, and BMI was computed from measured height and weight. Daily changes in MVPA and their correlates (gender, BMI, and maturity) were modeled with a multilevel approach, and tracking was calculated using Foulkes & Davies γ. A total of 51.3% of boys and 26.2% of girls achieved 60 min/day of MVPA on average. Daily MVPA was lower during the weekend (23.6% of boys and 13.6% of girls comply with the recommended 60 min/day of MVPA) compared to weekdays (60.8% and 35.4%, boys and girls, respectively). Normal weight children were more active than obese children and no effect was found for biological maturation. Tracking is low in both boys (γ = 0.59 ± 0.01) and girls (γ = 0.56 ± 0.01). Children’s MVPA levels during a week are highly unstable. In summary, boys are more active than girls, maturation does not affect their MVPA, and obese children are less likely to meet 60 min/day of MVPA. These results highlight the importance of providing opportunities for increasing children’s daily MVPA on all days of week, especially on the weekend. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Doctor-Shopping Behavior among Patients with Eye Floaters

by Gow-Lieng Tseng and Cheng-Yu Chen

Int. J. Environ. Res. Public Health 2015, 12(7), 7949-7958; https://doi.org/10.3390/ijerph120707949 - 13 Jul 2015

Cited by 10 | Viewed by 6561

Abstract

Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 [...] Read more.

Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers) who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Public Knowledge, Beliefs and Behavior on Antibiotic Use and Self-Medication in Lithuania

by Eglė Pavydė, Vincentas Veikutis, Asta Mačiulienė, Vytautas Mačiulis, Kęstutis Petrikonis and Edgaras Stankevičius

Int. J. Environ. Res. Public Health 2015, 12(6), 7002-7016; https://doi.org/10.3390/ijerph120607002 - 17 Jun 2015

Cited by 92 | Viewed by 11482

Abstract

Irrational antibiotic use has led society to antibiotic resistance—a serious health problem worldwide. This study aimed to assess public knowledge, beliefs, and behavior concerning antibiotic use and self-medication in Lithuania. The cross-sectional survey method was processed using a validated questionnaire in different regions [...] Read more.

Irrational antibiotic use has led society to antibiotic resistance—a serious health problem worldwide. This study aimed to assess public knowledge, beliefs, and behavior concerning antibiotic use and self-medication in Lithuania. The cross-sectional survey method was processed using a validated questionnaire in different regions of Lithuania. In total, 1005 adults completed the questionnaire and were included in the study. More than half of the respondents (61.1%) had poor knowledge of antibiotics. Almost half of the respondents incorrectly identified antibiotics as being effective either against viral (26.0%) or mixed (bacterial and viral) infections (21.7%). The respondents with lower educational qualifications (OR = 2.515; 95% CI 1.464–4.319; p = 0.001) and those from rural areas (OR = 1.765; 95% CI 1.041–2.991; p = 0.035) were significantly less knowledgeable of antibiotics. There was no significant difference between genders, different age groups, or different parenthood status. The determined level of self–medication with antibiotics was 31.0%. The men (OR = 1.650; 95% CI 1.120–2.430; p = 0.011), the respondents from rural areas (OR = 2.002; 95% CI 1.343–2.985; p = 0.001), and those without children (OR = 2.428; 95% CI 1.477–3.991; p < 0.001) were more likely to use antibiotics in self-medication. Lithuanian residents’ knowledge of antibiotics is insufficient. More information about antibiotic use should be provided by physicians and pharmacists. Self-medication with antibiotics is a serious problem in Lithuania and requires considerable attention. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

by Evelina Pappa, Simela Chatzikonstantinidou, George Chalkiopoulos, Angelos Papadopoulos and Dimitris Niakas

Int. J. Environ. Res. Public Health 2015, 12(6), 6669-6681; https://doi.org/10.3390/ijerph120606669 - 12 Jun 2015

Cited by 32 | Viewed by 6812

Abstract

The aim was to assess the health-related quality of life (HRQL) of the Roma and further to detect the significant determinants that are associated with their HRQL. The cross-sectional study involved 1068 Roma adults living in settlements (mean age 36). HRQL was measured [...] Read more.

The aim was to assess the health-related quality of life (HRQL) of the Roma and further to detect the significant determinants that are associated with their HRQL. The cross-sectional study involved 1068 Roma adults living in settlements (mean age 36). HRQL was measured by the Greek version of SF-36 Health Survey and further socio-demographic characteristics (sex, age, marital status, education, permanent occupation etc.) and housing conditions (stable housing, access to basic amenities such as drinkable water, drainage, electricity which compose material deprivation) were involved. Non parametric tests and multiple linear regression models were applied to identify the factors that have significant association with HRQL. After controlling for socio-demographic characteristics, health status and housing conditions, sex, age, education, chronic diseases, stable housing and material deprivation were found to be significant determinants of the Roma’s HRQL. Men reported significantly better health than women as well as those who attended school compared to the illiterate. Chronic diseases were remarkably associated with poor HRQL from 10 units in MH (Mental Health) to 34 units in RP (Role Physical). Material deprivation was related to lower GH (General Health), and VT (Vitality) scores and higher RP (Role Physical) and RE (Role Emotional) scores. Chronic conditions and illiteracy are two key areas that contribute significantly to worse HRQL. Policies should be part of a comprehensive and holistic strategy for the Roma through intervention to education, housing and public health. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

The Impact of Different Degrees of Feedback on Physical Activity Levels: A 4-Week Intervention Study

by Karen Van Hoye, Filip Boen and Johan Lefevre

Int. J. Environ. Res. Public Health 2015, 12(6), 6561-6581; https://doi.org/10.3390/ijerph120606561 - 9 Jun 2015

Cited by 21 | Viewed by 7164

Abstract

Assessing levels of physical activity (PA) and providing feedback about these levels might have an effect on participant’s PA behavior. This study discusses the effect of different levels of feedback—from minimal to use of a feedback display and coach—on PA over a 4-week [...] Read more.

Assessing levels of physical activity (PA) and providing feedback about these levels might have an effect on participant’s PA behavior. This study discusses the effect of different levels of feedback—from minimal to use of a feedback display and coach—on PA over a 4-week intervention period. PA was measured at baseline, during and immediately after the intervention. Participants (n = 227) were randomly assigned to a Minimal Intervention Group (MIG-no feedback), Pedometer Group (PG-feedback on steps taken), Display Group (DG-feedback on steps, minutes of moderate to vigorous physical activity and energy expenditure) or Coaching Group (CoachG-same as DG with need-supportive coaching). Two-way ANCOVA showed no significant Group × Time interaction effect for the different PA variables between the MIG and PG. Also no differences emerged between PG and DG. As hypothesized, CoachG had higher PA values throughout the intervention compared with DG. Self-monitoring using a pedometer resulted in more steps compared with a no-feedback condition at the start of the intervention. However, adding individualized coaching seems necessary to increase the PA level until the end of the intervention. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Health Status and Risk Factors among Adolescent Survivors One Month after the 2014 Ludian Earthquake

by Bihan Tang, Yang Ge, Chen Xue, Peng Kang, Yuan Liu, Xu Liu, Zhipeng Liu, Wenya Yu and Lulu Zhang

Int. J. Environ. Res. Public Health 2015, 12(6), 6367-6377; https://doi.org/10.3390/ijerph120606367 - 4 Jun 2015

Cited by 6 | Viewed by 5509

Abstract

Background: An earthquake struck Ludian in Yunnan Province (China) on 3 August 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the health status and associated determinants among adolescent survivors after the Ludian earthquake. Methods: [...] Read more.

Background: An earthquake struck Ludian in Yunnan Province (China) on 3 August 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the health status and associated determinants among adolescent survivors after the Ludian earthquake. Methods: A cross-sectional survey of 845 was conducted at the Ludian No. 1 Middle School. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. Results: The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.23 (SD = 7.10) and 36.34 (SD = 7.09), respectively. Lower PCS scores in the aftermath of an earthquake were associated with being trapped or in danger, being female, being an ethnic minority, injury to self and house damage, while lower MSC scores were associated with fear during the earthquake, Han ethnicity, death in the family, not being involved in the rescue and low household income. Conclusions: In our study, significant associations between demographic, socio-economic, and trauma-related experiences variables and overall physical and mental health of adolescent survivors were presented. The results of this study help expand our knowledge of health status among adolescent survivors after the Ludian earthquake. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Creating an Interest in Research and Development as a Means of Reducing the Gap between Theory and Practice in Primary Care: An Interventional Study Based on Strategic Communication

by Helena Morténius

Int. J. Environ. Res. Public Health 2014, 11(9), 8689-8708; https://doi.org/10.3390/ijerph110908689 - 26 Aug 2014

Cited by 5 | Viewed by 7187

Abstract

Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals’ [...] Read more.

Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals’ interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals’ interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Effects of Nutrition and Exercise Health Behaviors on Predicted Risk of Cardiovascular Disease among Workers with Different Body Mass Index Levels

by Jui-Hua Huang, Shu-Ling Huang, Ren-Hau Li, Ling-Hui Wang, Yu-Ling Chen and Feng-Cheng Tang

Int. J. Environ. Res. Public Health 2014, 11(5), 4664-4675; https://doi.org/10.3390/ijerph110504664 - 29 Apr 2014

Cited by 13 | Viewed by 7657

Abstract

Workplace health promotion programs should be tailored according to individual needs and efficient intervention. This study aimed to determine the effects of nutrition and exercise health behaviors on predicted risk for cardiovascular disease (CVD) when body mass index (BMI) is considered. In total, [...] Read more.

Workplace health promotion programs should be tailored according to individual needs and efficient intervention. This study aimed to determine the effects of nutrition and exercise health behaviors on predicted risk for cardiovascular disease (CVD) when body mass index (BMI) is considered. In total, 3350 Taiwanese workers were included in this cross-sectional study. A self-reported questionnaire was used to measure their nutrition and exercise behaviors. Data on anthropometric values, biochemical blood determinations, and predicted CVD risk (using the Framingham risk score) were collected. In multiple regression analyses, the nutrition behavior score was independently and negatively associated with CVD risk. Exercise was not significantly associated with the risk. However, the interactive effect of exercise and BMI on CVD risk was evident. When stratified by BMI levels, associations between exercise and CVD risk were statistically significant for ideal weight and overweight subgroups. In conclusion, nutrition behavior plays an important role in predicting the CVD risk. Exercise behavior is also a significant predictor for ideal weight and overweight workers. Notably, for underweight or obese workers, maintaining health-promoting exercise seems insufficient to prevent the CVD. In order to improve workers’ cardiovascular health, more specific health-promoting strategies should be developed to suit the different BMI levels. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Modifying Health Behavior to Prevent Cardiovascular Diseases: A Nationwide Survey among German Primary Care Physicians

by Sven Schneider, Katharina Diehl, Christina Bock, Raphael M. Herr, Manfred Mayer and Tatiana Görig

Int. J. Environ. Res. Public Health 2014, 11(4), 4218-4232; https://doi.org/10.3390/ijerph110404218 - 15 Apr 2014

Cited by 32 | Viewed by 7835

Abstract

Cardiovascular diseases (CVD) are a major public health concern as they are the leading cause of death in developed countries. Primary care is considered to be the ideal setting for CVD prevention. Therefore, more than 4,000 German primary care physicians (PCPs) were asked [...] Read more.

Cardiovascular diseases (CVD) are a major public health concern as they are the leading cause of death in developed countries. Primary care is considered to be the ideal setting for CVD prevention. Therefore, more than 4,000 German primary care physicians (PCPs) were asked about their attitudes towards and their activities regarding the prevention of CVD in the nationwide ÄSP-kardio Study. The focus of the study was on health behavior modification. Two thirds of the participating PCPs stated that they routinely provided brief inventions to assist patients in reducing both their tobacco (72%) and alcohol (61%) consumption, to encourage them to increase their levels of physical activity (72%), and to assist them in adjusting to a more healthy diet (66%), and in achieving a healthy body weight (69%). However, only between 23% (quitting smoking) and 49% (diet modification) of PCPs felt that they had been successful in helping patients modify their lifestyles. Insufficient reimbursement, cultural diversity and a lack of time were reported to be the most problematic barriers to successful intervention in the primary care setting. Despite these obstacles, the majority of German PCPs was engaged in prevention and health behavior intervention to reduce the incidence and progression of CVD. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Clinical and Individual Factors Associated with Smoking Quit Attempts among Adults with COPD: Do Factors Vary with Regard to Race?

by Dana S. Mowls, Vinay K. Cheruvu and Melissa D. Zullo

Int. J. Environ. Res. Public Health 2014, 11(4), 3717-3727; https://doi.org/10.3390/ijerph110403717 - 3 Apr 2014

Cited by 6 | Viewed by 6023

Abstract

Only half of adults with chronic obstructive pulmonary disease (COPD) report a smoking quit attempt in the past year. Adults with COPD have frequent encounters with the healthcare system that are opportunities for health behavior interventions that support quit attempts. The purpose of [...] Read more.

Only half of adults with chronic obstructive pulmonary disease (COPD) report a smoking quit attempt in the past year. Adults with COPD have frequent encounters with the healthcare system that are opportunities for health behavior interventions that support quit attempts. The purpose of this research was to examine individual- and clinical-level factors associated with smoking quit attempts in adults with COPD. Cross-sectional data were from the 2011 Behavioral Risk Factor Surveillance System. Race-stratified, weighted logistic regression examined factors associated with quit attempt among current smokers with COPD. Overall, quit attempt was reported by 65% (95% confidence interval (CI): 61.9, 67.5) of adults and was more likely among blacks than whites (p < 0.0001). Among whites with COPD quit attempt was associated with: Female gender (adjusted odds ratio (AOR) = 1.3; CI: 1.0, 1.7), exercise (AOR = 2.0; CI: 1.5, 2.5), and medications for COPD (AOR = 1.6; CI: 1.3, 2.2). Among black adults with COPD quit attempt was associated with: Having a partner (AOR = 4.5; CI: 1.3, 15.0), exercise (AOR = 3.7; CI: 1.6, 8.7), spirometry (AOR = 9.5; CI: 3.2, 28.7), and having a personal doctor (AOR = 6.4; CI: 1.8, 22.5). Individual and clinical-factors associated with quit attempt varied by race. These findings suggest an impact of the healthcare system that supports quit attempts in blacks but not whites with COPD. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Do Children’s Health Resources Differ According to Preschool Physical Activity Programmes and Parental Behaviour? A Mixed Methods Study

by Elena Sterdt, Natalie Pape, Silke Kramer, Sebastian Liersch, Michael Urban, Rolf Werning and Ulla Walter

Int. J. Environ. Res. Public Health 2014, 11(3), 2407-2426; https://doi.org/10.3390/ijerph110302407 - 26 Feb 2014

Cited by 4 | Viewed by 8128

Abstract

Preschool can have positive effects on the development of a healthy lifestyle. The present study analysed to what extent different conditions, structures and behavioural models in preschool and family—children’s central social microsystems—can lead to differences in children’s health resources. Using a cross-sectional mixed [...] Read more.

Preschool can have positive effects on the development of a healthy lifestyle. The present study analysed to what extent different conditions, structures and behavioural models in preschool and family—children’s central social microsystems—can lead to differences in children’s health resources. Using a cross-sectional mixed methods approach, contrast analyses of “preschools with systematic physical activity programmes” versus “preschools without physical activity programmes” were conducted to assess the extent to which children’s physical activity, quality of life and social behaviour differ between preschools with systematic and preschools without physical activity programmes. Differences in children’s physical activity according to parental behaviour were likewise assessed. Data on child-related outcomes and parent-related factors were collected via parent questionnaires and child interviews. A qualitative focused ethnographic study was performed to obtain deeper insight into the quantitative survey data. Two hundred and twenty seven (227) children were interviewed at 21 preschools with systematic physical activity programmes, and 190 at 25 preschools without physical activity programmes. There was no significant difference in children’s physical activity levels between the two preschool types (p = 0.709). However, the qualitative data showed differences in the design and quality of programmes to promote children’s physical activity. Data triangulation revealed a strong influence of parental behaviour. The triangulation of methods provided comprehensive insight into the nature and extent of physical activity programmes in preschools and made it possible to capture the associations between systematic physical activity promotion and children’s health resources in a differential manner. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Correlates of the Intention to Implement a Tailored Physical Activity Intervention: Perceptions of Intermediaries

by Denise Peels, Aart Mudde, Catherine Bolman, Rianne Golsteijn, Hein De Vries and Lilian Lechner

Int. J. Environ. Res. Public Health 2014, 11(2), 1885-1903; https://doi.org/10.3390/ijerph110201885 - 10 Feb 2014

Cited by 7 | Viewed by 7182

Abstract

The public health impact of health behaviour interventions is highly dependent on large-scale implementation. Intermediaries—intervention providers—determine to a large extent whether an intervention reaches the target population, and hence its impact on public health. A cross-sectional study was performed to identify the correlates [...] Read more.

The public health impact of health behaviour interventions is highly dependent on large-scale implementation. Intermediaries—intervention providers—determine to a large extent whether an intervention reaches the target population, and hence its impact on public health. A cross-sectional study was performed to identify the correlates of intermediaries’ intention to implement a computer-tailored physical activity intervention. According to theory, potential correlates are intervention characteristics, organisational characteristics, socio-political characteristics and intermediary characteristics. This study investigated whether intermediary characteristics mediated the association between the intervention, organisational and socio-political characteristics and intention to implement the intervention. Results showed that intervention characteristics (i.e., observability (B = 0.53; p = 0.006); relative advantage (B = 0.79; p = 0.020); complexity (B = 0.80; p < 0.001); compatibility (B = 0.70; p < 0.001)), organisational characteristics (i.e., type of organization (B = 0.38; p = 0.002); perceived task responsibility (B = 0.66; p ≤ 0.001); capacity (B = 0.83; p < 0.001)), and the social support received by intermediary organisations (B = 0.81; p < 0.001) were associated with intention to implement the intervention. These factors should thus be targeted by an implementation strategy. Since self-efficacy and social norms perceived by the intermediary organisations partially mediated the effects of other variables on intention to implement the intervention (varying between 29% and 84%), these factors should be targeted to optimise the effectiveness of the implementation strategy. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessCommunication

The Influence of Centre-Based Childcare on Preschoolers’ Physical Activity Levels: A Cross-Sectional Study

by Leigh M. Vanderloo, Patricia Tucker, Andrew M. Johnson, Melissa M. Van Zandvoort, Shauna M. Burke and Jennifer D. Irwin

Int. J. Environ. Res. Public Health 2014, 11(2), 1794-1802; https://doi.org/10.3390/ijerph110201794 - 5 Feb 2014

Cited by 111 | Viewed by 9735

Abstract

The childcare environment represents an appropriate avenue to support physical activity among preschoolers. The aim of this study was two-fold: (1) to measure the physical activity levels of a sample of preschoolers during childcare hours; and (2) to assess which attributes (e.g., space, [...] Read more.

The childcare environment represents an appropriate avenue to support physical activity among preschoolers. The aim of this study was two-fold: (1) to measure the physical activity levels of a sample of preschoolers during childcare hours; and (2) to assess which attributes (e.g., space, equipment, policies) within centre-based childcare environments influenced physical activity. Thirty-one preschoolers from 5 childcare centres across London, Canada participated. Actical accelerometers were worn by participants for one day during childcare hours to assess activity levels using a 15 second epoch length. The Environment and Policy Assessment and Observation instrument was used to conduct a full-day evaluation of the childcare environment. On average, participants engaged in 1.54 min/h of moderate-to-vigorous physical activity and 17.42 min/h of total physical activity. Sedentary opportunities, portable and fixed play equipment, and staff behaviour accounted for 49.3% of the variability in moderate-to-vigorous physical activity and 14.1% of the variability in total physical activity, with sedentary opportunities, fixed play equipment, and staff behaviours displaying an inverse relationship. Results emphasize the critical role the childcare environment plays in supporting physical activity among preschoolers. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Connectedness to Nature and Public (Skin) Health Perspectives: Results of a Representative, Population-Based Survey among Austrian Residents

by Daniela Haluza, Stana Simic, Jan Höltge, Renate Cervinka and Hanns Moshammer

Int. J. Environ. Res. Public Health 2014, 11(1), 1176-1191; https://doi.org/10.3390/ijerph110101176 - 20 Jan 2014

Cited by 34 | Viewed by 8491

Abstract

Connectedness to nature (CN) influences motivation to have contact with outdoor natural environments. Spending leisure time in natural environments is beneficial for human health and well-being. Besides these positive effects, health risks of open-air activities are mainly related to unprotected sun light exposure-associated [...] Read more.

Connectedness to nature (CN) influences motivation to have contact with outdoor natural environments. Spending leisure time in natural environments is beneficial for human health and well-being. Besides these positive effects, health risks of open-air activities are mainly related to unprotected sun light exposure-associated acute and chronic skin hazards. Thus, we conducted a cross-sectional, representative telephone survey among Austrian residents to study the association of perceived CN level with sun-exposure knowledge, tanning habits, and sun protective behaviour. In total, 1,500 study subjects (50.5% females) participated in this questionnaire survey. Although knowledge about tanning and motives to tan were similar among genders, females performed more photoprotective measures and were more connected to nature (all p < 0.001) compared to males. Older age and outdoor sport were significant gender-independent predictor variables influencing perceived CN level. Additionally, level of education was relevant in male CN, whereas non-smoking and higher knowledge were predictive of female CN. This survey provides so far unreported empirical data on the relationship between nature connectedness and skin health-relevant recreational habits of Austrian residents. The findings suggest to integrate hitherto neglected gender-specific Public (Skin) Health promotion when counselling on the manifold health advantages of outdoor activities. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

An Evaluation of Healthcare Information on the Internet: The Case of Colorectal Cancer Prevention

by Chia-Ching Chen, Tetsuji Yamada and John Smith

Int. J. Environ. Res. Public Health 2014, 11(1), 1058-1075; https://doi.org/10.3390/ijerph110101058 - 14 Jan 2014

Cited by 15 | Viewed by 9865

Abstract

Health information, provided through the Internet, has recently received attention from consumers and healthcare providers as an efficient method of motivating people to get screened for colorectal cancer (CRC). In this study, the primary purpose was to investigate the extent to which consumers [...] Read more.

Health information, provided through the Internet, has recently received attention from consumers and healthcare providers as an efficient method of motivating people to get screened for colorectal cancer (CRC). In this study, the primary purpose was to investigate the extent to which consumers were better educated about CRC screening information because of the information available on the Internet. Another purpose was to identify how better-informed consumers, with reliable and trustworthy health information, were enabled to make sound decisions regarding CRC screening. The data used in this study was taken from the 2003 Health Information National Trends Survey. People aged 55 and older were classified based on their compliance with recommended CRC screening. The study applied the PRECEDE-PROCEED model to evaluate the effects of health information taken from the Internet regarding CRC screening. The credibility and reliance of cancer related information on the Internet was significantly associated with patient compliance to be screened for CRC. Experience and knowledge of Internet use had a significant impact on the utilization of CRC screening. This analysis suggests that the design and publishing websites concerning CRC should emphasize credibility and reliance. Websites providing information about CRC must also contain the most current information so that people are able to make educated decisions about CRC screening. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Using Formative Research to Design a Behavior Change Strategy to Increase the Use of Improved Cookstoves in Peri-Urban Kampala, Uganda

by Stephanie L. Martin, Jennifer K. Arney, Lisa M. Mueller, Edward Kumakech, Fiona Walugembe and Emmanuel Mugisha

Int. J. Environ. Res. Public Health 2013, 10(12), 6920-6938; https://doi.org/10.3390/ijerph10126920 - 10 Dec 2013

Cited by 17 | Viewed by 8804

Abstract

Household air pollution from cooking with biomass fuels negatively impacts maternal and child health and the environment, and contributes to the global burden of disease. In Uganda, nearly 20,000 young children die of household air pollution-related pneumonia every year. Qualitative research was used [...] Read more.

Household air pollution from cooking with biomass fuels negatively impacts maternal and child health and the environment, and contributes to the global burden of disease. In Uganda, nearly 20,000 young children die of household air pollution-related pneumonia every year. Qualitative research was used to identify behavioral determinants related to the acquisition and use of improved cookstoves in peri-urban Uganda. Results were used to design a behavior change strategy for the introduction of a locally-fabricated top-lit updraft gasifier (TLUD) stove in Wakiso district. A theoretical framework—opportunity, ability, and motivation—was used to guide the research and behavior change strategy development. Participants consistently cited financial considerations as the most influential factor related to improved cookstove acquisition and use. In contrast, participants did not prioritize the potential health benefits of improved cookstoves. The theoretical framework, research methodology, and behavior change strategy design process can be useful for program planners and researchers interested in identifying behavioral determinants and designing and evaluating improved cookstove interventions. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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A Cross-Cultural Comparison of Health Behaviors between Saudi and British Adolescents Living in Urban Areas: Gender by Country Analyses

by Hazzaa M. Al-Hazzaa, Yahya Al-Nakeeb, Michael J. Duncan, Hana I. Al-Sobayel, Nada A. Abahussain, Abdulrahman O. Musaiger, Mark Lyons, Peter Collins and Alan Nevill

Int. J. Environ. Res. Public Health 2013, 10(12), 6701-6720; https://doi.org/10.3390/ijerph10126701 - 3 Dec 2013

Cited by 31 | Viewed by 11090

Abstract

This study investigated the cross-cultural differences and similarity in health behaviors between Saudi and British adolescents. A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The [...] Read more.

This study investigated the cross-cultural differences and similarity in health behaviors between Saudi and British adolescents. A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14–18 year-olds) were randomly selected using a multistage stratified cluster sampling technique. Measurements included anthropometric, screen time, validated physical activity (PA) questionnaire and dietary habits. The overweight/obesity prevalence among Saudi adolescents (38.3%) was significantly (p < 0.001) higher than that found among British adolescents (24.1%). The British adolescents demonstrated higher total PA energy expenditure than Saudi adolescents (means ± SE = 3,804.8 ± 81.5 vs. 2,219.9 ± 65.5 METs-min/week). Inactivity prevalence was significantly (p < 0.001) higher among Saudi adolescents (64%) compared with that of British adolescents (25.5%). The proportions of adolescents exceeding 2 h of daily screen time were high (88.0% and 90.8% among Saudis and British, respectively). The majority of Saudi and British adolescents did not have daily intakes of breakfast, fruit, vegetables and milk. MANCOVA showed significant (p < 0.05) gender by country interactions in several lifestyle factors. There was a significant (p < 0.001) gender differences in the ratio of physical activity to sedentary behaviors. In conclusion, Saudi and British adolescents demonstrated some similarities and differences in their PA levels, sedentary behaviors and dietary habits. Unhealthy lifestyle behaviors among adolescents appear to be a cross-cultural phenomenon. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Female University Students’ Physical Activity Levels and Associated Factors—A Cross-Sectional Study in Southwestern Saudi Arabia

by Atika Khalaf, Örjan Ekblom, Jan Kowalski, Vanja Berggren, Albert Westergren and Hazzaa Al-Hazzaa

Int. J. Environ. Res. Public Health 2013, 10(8), 3502-3517; https://doi.org/10.3390/ijerph10083502 - 9 Aug 2013

Cited by 60 | Viewed by 14382

Abstract

Background: The high prevalence of physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to examine the prevalence of physical activity (PA) and associated factors among female university students. Methods: This cross-sectional study involved 663 [...] Read more.

Background: The high prevalence of physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to examine the prevalence of physical activity (PA) and associated factors among female university students. Methods: This cross-sectional study involved 663 randomly selected female university students who completed the Arab Teens Life Style questionnaire. Data included measurements of anthropometric, socioeconomic and environmental factors, as well as self-reported PA. Ordinal regression was used to identify associated factors with low, moderate and high PA levels. Results: The mean age of participants was 20.4 years (SD 1.5). Mean BMI of the students in relation to PA were 23.0, 22.9, 22.1 for high, moderate and low levels of activity, respectively. The analysis revealed significantly higher PA levels among married students, those with high educated mothers, and those who lived far from parks, and lower activity levels among underweight students. Conclusions: This study raises four important determinants for female university students’ PA levels. These factors could be of great importance in the endeavor to prevent the health-threatening increase in physical inactivity patterns and thus non-communicable diseases and obesity where the focus should be on the specific situation and needs of women in Saudi Arabia. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Heat Waves and Climate Change: Applying the Health Belief Model to Identify Predictors of Risk Perception and Adaptive Behaviours in Adelaide, Australia

by Derick A. Akompab, Peng Bi, Susan Williams, Janet Grant, Iain A. Walker and Martha Augoustinos

Int. J. Environ. Res. Public Health 2013, 10(6), 2164-2184; https://doi.org/10.3390/ijerph10062164 - 29 May 2013

Cited by 116 | Viewed by 17649

Abstract

Heat waves are considered a health risk and they are likely to increase in frequency, intensity and duration as a consequence of climate change. The effects of heat waves on human health could be reduced if individuals recognise the risks and adopt healthy [...] Read more.

Heat waves are considered a health risk and they are likely to increase in frequency, intensity and duration as a consequence of climate change. The effects of heat waves on human health could be reduced if individuals recognise the risks and adopt healthy behaviours during a heat wave. The purpose of this study was to determine the predictors of risk perception using a heat wave scenario and identify the constructs of the health belief model that could predict adaptive behaviours during a heat wave. A cross-sectional study was conducted during the summer of 2012 among a sample of persons aged between 30 to 69 years in Adelaide. Participants’ perceptions were assessed using the health belief model as a conceptual frame. Their knowledge about heat waves and adaptive behaviours during heat waves was also assessed. Logistic regression analyses were performed to determine the predictors of risk perception to a heat wave scenario and adaptive behaviours during a heat wave. Of the 267 participants, about half (50.9%) had a high risk perception to heat waves while 82.8% had good adaptive behaviours during a heat wave. Multivariate models found that age was a significant predictor of risk perception. In addition, participants who were married (OR = 0.21; 95% CI, 0.07–0.62), who earned a gross annual household income of ≥$60,000 (OR = 0.41; 95% CI, 0.17–0.94) and without a fan (OR = 0.29; 95% CI, 0.11–0.79) were less likely to have a high risk perception to heat waves. Those who were living with others (OR = 2.87; 95% CI, 1.19–6.90) were more likely to have a high risk perception to heat waves. On the other hand, participants with a high perceived benefit (OR = 2.14; 95% CI, 1.00–4.58), a high “cues to action” (OR = 3.71; 95% CI, 1.63–8.43), who had additional training or education after high school (OR = 2.65; 95% CI, 1.25–5.58) and who earned a gross annual household income of ≥$60,000 (OR = 2.66; 95% CI, 1.07–6.56) were more likely to have good adaptive behaviours during a heat wave. The health belief model could be useful to guide the design and implementation of interventions to promote adaptive behaviours during heat waves. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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A Study of the Perception of Health Risks among College Students in China

by Chenggang Zhang and Jingbo Fan

Int. J. Environ. Res. Public Health 2013, 10(6), 2133-2149; https://doi.org/10.3390/ijerph10062133 - 27 May 2013

Cited by 16 | Viewed by 8986

Abstract

The present survey was designed to investigate the perception of health risks among college students in China. The data are the responses of a sample of 3,069 college students at one university to surveys that include measures of several dimensions of public judgments [...] Read more.

The present survey was designed to investigate the perception of health risks among college students in China. The data are the responses of a sample of 3,069 college students at one university to surveys that include measures of several dimensions of public judgments about fifteen specific hazards. Chinese college students conveyed their concerns as falling into three broad categories: Environmental (e.g., global warming, natural catastrophes, the ozone hole, air pollution, chemical pollution, pesticides in food), Technological (e.g., nuclear power stations, thermal power, genetically modified food, medical X-rays), and Social (cigarette smoking, drinking alcohol, overtime study or work, mental stress, motor vehicle accidents). The data were collected with a self-report questionnaire. Descriptive statistics were used to illustrate the levels of perceived risk according to the percent of “high risk” responses as well as the mean response values. Generally, the hazards that were perceived as posing the greatest health risk were those belonging to the social health risks; items related to technology risks received the lowest percentage of “high health risk” rankings. Traditional environmental risks such as natural catastrophes, pollution issues (chemical pollution, air pollution), and pesticides in food were ranked as being relatively high risks. The respondents were less concerned about new emerging issues and long-term environmental risks (global warming). In this survey, motor vehicle accidents were considered to be a “high health risk” by the greatest percentage of respondents. Generally speaking, the female respondents’ degree of recognition of health risks is higher than that of male respondents. Only for the item of smoking was the male respondents’ degree higher than that of females. There is also a geographic imbalance in the health risk perceptions. The degree of recognition of health risks from respondents in municipalities is generally lower than that of respondents from other areas except for items such as natural disasters, smoking, medical X-rays, and mental stress, which are exceptions. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Screening and Brief Interventions for Hazardous and Harmful Alcohol Use among University Students in South Africa: Results from a Randomized Controlled Trial

by Supa Pengpid, Karl Peltzer, Hendry Van der Heever and Linda Skaal

Int. J. Environ. Res. Public Health 2013, 10(5), 2043-2057; https://doi.org/10.3390/ijerph10052043 - 21 May 2013

Cited by 41 | Viewed by 9115

Abstract

The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to [...] Read more.

The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was −1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Environmental and Individual Correlates of Various Types of Physical Activity among Community-Dwelling Middle-Aged and Elderly Japanese

by Yoshinobu Saito, Yuko Oguma, Shigeru Inoue, Ayumi Tanaka and Yoshitaka Kobori

Int. J. Environ. Res. Public Health 2013, 10(5), 2028-2042; https://doi.org/10.3390/ijerph10052028 - 17 May 2013

Cited by 34 | Viewed by 8006

Abstract

Recent studies have suggested the importance of the neighborhood environment in determining the specific type of physical activity. However, few studies on this topic have been undertaken in Japan. This study examined the association of three types of physical activity and their associations [...] Read more.

Recent studies have suggested the importance of the neighborhood environment in determining the specific type of physical activity. However, few studies on this topic have been undertaken in Japan. This study examined the association of three types of physical activity and their associations with individual and neighborhood environmental factors among middle-aged and elderly Japanese. Participants were 2,449 adults aged 40–69 living in Fujisawa city who had undergone health checkups and responded to our survey by mail. Individual factors, the International Physical Activity Questionnaire (long form), and its environmental module acted as inputs to the study. The adjusted odds ratios (ORs) of high levels of moderate-to-vigorous intensity leisure-time physical activity (LTPA), walking for active recreation, and transportation were calculated in relation to individual and neighborhood environmental factors through multiple logistic regression models. Not working and good self-rated health were significantly associated with a higher level of each physical activity outcome. According to the adjusted ORs, higher educational attainment, higher economic status, good access to exercise facilities, and owning motor vehicles were associated with longer LTPA time. However, different sets of factors were associated with longer walking times for recreation and transportation. The results suggest that diverse individual and neighborhood environmental characteristics are associated with different physical activity outcomes. Therefore, customizing environments to become activity-friendly is necessary to increase physical activity effectively among middle-aged and elderly Japanese. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Investigating Unmet Health Needs in Primary Health Care Services in a Representative Sample of the Greek Population

by Evelina Pappa, Nick Kontodimopoulos, Angelos Papadopoulos, Yannis Tountas and Dimitris Niakas

Int. J. Environ. Res. Public Health 2013, 10(5), 2017-2027; https://doi.org/10.3390/ijerph10052017 - 17 May 2013

Cited by 91 | Viewed by 10264

Abstract

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the [...] Read more.

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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The Role of Community Centre-based Arts, Leisure and Social Activities in Promoting Adult Well-being and Healthy Lifestyles

by Mat Jones, Richard Kimberlee, Toity Deave and Simon Evans

Int. J. Environ. Res. Public Health 2013, 10(5), 1948-1962; https://doi.org/10.3390/ijerph10051948 - 10 May 2013

Cited by 49 | Viewed by 15524

Abstract

Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to [...] Read more.

Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Exposure to Drinking Water Trihalomethanes and Their Association with Low Birth Weight and Small for Gestational Age in Genetically Susceptible Women

by Asta Danileviciute, Regina Grazuleviciene, Jone Vencloviene, Algimantas Paulauskas and Mark J. Nieuwenhuijsen

Int. J. Environ. Res. Public Health 2012, 9(12), 4470-4485; https://doi.org/10.3390/ijerph9124470 - 6 Dec 2012

Cited by 30 | Viewed by 7577

Abstract

Little is known about genetic susceptibility to individual trihalomethanes (THM) in relation to adverse pregnancy outcomes. We conducted a nested case-control study of 682 pregnant women in Kaunas (Lithuania) and, using individual information on drinking water, ingestion, showering and bathing, and uptake factors [...] Read more.

Little is known about genetic susceptibility to individual trihalomethanes (THM) in relation to adverse pregnancy outcomes. We conducted a nested case-control study of 682 pregnant women in Kaunas (Lithuania) and, using individual information on drinking water, ingestion, showering and bathing, and uptake factors of THMs in blood, estimated an internal THM dose. We used logistic regression to evaluate the relationship between internal THM dose, birth outcomes and individual and joint (modifying) effects of metabolic gene polymorphisms. THM exposure during entire pregnancy and specific trimesters slightly increased low birth weight (LBW) risk. When considering both THM exposure and maternal genotypes, the largest associations were found for third trimester among total THM (TTHM) and chloroform-exposed women with the GSTM1–0 genotype (OR: 4.37; 95% CI: 1.36–14.08 and OR: 5.06; 95% CI: 1.50–17.05, respectively). A test of interaction between internal THM dose and GSTM1–0 genotype suggested a modifying effect of exposure to chloroform and bromodichloromethane on LBW risk. However, the effect on small for gestational age (SGA) was not statistically significant. These data suggest that THM internal dose may affect foetal growth and that maternal GSTM1 genotype modifies the THM exposure effects on LBW. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Fruits and Vegetables Consumption and Associated Factors among In-School Adolescents in Five Southeast Asian Countries

by Karl Peltzer and Supa Pengpid

Int. J. Environ. Res. Public Health 2012, 9(10), 3575-3587; https://doi.org/10.3390/ijerph9103575 - 11 Oct 2012

Cited by 59 | Viewed by 10810

Abstract

The aim of the study was to assess the prevalence of fruits and vegetable consumption and associated factors among Southeast Asian in-school adolescents. Data were collected by self-report questionnaire from nationally representative samples (total 16,084) of school children aged 13 to 15 years [...] Read more.

The aim of the study was to assess the prevalence of fruits and vegetable consumption and associated factors among Southeast Asian in-school adolescents. Data were collected by self-report questionnaire from nationally representative samples (total 16,084) of school children aged 13 to 15 years in five Southeast Asian countries. Overall, 76.3% of the 13 to 15 year-olds had inadequate fruits and vegetables consumptions (less than five servings per day); 28% reported consuming fruits less than once per day and 13.8% indicated consuming vegetables less than once per day. In multivariable analysis, lack of protective factors and being physically inactive were associated with inadequate fruits and vegetable consumption, and sedentary behaviour and being overweight was protective of inadequate fruits and vegetable consumption. The results stress the need for intervention programmes aimed at increased consumption of fruits and vegetables, targeting proximal factors such as the family environment and distal factors by aiming at integrating other risk factors such as physical activity into health promotion among adolescents. Full article

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Helmet Use and Associated Factors among Thai Motorcyclists during Songkran Festival

by Penprapa Siviroj, Karl Peltzer, Supa Pengpid and Sompong Morarit

Int. J. Environ. Res. Public Health 2012, 9(9), 3286-3297; https://doi.org/10.3390/ijerph9093286 - 10 Sep 2012

Cited by 25 | Viewed by 9275

Abstract

The aim of this study was to assess helmet use and associated factors among motorcycle riders during Songkran festival in Thailand. A cross-sectional survey was conducted to determine the prevalence of helmet use among Thai motorcycle riders (sample size = 18,998) during four [...] Read more.

The aim of this study was to assess helmet use and associated factors among motorcycle riders during Songkran festival in Thailand. A cross-sectional survey was conducted to determine the prevalence of helmet use among Thai motorcycle riders (sample size = 18,998) during four days of the Songkran festival. For this sample, the population of motorcycle riders was consecutively selected using quota sampling from 12 petrol stations in four provinces from each of the four main geographical regions of Thailand. The study was conducted at petrol stations at roads in town, outside town and highway at different time intervals when trained field staff administered a structured questionnaire and performed an observation checklist. Results indicate that 44.2% of the motorcycle riders and 72.5% of the motorcycle passengers had not been using a helmet. In multivariable analysis demographics, environmental factors, helmet use experiences and attitudes and recalling a lower exposure to road safety awareness (RSA) campaign were associated with non-helmet use among motorcyclists. It appears that the RSA campaign may have some positive effect on reducing non-helmet use among motorcycle riders during the Songkran festival. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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The Impact of the Built Environment on Young People’s Physical Activity Patterns: A Suburban-Rural Comparison Using GPS

by Peter Collins, Yahya Al-Nakeeb, Alan Nevill and Mark Lyons

Int. J. Environ. Res. Public Health 2012, 9(9), 3030-3050; https://doi.org/10.3390/ijerph9093030 - 24 Aug 2012

Cited by 42 | Viewed by 9994

Abstract

The built environment in which young people live has a significant influence on their physical activity (PA). However, little is known regarding how youth from suburban and rural settings utilise their surrounding environments to participate in free-living PA. 50 adolescents aged 13–14 years [...] Read more.

The built environment in which young people live has a significant influence on their physical activity (PA). However, little is known regarding how youth from suburban and rural settings utilise their surrounding environments to participate in free-living PA. 50 adolescents aged 13–14 years old (22 rural; 28 suburban) wore an integrated GPS and heart rate device during non-school hours and completed a daily PA diary over 7 days. Descriptive statistics and analyses of variance were used to explore differences in the amount and location of moderate-to-vigorous physical activity (MVPA) between genders and youth from different geographical settings. Suburban youth participated in significantly (p = 0.004) more daily PA (52.14 minutes MVPA) and were more extensive in their utilisation of their surroundings, compared to rural youth (26.61 minutes MVPA). Suburban youth visited more public recreational facilities and spent significantly more time outdoors and on local streets (109.71 minutes and 44.62 minutes, respectively) compared to rural youth (55.98 minutes and 17.15 minutes, respectively) during weekdays. Rural youth on average spent significantly more time within the home (350.69 minutes) during weekends compared to suburban youth (214.82 minutes). Rural females were the least active group of adolescents, participating in the least amount of daily PA (20.14 minutes MVPA) and spending the least amount of time outdoors (31.37 minutes) during weekdays. Time spent outdoors was positively associated with PA. The findings highlight the disparity in PA levels and the utilisation of the surrounding built environment between youth from two different geographical settings and possible environmental causes are discussed. The study supports the use of GPS (combined with other methods) in investigating geographical differences in young people’s PA and movement patterns. This method provides a wealth of information that may assist future policies and interventions in identifying environmental characteristics that promote PA in youth from different geographical settings. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Comparison of BMI Derived from Parent-Reported Height and Weight with Measured Values: Results from the German KiGGS Study

by Anna-Kristin Brettschneider, Ute Ellert and Angelika Schaffrath Rosario

Int. J. Environ. Res. Public Health 2012, 9(2), 632-647; https://doi.org/10.3390/ijerph9020632 - 16 Feb 2012

Cited by 37 | Viewed by 8197

Abstract

The use of parent-reported height and weight is a cost-efficient instrument to assess the prevalence of children’s weight status in large-scale surveys. This study aimed to examine the accuracy of BMI derived from parent-reported height and weight and to identify potential predictors of [...] Read more.

The use of parent-reported height and weight is a cost-efficient instrument to assess the prevalence of children’s weight status in large-scale surveys. This study aimed to examine the accuracy of BMI derived from parent-reported height and weight and to identify potential predictors of the validity of BMI derived from parent-reported data. A subsample of children aged 2–17 years (n = 9,187) was taken from the 2003–2006 cross-sectional German KiGGS study. Parent-reported and measured height and weight were collected and BMI was calculated. Besides descriptive analysis, linear regression models with BMI difference and logistic regression models with weight status misclassification as dependent variables were calculated. Height differences varied by gender and were generally small. Weight and BMI were under-reported in all age groups, the under-reporting getting stronger with increasing age. Overall, the proportion for overweight and obesity based on parental and measured reports differed slightly. In the youngest age group, the proportion of overweight children was overestimated, while it was underestimated for older children and adolescents. Main predictors of the difference between parent reported and measured values were age, gender, weight status and parents’ perception of the child’s weight. In summary, the exclusive use of uncorrected parental reports for assessment of prevalence rates of weight status is not recommended. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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The Relevance of Personal Characteristics in Allocating Health Care Resources—Controversial Preferences of Laypersons with Different Educational Backgrounds

by Jeannette Winkelhage and Adele Diederich

Int. J. Environ. Res. Public Health 2012, 9(1), 223-243; https://doi.org/10.3390/ijerph9010223 - 16 Jan 2012

Cited by 21 | Viewed by 8437

Abstract

In all industrial countries publicly funded health care systems are confronted with budget constraints. Therefore, priority setting in resource allocation seems inevitable. This paper examines whether personal characteristics could be taken into consideration when allocating health services in Germany, and whether attitudes towards [...] Read more.

In all industrial countries publicly funded health care systems are confronted with budget constraints. Therefore, priority setting in resource allocation seems inevitable. This paper examines whether personal characteristics could be taken into consideration when allocating health services in Germany, and whether attitudes towards prioritizing health care vary among individuals with different levels of education. Using a conjoint analysis approach, hypothetical patients described in terms of ‘lifestyle’, ‘age’, ‘severity of illness’, ‘type of illness’, ‘improvement in health’, and ‘treatment costs’ were constructed, and the importance weights for these personal characteristics were elicited from 120 members of the general public. Participants were selected according to a sampling guide including educational background, age, chronic illness and gender. Results are reported for groups with different levels of education (low, middle, high) only. The findings show that the patients’ age is the most important criterion for the allocation of health care resources, followed by ‘severity of illness’ and ‘improvement in health’. Preferences vary among participants with different educational backgrounds, which refer to different attitudes towards distributive justice and might represent different socialization experiences. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Implications of Edentulism on Quality of Life among Elderly

by Suely Maria Rodrigues, Ana Cristina Oliveira, Andréa Maria Duarte Vargas, Allyson Nogueira Moreira and Efigênia Ferreira e Ferreira

Int. J. Environ. Res. Public Health 2012, 9(1), 100-109; https://doi.org/10.3390/ijerph9010100 - 4 Jan 2012

Cited by 61 | Viewed by 11065

Abstract

This study aimed was to test the association between quality of life and edentulism among elderly individuals in a city in southeastern Brazil. This cross-sectional study was carried out with 163 individuals aged 60 years or older, functionally independent and non-institutionalized. Data were [...] Read more.

This study aimed was to test the association between quality of life and edentulism among elderly individuals in a city in southeastern Brazil. This cross-sectional study was carried out with 163 individuals aged 60 years or older, functionally independent and non-institutionalized. Data were collected with a questionnaire and oral examination. The edentulism was the dependent variable. The independent variables were sex, age, household income and quality of life (WHOQOL-Old) and their scores. To assess the association between the dependent variable and independent variables was used bivariate analysis (p < 0.10). Poisson regression model was performed, adjusting for age and sex. The average age of participants was 69 years (± 6.1), 68.7% were female and 52.8% were diagnosed as completely edentulous (90% CI: 0.33–1.24). When the independent variables were associated to the prevalence of edentulism, statistically significant associations were found for age (p = 0.03) and social participation dimension of the WHOQOL-Old (p = 0.08). In the Poisson regression, social participation remained statistically associated to edentulism {RP = 2.12 [90% CI (1.10–4.00)]}. The social participation proved to have a significant association to edentulism, thereby attesting to the negative effect of this condition on social aspects. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Self-Reported Dental Fear among Dental Students and Their Patients

by Junia Serra-Negra, Saul M. Paiva, Mauricio Oliveira, Efigenia Ferreira, Fernanda Freire-Maia and Isabela Pordeus

Int. J. Environ. Res. Public Health 2012, 9(1), 44-54; https://doi.org/10.3390/ijerph9010044 - 29 Dec 2011

Cited by 18 | Viewed by 8961

Abstract

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from [...] Read more.

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from 18 to 65 years participated in the study. A self-administered pre-tested questionnaire consisting of 13 items was used for data acquisition. The city of Belo Horizonte Social Vulnerability Index (SVI) was employed for socioeconomic classification. The chi-square test and binary and multinomial logistic regression were employed in the statistical analysis, with the significance level set at 0.05. The majority of dental students (76.5%) sought the dentist for the first time for a routine exam, while patients (77.3%) mostly sought a dentist for the treatment of dental pain. Dental fear was more prevalent among the patients (72.5%) than the students (27.5%). A total of 47.1% of the students and 52.9% of the patients reported having had negative dental experiences in childhood. The logistic model revealed an association between dental fear and a pain-related experience (OR: 1.8; 95%CI: 1.3–2.6). Patients were more prone to dental fear (OR: 2.2; 95%CI: 1.0–5.0). Although at different percentages, both students and patients experienced dental fear. Current patient with previous experience of dental pain had more dental fear. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Physician Consultations According to Different BMI Levels of the Greek General Population

by Evelina Pappa, Nick Kontodimopoulos, Angelos A. Papadopoulos, Yannis Tountas and Dimitris Niakas

Int. J. Environ. Res. Public Health 2011, 8(11), 4300-4311; https://doi.org/10.3390/ijerph8114300 - 14 Nov 2011

Cited by 2 | Viewed by 6824

Abstract

Obesity constitutes a global epidemic which is rapidly becoming a major public health problem in many parts of the world, threatening peoples’ health and quality of life. The aim of our study was to estimate the prevalence and impact of overweight and obesity [...] Read more.

Obesity constitutes a global epidemic which is rapidly becoming a major public health problem in many parts of the world, threatening peoples’ health and quality of life. The aim of our study was to estimate the prevalence and impact of overweight and obesity on physician consultations and frequency of use and furthermore, to investigate whether physician consultations in each of the groups defined by BMI level correspond to the need for care implied by health risk level, using logistic regression models. The survey was carried out in Greece in 2006 and involved complete data from 645 individuals consulted by physicians. Overweight and obese users constituted 41.7% and 19% of the sample respectively. The findings showed firstly that the odds of obese individuals visiting a physician (OR 2.15) or making more than three visits (OR 2.12) was doubled compared to the odds of individuals with normal weight. Secondly, we conclude that physician consultations in overweight and obese subgroups as well as the frequency of visits were predicted by factors such as co-morbidities, low HRQL, low educational level which are associated directly or indirectly with obesity, and thus with a greater health need, assuming vertical equity in the utilization of such services. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Knowledge, Attitudes, and Behavior in Avoiding Secondhand Smoke Exposure Among Non-Smoking Employed Women with Higher Education in Jordan

by Huda Gharaibeh, Linda Haddad, Sukaina Alzyoud, Omar El-Shahawy, Nesrin Abu Baker and Mary Umlauf

Int. J. Environ. Res. Public Health 2011, 8(11), 4207-4219; https://doi.org/10.3390/ijerph8114207 - 9 Nov 2011

Cited by 45 | Viewed by 10261

Abstract

Secondhand smoke (SHS) exposure is a serious public health threat worldwide; in the developing world there are less serious efforts towards controlling women’s and children’s exposure to SHS. Knowledge, attitudes and avoidance practices among Jordanian women have never been thoroughly studied. The purpose [...] Read more.

Secondhand smoke (SHS) exposure is a serious public health threat worldwide; in the developing world there are less serious efforts towards controlling women’s and children’s exposure to SHS. Knowledge, attitudes and avoidance practices among Jordanian women have never been thoroughly studied. The purpose of this study was to assess the knowledge, attitudes, and avoidance behavior towards SHS exposure among employed Jordanian women with higher education. Methods: A survey was conducted among employed Jordanian women at two universities. A total of 209 women were included in the analysis. Two questionnaires regarding SHS exposure were used to measure knowledge, attitudes and avoidance practices. Results: Most respondents were regularly exposed to SHS in various locations during daily life, even though they were very knowledgeable about the dangers of SHS exposure for women and children. However, the subject’s attitudes and avoidance behavior did not reflect the level of knowledge about SHS risks. The results suggests there is a large discrepancy between SHS exposure, knowledge, attitudes and avoidance behavior among highly educated Jordanian women that is likely influenced by culture and traditional gender roles. Public health initiatives are needed in Jordan to address public policy, institutional practices and to empowerment of women to reduce SHS exposure. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Influenza Vaccination Among Adults 65 Years or Older: A 2009–2010 Community Health Survey in the Honam Region of Korea

by So Yeon Ryu, So Hui Kim, Hyung Su Park and Jong Park

Int. J. Environ. Res. Public Health 2011, 8(11), 4197-4206; https://doi.org/10.3390/ijerph8114197 - 8 Nov 2011

Cited by 27 | Viewed by 7573

Abstract

The present study examined the rates and related factors for influenza vaccination among the elderly Korean population during the 2008/09 influenza seasons. We obtained data for 6,391 adults aged 65 years or older from Community Health Surveys conducted in 2009 and 2010 in [...] Read more.

The present study examined the rates and related factors for influenza vaccination among the elderly Korean population during the 2008/09 influenza seasons. We obtained data for 6,391 adults aged 65 years or older from Community Health Surveys conducted in 2009 and 2010 in 13 communities in the Honam region of Korea. A multiple logistic regression analysis was used to identify the factors associated with self-reported influenza vaccinations. In this elderly population, 81.7% reported to having received an influenza vaccination in the past year. The main contributing factors were older age, lower economic status, lower educational level, married, non-smoking, regular alcohol consumption, regular walking exercise, receiving a health check-up during the past two years, not stressed, and having comorbid conditions. The influenza vaccination coverage rate among elderly Koreans was relatively high, but improvements in vaccination rates are required. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Street Connectivity is Negatively Associated with Physical Activity in Canadian Youth

by Graham Mecredy, William Pickett and Ian Janssen

Int. J. Environ. Res. Public Health 2011, 8(8), 3333-3350; https://doi.org/10.3390/ijerph8083333 - 16 Aug 2011

Cited by 60 | Viewed by 10607

Abstract

Street connectivity, defined as how well streets connect to one and other and the density of intersections, is positively associated with active transportation in adults. Our objective was to study the relation between street connectivity and physical activity in youth. Study participants consisted [...] Read more.

Street connectivity, defined as how well streets connect to one and other and the density of intersections, is positively associated with active transportation in adults. Our objective was to study the relation between street connectivity and physical activity in youth. Study participants consisted of 8,535 students in grades 6–10 from 180 schools across Canada who completed the 2006 Health Behaviour in School-aged Children (HBSC) survey. Street connectivity was measured in a 5 km circular buffer around these schools using established geographic information system measures. Physical activity performed outside of school hours was assessed by questionnaire, and multi-level regression analyses were used to estimate associations with street connectivity after controlling for several covariates. Compared to students living in the highest street connectivity quartile, those in the second (relative risk = 1.22, 95% confidence interval = 1.10–1.35), third (1.25, 1.13–1.37), and fourth (1.21, 1.09–1.34) quartiles were more likely to be physically active outside of school. In conclusion, youth in neighbourhoods with the most highly connected streets reported less physical activity outside of school than youth from neighbourhoods with less connected streets. Relationships between street connectivity and physical activity reported in this national study are in the opposite direction to those previously observed for active transportation in adult populations. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Prevalence of Symptoms of Severe Asthma and Allergies in Irish School Children: An ISAAC Protocol Study, 1995–2007

by Zubair Kabir, Patrick J. Manning, Jean Holohan, Patrick G. Goodman and Luke Clancy

Int. J. Environ. Res. Public Health 2011, 8(8), 3192-3201; https://doi.org/10.3390/ijerph8083192 - 2 Aug 2011

Cited by 20 | Viewed by 9213

Abstract

Childhood asthma is a recurring health burden and symptoms of severe asthma in children are also emerging as a health and economic issue. This study examined changing patterns in symptoms of severe asthma and allergies (ever eczema and hay fever), using the Irish [...] Read more.

Childhood asthma is a recurring health burden and symptoms of severe asthma in children are also emerging as a health and economic issue. This study examined changing patterns in symptoms of severe asthma and allergies (ever eczema and hay fever), using the Irish International Study of Asthma and Allergies in Childhood (ISAAC) protocol. ISAAC is a cross-sectional self-administered questionnaire survey of randomly selected representative post-primary schools. Children aged 13–14 years were studied: 2,670 (in 1995), 2,273 (in 1998), 2,892 (in 2002–2003), and 2,805 (in 2007). Generalized linear modelling using Poisson distribution was employed to compute adjusted prevalence ratios (PR). A 39% significant increase in symptoms of severe asthma was estimated in 2007 relative to the baseline year 1995 (adjusted PR: 1.39 [95% CI: 1.14–1.69]) increasing from 12% in 1995 to 15.3% in 2007. Opposite trends were observed for allergies, showing a decline in 2007, with an initial rise. The potential explanations for such a complex disease pattern whose aetiological hypothesis is still evolving are speculative. Changing environmental factors may be a factor, for instance, an improvement in both outdoor and indoor air quality further reinforcing the hygiene hypothesis but obesity as a disease modifier must also be considered. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Aging Risk and Health Care Expenditure in Korea

by Byongho Tchoe and Sang-Ho Nam

Int. J. Environ. Res. Public Health 2010, 7(8), 3235-3254; https://doi.org/10.3390/ijerph7083235 - 20 Aug 2010

Cited by 22 | Viewed by 12053

Abstract

This paper analyzes the impact of population aging on health care expenditures in Korea. Examination of the age-expenditure profile reveals that health care resources are allocated more for the older cohort of population over time, suggesting significant growth of health care expenditures due [...] Read more.

This paper analyzes the impact of population aging on health care expenditures in Korea. Examination of the age-expenditure profile reveals that health care resources are allocated more for the older cohort of population over time, suggesting significant growth of health care expenditures due to population aging. We contend, however, that population aging is considered as a parameter rather than an independent variable to explain rising health care expenditures. This paper shows that population aging is not found to be a significant determinant of health care expenditures according to the econometric analysis using OECD health data and time-series data for Korea. Using the components decomposition method, which measures the contribution of each component of health care expenditure, we estimate that population aging contributes only less than 10 percent. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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The Global Challenge of Antimicrobial Resistance: Insights from Economic Analysis

by Karen Eggleston, Ruifang Zhang and Richard J. Zeckhauser

Int. J. Environ. Res. Public Health 2010, 7(8), 3141-3149; https://doi.org/10.3390/ijerph7083141 - 9 Aug 2010

Cited by 32 | Viewed by 12291

Abstract

The prevalence of antimicrobial resistance (AR) limits the therapeutic options for treatment of infections, and increases the social benefit from disease prevention. Like an environmental resource, antimicrobials require stewardship. The effectiveness of an antimicrobial agent is a global public good. We argue for [...] Read more.

The prevalence of antimicrobial resistance (AR) limits the therapeutic options for treatment of infections, and increases the social benefit from disease prevention. Like an environmental resource, antimicrobials require stewardship. The effectiveness of an antimicrobial agent is a global public good. We argue for greater use of economic analysis as an input to policy discussion about AR, including for understanding the incentives underlying health behaviors that spawn AR, and to supplement other methods of tracing the evolution of AR internationally. We also discuss integrating antimicrobial stewardship into global health governance.The prevalence of antimicrobial resistance (AR) limits the therapeutic options for treatment of infections, and increases the social benefit from disease prevention. Like an environmental resource, antimicrobials require stewardship. The effectiveness of an antimicrobial agent is a global public good. We argue for greater use of economic analysis as an input to policy discussion about AR, including for understanding the incentives underlying health behaviors that spawn AR, and to supplement other methods of tracing the evolution of AR internationally. We also discuss integrating antimicrobial stewardship into global health governance. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Promotion of Physical Activity Using Point-of-Decision Prompts in Berlin Underground Stations

by Falk Müller-Riemenschneider, Marc Nocon, Thomas Reinhold and Stefan N. Willich

Int. J. Environ. Res. Public Health 2010, 7(8), 3063-3070; https://doi.org/10.3390/ijerph7083063 - 4 Aug 2010

Cited by 12 | Viewed by 10493

Abstract

To evaluate point-of-decision prompts in the promotion of stair use in Germany, motivational posters were placed at three underground stations in Berlin. The proportion of passengers using stairs or stairways was counted before, during installation, and two weeks after removal of posters. In [...] Read more.

To evaluate point-of-decision prompts in the promotion of stair use in Germany, motivational posters were placed at three underground stations in Berlin. The proportion of passengers using stairs or stairways was counted before, during installation, and two weeks after removal of posters. In total, 5,467 passersby were counted. Stair use increased significantly in women, but not in men. The present pilot study thereby shows that the use of point-of-decision prompts is also feasible in Germany and it provides some evidence of effectiveness. Methodologically rigorous studies are warranted to confirm these findings. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Micro Data Analysis of Medical and Long-Term Care Utilization Among the Elderly in Japan

by Hideki Hashimoto, Hiromasa Horiguchi and Shinya Matsuda

Int. J. Environ. Res. Public Health 2010, 7(8), 3022-3037; https://doi.org/10.3390/ijerph7083022 - 30 Jul 2010

Cited by 36 | Viewed by 12195

Abstract

Japan is currently experiencing the most rapid population aging among all OECD countries. Increasing expenditures on medical care in Japan have been attributed to the aging of the population. Authors in the recent debate on end-of-life care and long-term care (LTC) cost in [...] Read more.

Japan is currently experiencing the most rapid population aging among all OECD countries. Increasing expenditures on medical care in Japan have been attributed to the aging of the population. Authors in the recent debate on end-of-life care and long-term care (LTC) cost in the United States and Europe have attributed time to death and non-medical care cost for the aged as a source of rising expenditures. In this study, we analyzed a large sample of local public insurance claim data to investigate medical and LTC expenditures in Japan. We examined the impact of aging, time to death, survivorship, and use of LTC on medical care expenditure for people aged 65 and above. On the basis of these findings, we conclude that age is a contributing factor to the rising expenditures on LTC, and that the contribution of aging to rising medical care expenditures should be distinguished according to survivorship. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Successful Smoking Cessation and Duration of Abstinence—An Analysis of Socioeconomic Determinants

by Joachim Marti

Int. J. Environ. Res. Public Health 2010, 7(7), 2789-2799; https://doi.org/10.3390/ijerph7072789 - 30 Jun 2010

Cited by 30 | Viewed by 10349

Abstract

Smoking does not affect every socioeconomic subgroup of the population equally, resulting in major inequalities in terms of smoking-related morbidity and mortality. While previous studies mainly focused on inequalities in smoking prevalence, we have analysed the socioeconomic dimensions that might be associated with [...] Read more.

Smoking does not affect every socioeconomic subgroup of the population equally, resulting in major inequalities in terms of smoking-related morbidity and mortality. While previous studies mainly focused on inequalities in smoking prevalence, we have analysed the socioeconomic dimensions that might be associated with two other smoking-related outcomes: the odds of successfully quitting and the duration of abstinence. Using nationally representative Swiss data, we found evidence of a socioeconomic gradient in successful cessation and abstinence duration with respect to education level and income for both men and women. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

by Jordan W. Tompkins, Isaac N. Luginaah, Gillian L. Booth and Stewart B. Harris

Int. J. Environ. Res. Public Health 2010, 7(5), 2407-2422; https://doi.org/10.3390/ijerph7052407 - 19 May 2010

Cited by 10 | Viewed by 11013

Abstract

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic [...] Read more.

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, Canada) to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Adolescent Propensity to Engage in Health Risky Behaviors: The Role of Individual Resilience

by Mir M. Ali, Debra S. Dwyer, Elizabeth A. Vanner and Alexander Lopez

Int. J. Environ. Res. Public Health 2010, 7(5), 2161-2176; https://doi.org/10.3390/ijerph7052161 - 4 May 2010

Cited by 37 | Viewed by 12810

Abstract

In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs. Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience. Our analysis [...] Read more.

In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs. Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience. Our analysis reveals that the overall-resilient were less likely to engage in risky behaviors. The self/family resilient were more likely to engage in risky behaviors, but consumed less. The self-resilient had reduced risk for smoking and drinking alcohol but elevated risk for using illegal drugs and being in an addictive stage of smoking and drinking, if participating. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Are Adolescents with ADHD Interested in Genetic Testing for Nicotine Addiction Susceptibility?

by Linda J. Herbert, Leslie R. Walker, McKane E. Sharff, Anisha A. Abraham and Kenneth P. Tercyak

Int. J. Environ. Res. Public Health 2010, 7(4), 1694-1707; https://doi.org/10.3390/ijerph7041694 - 14 Apr 2010

Cited by 3 | Viewed by 11205

Abstract

It has been well-established that some adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking. Current research on the genetic basis of this association could ultimately translate into genetic tests capable of identifying smoking-prone adolescents with ADHD. In this [...] Read more.

It has been well-established that some adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking. Current research on the genetic basis of this association could ultimately translate into genetic tests capable of identifying smoking-prone adolescents with ADHD. In this study we examined 81 ADHD affected adolescents’ (age 13–21) interest in genetic testing for nicotine addiction susceptibility. Fifty-seven percent of adolescents indicated a fair amount of interest or more in testing. Most adolescents indicated that the personal information revealed from testing would be either useful (29%) or interesting (37%). Implications for genetically-informed smoking prevention and cessation interventions in high risk adolescents with ADHD are discussed. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessArticle

Barriers to Health Care among the Elderly in Japan

by Chiyoe Murata, Tetsuji Yamada, Chia-Ching Chen, Toshiyuki Ojima, Hiroshi Hirai and Katsunori Kondo

Int. J. Environ. Res. Public Health 2010, 7(4), 1330-1341; https://doi.org/10.3390/ijerph7041330 - 26 Mar 2010

Cited by 63 | Viewed by 16747

Abstract

Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted [...] Read more.

Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted in seven municipalities in 2006, to reveal clear-cut evidence of barriers to necessary care. The reasons for not getting health care is attributed to health care cost for the elderly with lower income, while higher income counterparts reported being busy or having a condition not serious enough to seek care. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Workplace Vaccination and Other Factors Impacting Influenza Vaccination Decision among Employees in Israel

by Shosh Shahrabani and Uri Benzion

Int. J. Environ. Res. Public Health 2010, 7(3), 853-869; https://doi.org/10.3390/ijerph7030853 - 8 Mar 2010

Cited by 50 | Viewed by 11306

Abstract

The study examined the factors affecting the decision to be vaccinated against influenza among employees in Israel. The research, conducted in 2007/2008, included 616 employees aged 18−65 at various workplaces in Israel, among them companies that offered their employees influenza vaccination. The research [...] Read more.

The study examined the factors affecting the decision to be vaccinated against influenza among employees in Israel. The research, conducted in 2007/2008, included 616 employees aged 18−65 at various workplaces in Israel, among them companies that offered their employees influenza vaccination. The research questionnaire included socio-demographic characteristics, and the Health Belief Model principles. The results show that the significant factors affecting vaccination compliance include a vaccination program at workplaces, vaccinations in the past, higher levels of vaccine's perceived benefits, and lower levels of barriers to getting the vaccine. We conclude that vaccine compliance is larger at companies with workplace vaccination programs providing easier accessibility to vaccination. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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The Influence of Secondhand Smoke Exposure on Birth Outcomes in Jordan

by Nesrin N. Abu-Baker, Linda Haddad and Christine Savage

Int. J. Environ. Res. Public Health 2010, 7(2), 616-634; https://doi.org/10.3390/ijerph7020616 - 22 Feb 2010

Cited by 29 | Viewed by 11874

Abstract

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight [...] Read more.

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight decreased while holding all covariates constant. Women who reported a higher average number of SHS exposure hours per week from work in the second trimester, home in the third trimester, and outside in the third trimester were at greater risk for having a low birth weight neonate than women who reported a lower average number of SHS exposure hours. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Do Health Beliefs and Behaviors Differ According to Severity of Obesity? A Qualitative Study of Australian Adults

by Sophie Lewis, Samantha L. Thomas, R. Warwick Blood, Jim Hyde, David J. Castle and Paul A. Komesaroff

Int. J. Environ. Res. Public Health 2010, 7(2), 443-459; https://doi.org/10.3390/ijerph7020443 - 3 Feb 2010

Cited by 30 | Viewed by 17269

Abstract

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, [...] Read more.

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, compares the health beliefs and behaviors of 141 Australian adults with mild to moderate (BMI 30−39.9) and severe (BMI ≥ 40) obesity. Mildly obese individuals felt little need to change their health behaviors or to lose weight for health reasons. Most believed they could “lose weight” if they needed to, distanced themselves from the word obesity, and stigmatized those “fatter” than themselves. Severely obese individuals felt an urgent need to change their health behaviors, but felt powerless to do so. They blamed themselves for their weight, used stereotypical language to describe their health behaviors, and described being “at war” with their bodies. Further research, particularly about the role of stigma and stereotyping, is needed to fully understand the impact of obesity messaging on the health beliefs, behaviors, and wellbeing of obese and severely obese adults. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Nutritionist’s Variation in Counseling Style and the Effect on Weight Change of Patients Attending a Community Based Lifestyle Modification Program

by Kris Y. W. Lok, Ruth S. M. Chan, Mandy M. M. Sea and Jean Woo

Int. J. Environ. Res. Public Health 2010, 7(2), 413-426; https://doi.org/10.3390/ijerph7020413 - 2 Feb 2010

Cited by 14 | Viewed by 9364

Abstract

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed [...] Read more.

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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What Defines an Effective Anti-Tobacco TV Advertisement? A Pilot Study among Greek Adolescents

by Constantine I. Vardavas, Emmanouil K. Symvoulakis, Gregory N. Connolly, Evridiki Patelarou and Christos Lionis

Int. J. Environ. Res. Public Health 2010, 7(1), 78-88; https://doi.org/10.3390/ijerph7010078 - 8 Jan 2010

Cited by 10 | Viewed by 11402

Abstract

As the Framework Convention on Tobacco Control (FCTC) calls for public health awareness on tobacco use, mass media campaigns should be appropriately designed so as to maximize their effectiveness. In this methodological pilot study, 95 Greek adolescents (mean age 15 ± 1.8 years), [...] Read more.

As the Framework Convention on Tobacco Control (FCTC) calls for public health awareness on tobacco use, mass media campaigns should be appropriately designed so as to maximize their effectiveness. In this methodological pilot study, 95 Greek adolescents (mean age 15 ± 1.8 years), were shown seven different anti tobacco ads, and asked to rate the ad theme, message and emotional context on a 1−7 Likert scale. Health related ads were rated the highest, and as identified through the logistic regression analysis, adolescents who perceived an ad to be emotional or to have a clear message that was relevant to them, were more likely to rate the ad as more effective. The strong agreement between the above findings and the existing literature indicates the applicability of this pilot study’s methodological approach. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Quality Health Care in the European Union Thanks to Competition Law

by Diego Fornaciari

Int. J. Environ. Res. Public Health 2010, 7(1), 1-8; https://doi.org/10.3390/ijerph7010001 - 24 Dec 2009

Cited by 4 | Viewed by 9271

Abstract

There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union [...] Read more.

There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Effect of Medicaid Coverage of Tobacco-Dependence Treatments on Smoking Cessation

by Feng Liu

Int. J. Environ. Res. Public Health 2009, 6(12), 3143-3155; https://doi.org/10.3390/ijerph6123143 - 9 Dec 2009

Cited by 12 | Viewed by 9513

Abstract

Smoking cessation aids (nicotine replacement products and anti-depressant medication) have been proven to double quitting rates compared to placebo in several randomized controlled trials. But the high initial cost of cessation aids might create a financial barrier to cessation for low-income smokers. In [...] Read more.

Smoking cessation aids (nicotine replacement products and anti-depressant medication) have been proven to double quitting rates compared to placebo in several randomized controlled trials. But the high initial cost of cessation aids might create a financial barrier to cessation for low-income smokers. In the U.S., Medicaid provides health insurance coverage to low-income people, and in some states covers smoking cessation products. This paper uses nationally representative data of the U.S. to examine how the Medicaid coverage of cessation aids affect smoking behavior. The results indicate the Medicaid coverage of cessation products is positively associated with successful quitting among women aged 18–44. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Application of the WHO Keys of Safer Food to Improve Food Handling Practices of Food Vendors in a Poor Resource Community in Ghana

by Eric S. Donkor, Boniface B. Kayang, Jonathan Quaye and Moses L. Akyeh

Int. J. Environ. Res. Public Health 2009, 6(11), 2833-2842; https://doi.org/10.3390/ijerph6112833 - 13 Nov 2009

Cited by 43 | Viewed by 13864

Abstract

Data was collected from food vendors in a poor resource community in Ghana, which showed that the vendors constituted an important source of oro-faecal transmission. Following this, the WHO five keys of safer food were utilized in an evidence based training programme for [...] Read more.

Data was collected from food vendors in a poor resource community in Ghana, which showed that the vendors constituted an important source of oro-faecal transmission. Following this, the WHO five keys of safer food were utilized in an evidence based training programme for the vendors to improve their food handling practices. Impact assessment of the food safety training showed that 67.6% of the vendors had acquired some knowledge from the workshop and were putting it into practice. Lack of food safety equipment was a major hinderance to behavioral change among the vendors as far food handling practices are concerned. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

117 KiB

Open AccessArticle

Factors Affecting Use of Preventive Tests for Cardiovascular Risk among Greeks

by Evelina Pappa, Nick Kontodimopoulos, Angelos A. Papadopoulos, Georgia Pallikarona, Dimitris Niakas and Yannis Tountas

Int. J. Environ. Res. Public Health 2009, 6(10), 2712-2724; https://doi.org/10.3390/ijerph6102712 - 23 Oct 2009

Cited by 10 | Viewed by 9872

Abstract

Data from a Greek national representative sample was used to investigate socio-demographic, self-perceived health, and health risk factors that determine the use of cardiovascular preventive tests (blood pressure, cholesterol and blood glucose). Chi-square and logistic regression analyses were used (p [...] Read more.

Data from a Greek national representative sample was used to investigate socio-demographic, self-perceived health, and health risk factors that determine the use of cardiovascular preventive tests (blood pressure, cholesterol and blood glucose). Chi-square and logistic regression analyses were used (p < 0.05). Older age, marriage, regular family doctor and chronic diseases increased the likelihood of receiving preventive tests, whereas low education and alcohol consumption reduced the likelihood of having these tests. The effect of obesity varied. Interventions which improve the knowledge of the poorly educated and empower the preventive role of the physicians may redress the inequalities and improve the effectiveness of preventive services utilization. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

123 KiB

Open AccessArticle

Clients’ Experiences of a Community Based Lifestyle Modification Program: A Qualitative Study

by Ruth S.M. Chan, Kris Y.W. Lok, Mandy M.M. Sea and Jean Woo

Int. J. Environ. Res. Public Health 2009, 6(10), 2608-2622; https://doi.org/10.3390/ijerph6102608 - 2 Oct 2009

Cited by 18 | Viewed by 11301

Abstract

There is little information about how clients attending lifestyle modification programs view the outcomes. This qualitative study examined the clients’ experience of a community based lifestyle modification program in Hong Kong. Semi-structured interviews were conducted with 25 clients attending the program. Clients perceived [...] Read more.

There is little information about how clients attending lifestyle modification programs view the outcomes. This qualitative study examined the clients’ experience of a community based lifestyle modification program in Hong Kong. Semi-structured interviews were conducted with 25 clients attending the program. Clients perceived the program had positive impacts on their health and nutrition knowledge. They experienced frustration, negative emotion, lack of motivation, and pressure from others during the program. Working environment and lack of healthy food choices in restaurants were the major perceived environmental barriers for lifestyle modification. Clients valued nutritionists’ capability of providing professional information and psychological support in the program. Our results suggest that nutritionist’s capability of providing quality consultations and patient-centered care are important for empowering clients achieve lifestyle modification. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

Review

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251 KiB

Open AccessReview

Behavioural Change, Indoor Air Pollution and Child Respiratory Health in Developing Countries: A Review

by Brendon R. Barnes

Int. J. Environ. Res. Public Health 2014, 11(5), 4607-4618; https://doi.org/10.3390/ijerph110504607 - 25 Apr 2014

Cited by 61 | Viewed by 12482

Abstract

Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce [...] Read more.

Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983–2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%–98% in laboratory settings and 31%–94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

316 KiB

Open AccessReview

Healthy Food Procurement Policies and Their Impact

by Mark L. Niebylski, Tammy Lu, Norm R. C. Campbell, Joanne Arcand, Alyssa Schermel, Diane Hua, Karen E. Yeates, Sheldon W. Tobe, Patrick A. Twohig, Mary R. L'Abbé and Peter P. Liu

Int. J. Environ. Res. Public Health 2014, 11(3), 2608-2627; https://doi.org/10.3390/ijerph110302608 - 3 Mar 2014

Cited by 57 | Viewed by 15610

Abstract

Unhealthy eating is the leading risk for death and disability globally. As a result, the World Health Organization (WHO) has called for population health interventions. One of the proposed interventions is to ensure healthy foods are available by implementing healthy food procurement policies. [...] Read more.

Unhealthy eating is the leading risk for death and disability globally. As a result, the World Health Organization (WHO) has called for population health interventions. One of the proposed interventions is to ensure healthy foods are available by implementing healthy food procurement policies. The objective of this systematic review was to evaluate the evidence base assessing the impact of such policies. A comprehensive review was conducted by searching PubMed and Medline for policies that had been implemented and evaluated the impact of food purchases, food consumption, and behaviors towards healthy foods. Thirty-four studies were identified and found to be effective at increasing the availability and purchases of healthy food and decreasing purchases of unhealthy food. Most policies also had other components such as education, price reductions, and health interventions. The multiple gaps in research identified by this review suggest that additional research and ongoing evaluation of food procurement programs is required. Implementation of healthy food procurement policies in schools, worksites, hospitals, care homes, correctional facilities, government institutions, and remote communities increase markers of healthy eating. Prior or simultaneous implementation of ancillary education about healthy eating, and rationale for the policy may be critical success factors and additional research is needed. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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340 KiB

Open AccessReview

Health Professionals’ Alcohol-Related Professional Practices and the Relationship between Their Personal Alcohol Attitudes and Behavior and Professional Practices: A Systematic Review

by Savita Bakhshi and Alison E. While

Int. J. Environ. Res. Public Health 2014, 11(1), 218-248; https://doi.org/10.3390/ijerph110100218 - 23 Dec 2013

Cited by 49 | Viewed by 12225

Abstract

Health professionals’ personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims [...] Read more.

Health professionals’ personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals’ alcohol-related health promotion practices; and (2) explore the relationship between health professionals’ personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007–2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals’ alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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163 KiB

Open AccessReview

External Costs of Risky Health Behaviors Associated with Leading Actual Causes of Death in the U.S.: A Review of the Evidence and Implications for Future Research

by Armineh Zohrabian and Tomas J Philipson

Int. J. Environ. Res. Public Health 2010, 7(6), 2460-2472; https://doi.org/10.3390/ijerph7062460 - 3 Jun 2010

Cited by 15 | Viewed by 12600

Abstract

This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the [...] Read more.

This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question. We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change. The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

137 KiB

Open AccessReview

Maternal Diet, Behaviour and Offspring Skeletal Health

by Laura R. Goodfellow, Susannah Earl, Cyrus Cooper and Nicholas C. Harvey

Int. J. Environ. Res. Public Health 2010, 7(4), 1760-1772; https://doi.org/10.3390/ijerph7041760 - 16 Apr 2010

Cited by 25 | Viewed by 9898

Abstract

Osteoporotic fracture has a major impact upon health, both in terms of acute and long term disability and economic cost. Peak bone mass, achieved in early adulthood, is a major determinant of osteoporosis risk in later life. Poor early growth predicts reduced bone [...] Read more.

Osteoporotic fracture has a major impact upon health, both in terms of acute and long term disability and economic cost. Peak bone mass, achieved in early adulthood, is a major determinant of osteoporosis risk in later life. Poor early growth predicts reduced bone mass, and so risk of fracture in later life. Maternal lifestyle, body build and 25(OH) vitamin D status predict offspring bone mass. Recent work has suggested epigenetic mechanisms as key to these observations. This review will explore the role of the early environment in determining later osteoporotic fracture risk. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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Open AccessReview

Improving Physical Activity and Dietary Behaviours with Single or Multiple Health Behaviour Interventions? A Synthesis of Meta-Analyses and Reviews

by Shane N. Sweet and Michelle S. Fortier

Int. J. Environ. Res. Public Health 2010, 7(4), 1720-1743; https://doi.org/10.3390/ijerph7041720 - 16 Apr 2010

Cited by 80 | Viewed by 12600

Abstract

Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective [...] Read more.

Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic. Full article

(This article belongs to the Special Issue Health Behaviors and Public Health)

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