Factors influencing weight management behavior among college students: An application of the Health Belief Model

The effect of web-based and face-to-face training given to office workers on health beliefs and physical activity levels regarding obesity

AIM

This study compared the effects of web-based and face-to-face education given to office workers on health beliefs and physical activity levels towards obesity.

METHODS

The research was conducted as a randomized controlled experimental study. The study population consisted of 768 office workers between February 2020 and April 2021, and the sample of the research consisted of 90 individuals selected from the population using the nonprobability sampling method. Clinical trial number of the study is NCT05591846.

RESULTS

A total of 90 people, including 30 people in each group, were included in the study. According to the obesity health belief model, a positive change was achieved in the beliefs of individuals about obesity; it was determined that there was a significant increase in the subdimensions of the importance of health, sensitivity, seriousness and perception of benefit and a decrease in the perception of obstacles (p < 0.05). After both education methods were given according to the health belief model, a positive change was achieved in the physical activity level of the individuals; it was determined that the physical activity level score increased significantly (p < 0.05).

CONCLUSION

It was determined that web-based and face-to-face education given to individuals had a positive effect on the obesity health belief model components and the levels of physical activity level.

Efficacy of a theory-based and setting-based intervention in promoting strength training among older adults in Hong Kong: A clustered randomized controlled trial

The present study aimed to examine the efficacy of an intervention, based on the Health Belief Model (HBM) and social support, in promoting strength training (ST) among older adults. A two-arm clustered randomized controlled trial (RCT) was conducted among 235 older adults from eight elderly centers in Hong Kong. The intervention group engaged in a 6-month intervention comprising ST sessions, exercise consultations, social gatherings, and a buddy program, while the control group participated in social gatherings. Assessments were conducted at baseline (Month 0), post-intervention (Month 6), and 3-month follow-up (Month 9), with primary outcome being the prevalence of meeting the American College of Sports Medicine (ACSM) recommendations of ST. Results showed that the intervention group reported significantly higher prevalence of meeting ACSM recommendations for ST at both post-intervention and follow-up. Linear mixed models showed significant interaction effect between condition and time on perceived susceptibility of sarcopenia and muscle strength and significant condition effect on self-efficacy for ST, perceived severity of sarcopenia, perceived barriers of ST, and intention to perform ST. Findings suggest that the intervention, guided by HBM and social support, improves older adults' ST participation, muscle strength, perceptions on sarcopenia, and self-efficacy for ST, which offers great potential for broader application in other settings.

Analysis of Actual Fitness Supplement Consumption among Health and Fitness Enthusiasts

With the rising popularity of fitness supplements, understanding the factors driving their consumption behaviors is crucial. This study investigated the actual consumption of fitness supplements utilizing the Theory of Planned Behavior (TPB), Health Belief Model (HBM), and the Theory of Effort Minimization in Physical Activity (TEMPA) frameworks. The TPB provided insights into how attitudes, subjective norms, and perceived behavioral control influence individuals' intentions to consume fitness supplements. Additionally, the HBM sheds light on perceived effectiveness, benefits, barriers, and health motivation related to supplement consumption. Integrating the TEMPA framework further investigated the role of effort minimization in physical activity contexts. Through an online questionnaire, data were collected from a sample of 250 fitness supplement-consuming respondents. SEM analysis revealed significant associations between behavioral intentions and attitudes, perceived behavioral control, health motivation, and controlled precursors. However, it was seen that subjective norms, perceived effectiveness, perceived benefits, and automatic precursors were deemed insignificant. The findings contribute to a comprehensive understanding of the factors shaping actual consumption behaviors, offering valuable implications for marketers, health professionals, and policymakers seeking to promote informed and responsible supplement use among health and fitness enthusiasts.

Utilisation of the health belief model to study the behavioural intentions relating to obesity management among university students: a cross-sectional study

BACKGROUND

Overweight and obesity are excessive fat accumulations linked with many health problems, including heart diseases, type 2 diabetes and cancer. Multiple studies have demonstrated that beliefs about overweight, obesity and self-efficacy play essential roles in the success of interventions for obesity management.

OBJECTIVES

This study aimed to identify the perceptions of university students of overweight and obesity using the health belief model (HBM) and to analyse their association with the body mass index (BMI) categories of the students.

DESIGN

A cross-sectional questionnaire-based study and a multistage sampling technique were used to ensure the recruitment of students from selected colleges of Jazan University-Saudi Arabia.

SETTING

Six colleges of Jazan University were randomly selected to ensure equal representation of health sciences, sciences and humanities colleges.

PARTICIPANTS

A total of 579 students completed an online survey between January and April 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were demographic characteristics and HBM constructs. Secondary outcome measures were behavioural intentions relating to obesity management.

RESULTS

This study demonstrated that gender and self-reported family history of obesity were significantly correlated with the BMI categories of the students (p <0.001). Students in the underweight category showed the highest mean score for perceived severity (3.62 ±0.08). Perceived self-efficacy in exercise and diet was significantly associated with BMI categories, with adjusted ORs of 2.82 (2.10 to 3.79) and 1.51 (1.09 to 2.09), respectively. Perceived barriers to healthy eating and regular physical activity were significantly related to the behavioural intentions of obesity management. Multivariate logistic regression showed that perceived severity, perceived cues to action, perceived barriers and self-efficacy in dieting and exercise were significant predictors of behavioural intentions for the management of obesity.

CONCLUSION

This study underscores the need for tailored health promotion strategies that consider the perceptions and beliefs of people about the management of obesity.

Structural equation models of health behaviour, psychological well-being, symptom severity and quality of life in abdominal bloating

Background

The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating.

Methods

The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors.

Results

A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041-0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL.

Conclusion

The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

The Association of Malnutrition and Health-Related Factors among 474,467 Older Community-Dwellers: A Population-Based Data Mining Study in Guangzhou, China

BACKGROUND

This study aimed to examine the prevalence and associated factors of malnutrition in older community-dwellers and explore the interaction between associated factors.

METHODS

A total of 474,467 older community-dwellers aged 65 or above were selected in Guangzhou, China. We used a two-step methodology to detect the associated factors of malnutrition and constructed logistic regression models to explore the influencing factors and interactive effects on three patterns of malnutrition.

RESULTS

The prevalence of malnutrition was 22.28%. Older adults with both hypertension and diabetes (RERI = 0.13), both meat or fish diet and hypertension (RERI = 0.79), and both meat or fish diet and diabetes (RERI = 0.81) had positive additive interaction effects on the risk of obesity, whereas those on a vegetarian diet with hypertension (RERI = -0.25) or diabetes (RERI = -0.19) had negative additive interaction effects. Moreover, the interactions of physical activity with a meat or fish diet (RERI = -0.84) or dyslipidemia (RERI = -0.09) could lower the risk of obesity.

CONCLUSIONS

Malnutrition was influenced by different health factors, and there were interactions between these influencing factors. Pertinent dietary instruction should be given according to different nutritional status indexes and the prevalence of metabolic diseases to avoid the occurrences of malnutrition among older adults.

Incorporating Cardiovascular Risk Assessment into Adolescent Reproductive Health and Primary Care Visits

STUDY OBJECTIVE

This study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits.

DESIGN, SETTING, AND PARTICIPANTS

We recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in 2 adolescent clinics in Atlanta, GA.

MAIN OUTCOME MEASURES

Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants' perceived risk, blood pressure, and body mass index were measured at baseline and 3 months after enrollment. Health care providers (HCP, n = 5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice.

RESULTS

Adolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (interquartile range [IQR] 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants' median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants' median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits.

CONCLUSION

HerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics.

Exploring the dietary practices and perceptions of African immigrants in Illinois- a qualitative study of immigrants from Nigeria and Congo

OBJECTIVE

Previous studies suggest an increased prevalence of diet-related chronic diseases among African immigrants with increased length of stay in the U.S. The objective of the current study is to understand the dietary practices and perceptions of recent African immigrant families.

DESIGN

Focus group sessions were conducted with Nigerian and Congolese immigrant parents residing in Illinois. Participants were recruited using convenience sampling methods and focus group sessions were conducted via videoconference. Participants discussed dietary practices, meal preparation, and family mealtimes for their families. They also discussed experiences with eating different kinds of foods since arrival in the U.S. Verbatim transcription of focus group sessions were completed and deductive thematic analysis of transcribed data was conducted using NVivo (QSR International Pty Ltd. [2020] NVivo [version 12]).

RESULTS

Twenty African immigrant parents (Mean age: 42 years, Female: 95%) residing in Northern and Central Illinois participated in a total of five focus group sessions. Seven themes were derived from the analysis. Participants had a positive attitude toward healthy diet and had a high level of interest in receiving educational resources to make healthier food choices. Participants preferred and mostly consumed foods they were familiar with before migration. A majority of the participants perceived 'American foods' as unhealthy, characterizing them as containing a high amount of sugar and salt. Parents reported that their school-aged children often preferred a western diet over traditional African meals.

CONCLUSION

This study helps to understand unique diet-related practices and perceptions of recent Nigerian and Congolese African immigrants in Illinois. Findings could help to inform cultural adaptation of evidence-based nutrition education programs for these groups of African immigrants.

"For me, it is for longevity and making sure I am fit and around for my children": exploring motivations and barriers for weight management among minoritised communities in Medway, England

BACKGROUND

Migration-related changes in dietary patterns and other structural and individual factors affect weight-related health practices of individuals migrating from low-and-middle-income to high-income countries. Thus, individuals of ethnically diverse backgrounds may be disproportionately affected by poorer health outcomes, including weight-related health issues. Understanding how this community could be supported to adopt weight-related healthy practices such as optimum dietary and exercise behaviour is an important issue for public health research. Against this backdrop, we explored structural and individual factors that facilitate and constrain the uptake of weight management services among members of minority ethnic communities in Medway, England.

METHODS

Data were collected from audio-recorded interviews with 12 adult community members from minoritised ethnic communities using a semi-structured interview guide. Participants were recruited through a purposive and convenient sampling technique. Generated data were transcribed, coded into NVivo and analysed using the reflexive thematic analytical technique.

RESULTS

Results showed that social support and health benefits of weight management were the main motivating factors for weight management among the study participants. Conversely, systemic barriers, family commitment and caring responsibilities, changes in dietary patterns post-migration and cultural norms were major factors constraining participants from adopting weight management behaviours.

CONCLUSION

The results of this study indicate that structural and person-level factors serve as both facilitators and barriers to weight management among ethnically diverse communities in Medway, England. While our study is exploratory and opens doors for more studies among the population, we conclude that these minoritised communities could benefit from more equitable, tailored weight management programmes to support them in adopting weight-related practices.

Establishing the feasibility and preliminary efficacy of a health belief model based educational training program on health belief perceptions and dementia-preventive behaviors in people with type 2 diabetes

This quasi-experimental study evaluated feasibility and preliminary efficacy of dementia-preventive educational training intervention program based on the health belief model for improving perceived health beliefs and dementia-preventive behaviors among people with type 2 diabetes mellitus. Two community hospitals with 72 eligible participants were chosen from 12 local institutions using simple random sampling method. One hospital (22 patients) was allocated to dementia-preventive educational training intervention, and the other hospital (23 patients) was allocated to control intervention (using simple random sampling). Primary study outcome was feasibility, and secondary outcomes were changes in dementia prevention behaviors and health belief perceptions. Recruitment rate was 62.5% (45/72) and 22 patients in each group totally completed outcome measures and attended sessions, indicating feasibility of the intervention and study design. There were no significant differences between groups at baseline. After training, participants in the intervention group had significantly higher scores than control group in prevention behaviors and perceptions of health beliefs. The intervention group experienced significant with-group changes in outcomes. Results show that conducting a subsequent fully powered experimental study is feasible, and the intervention has promising efficacy.

Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial

Introduction

The highest incidence of overweight among adults is found among women, predominantly middle-aged women. While it has been demonstrated that being overweight increases mortality by compromising physical and mental health, it also imposes substantial costs on the healthcare system. Lack of physical activity is a primary contributing factor to becoming overweight. The majority of inactive adults are women, particularly middle-aged women. Consequently, this study investigated the training program for overweight women based on the health belief model (HBM) and social support approach.

Methods

A randomized, controlled trial involving 73 overweight middle-aged women (control group: 37, intervention group: 36) was conducted using simple random sampling. The intervention group participated in six 120-min sessions per week for 6 weeks of a training program based on HBM and social support through physical activity, group discussion, role play, and media. Data were collected using the Physical Activity Questionnaire (IPAQ), Bandura's Exercise Self-Efficacy Scale (Bandura's ESE), and a researcher-made questionnaire before and 4 weeks after the training. The collected data were analyzed using descriptive and inferential statistics via SPSS 27 software. p-values <0.05 were considered statistically significant.

Results

A training program based on HBM and social support led to improved perceived benefits (p < 0.001), cues to action (p = 0.03), and self-efficacy (p < 0.001) of physical activity; decreased perceived barriers (p = 0.001); increased social support (p = 0.001); and increased physical activity (p < 0.001). In addition, the BMI of the intervention group decreased after the training program (p = 0.01).

Conclusion

The findings of the study demonstrate the efficacy of the training program based on HBM and the social support approach in improving social support and physical activity of women. In addition, the study evaluates the long-term outcome in populations with varying social, economic, and cultural standings.

Clinical Trials Registration

https://clinicaltrials.gov/, (IRCT201706236261N17).

Effectiveness of education intervention, with regards to physical activity level and a healthy diet, among Middle Eastern adolescents in Malaysia: A study protocol for a randomized control trial, based on a health belief model

BACKGROUND

Among the most urgent public health challenges, of the twenty-first century, is obesity. This can be attributed to its relationship with several non-communicable diseases (NCDs), as well as premature mortality. Being overweight or obese is a major concern not only in high-income countries, but also in low-income and middle-income countries, particularly in urban areas. Several studies have highlighted the prevalence of obesity, among Middle Eastern-descent adolescents, studying in Arabic secondary schools, located in Malaysia. Intervention studies, directed at Middle Eastern adolescents in Malaysia, are limited. This paper, describes the protocol, for an integrated health education intervention process. Titled 'Healthy lifestyle', it is a primary prevention process, aimed at curbing obesity and disordered eating, among Middle Eastern secondary school adolescents, aged 13-14 years old, residing in Malaysia.

METHODS AND ANTICIPATED RESULTS

A cluster randomized controlled study will be conducted, involving 250 Middle Eastern adolescents, in Arabic schools in Malaysia. The participants will be randomly assigned to the intervention and control groups. While the intervention group participates in six weeks of fortnightly six sessions (45 minutes per session), the control group will carry on with their regular curriculums, and normal physical activity routines. The variables which will be evaluated include anthropometric measurements, knowledge, attitude, daily routines, physical activity, sedentary behaviour, food assessment, eating attitudes test-26, and a structured questionnaire based on the HBM. Data will be collected from the intervention and control groups at baseline, post-intervention, and two months following the intervention. Data analysis will be performed by way of the SPSS Statistics software version 26. The generalized estimating equation (GEE) will be used, to test the effect of the intervention program, with regards to the selected variables (outcomes), between and within-group at baseline, as well as six weeks and two months following intervention, after adjusting for clustering. Outcomes will be assessed at each time point, along with a derived average over all three-time points; thus, ensuring that both the cumulative and overall effects are determined.

CONCLUSIONS

This trial will provide useful information for improving the knowledge, attitude, and practices of Middle Eastern adolescents, with regards to body weight status, physical activity level, nutrition status (BMI and dietary intake), and disordered eating. This will go a long way, towards ensuring their adherence to appropriate physical activities, and a healthy diet, to keep non-communicable diseases at bay.

TRIAL REGISTRATION

This study is registered at NCT: NCT05694143.

Probing the parental cognizance of antibiotic resistance by using Health Belief Model: An exploratory study

OBJECTIVE

To explore the determinants that innervate or avert the parents to use antibiotics responsibly for their children in Bahawalpur, Pakistan. Further, to assess the cognizance of Pakistani parents about antibiotic resistance.

METHODS

The Health Belief Model (HBM) was utilized to design this study. Parents who were using antibiotics for their children were taken as study participants. They were recruited purposively from various public and private healthcare settings and were asked to conveniently participate in the study. A total of 18 in-depth interviews were conducted at time and place convenient to the study participants. Data were transcribed, translated and analyzed by framework analysis in accordance with the constructs of Health Belief Model including perceived susceptibility, severity, benefit, barriers, self-efficacy and cues to action.

RESULTS

Within each HBM construct, responses of participants were analyzed, yielding 8 themes and 17 subthemes. Parents had a knowledge of antibiotics but considered their families to be at low risk of antibiotic resistance since their families were "low users" of antibiotics. Majority of the participants were not aware of the indications and risks of antibiotic use and perceived the antibiotics as a quick fix for every ailment. Communicating the risks of antibiotic resistance to parents and providing actionable solutions to tackle antibiotic resistance may address these perceptions.

CONCLUSION

Though parents revealed awareness about antibiotics, they continue to overestimate the value of antibiotics. Refocus of the antibiotic stewardship interventions are required and these campaigns are needed to be tailored to target their intended audience in a format that is appropriate to them.

The Impact of Heart Attack and Sudden Cardiac Death Risk Perception on Lifestyle Modification Intention Among Adults in Jazan Province

Purpose

This study aimed to assess the perception of sudden cardiac death (SCD) and heart attack risk and its influence on the intention to adopt healthy lifestyle behaviors among the general population in Jazan province, Saudi Arabia. SCD refers to an abrupt and unexpected loss of heart function resulting in death, and its incidence has been alarmingly increasing worldwide. Several factors, including smoking, hypertension, diabetes, obesity, and specific medications, have been associated with an elevated risk of SCD.

Methods

A descriptive cross-sectional study was conducted using a pretested questionnaire distributed among the general population in Jazan province. Descriptive statistics, chi-square, and t-tests were employed for data analysis.

Results

The study included 974 participants with a mean age of 27.90 ± 9.32 years, of whom 56% were female. More than half of the participants perceived themselves as highly susceptible to SCD, and all participants demonstrated a moderate willingness and readiness to modify their unhealthy lifestyle behaviors. Age, gender, marital status, body mass index (BMI), history of hypertension, dyslipidemia, medication use, physical exercise, and family history of chronic diseases and SCD were statistically associated with the perception of SCD.

Conclusion

The study revealed a high-risk perception and a moderate readiness to adopt lifestyle modifications. These findings can inform the development of effective strategies and support programs aimed at reducing the burden of SCD.

Uptake and Utilization of the COVID-19 Alert App within a University Community in New York

The rapid onset of the COVID-19 pandemic elicited a swift response to control the virus ubiquitous within the United States. Expanded telehealth and health informatics became critical components of the pandemic response. The aim of this study was to assess the utilization of the COVID-19 New York (NY) Alert App and identify the perceived benefits and limitations of the App. A cross-sectional design was employed to collect data by using questionnaires with closed-ended and open-ended questions. The survey was developed and administered during March through April 2021. The study found that the highest rated benefit from using the COVID-19 NY Alert App was receiving alerts about being in close proximity to individuals diagnosed with COVID-19. Results showed that ineffective (insufficient and inappropriate) usage was the highest rated potential challenge for using the App. Study subjects were likely to download this Alert App when they perceived more benefits and less barriers to using the App. Findings from this study can help improve utilization of the App and inform development of similar tele-education tools. The study illuminated considerations for health information applications in scaling-up traditional COVID-19 tracing efforts and may facilitate the design of similar emergency preparedness health technology.

Body image and willingness to change it-A study of university students in Poland

The present study aimed to identify declared patterns of ideal appearance among students at selected higher education institutions in Poland. In the present study, we set out to identify the body image and the propensity to change it. In order to achieve the goal of the study, a nationwide survey was carried out using a voluntary diagnostic survey. A total of 810 respondents took part in the survey. The study was conducted using a custom-made self-designed survey questionnaire with an indirect interview technique via a web-based platform (CAWI). The study results indicate that women were far more eager to maintain an attractive appearance through dieting than men. Importantly, the respondents, both women and men, did not identify influencers as role models of attractive appearance. Results of the present survey reveal that attitudes towards one's physical appearance are diverse and influenced by the considered factors. The attributes that determined the perception of oneself as an attractive person included height, weight, and body build. Normal body weight is a key feature of an attractive appearance, according to the respondents; nevertheless, students show a higher tolerance for being overweight than for being underweight. Furthermore, preferences in this respect are largely conditioned by individual personal characteristics. According to young people, a person with an attractive appearance is one who eats and exercises regularly, and who does not fall into extremes in terms of their appearance. On the other hand, the fear of growing fat and losing one's attractive appearance was frequently indicated among the concerns over personal appearance. Only one in five respondents expressed complete satisfaction with how they looked, with men and those with a normal BMI significantly more likely to do so. Respondents expressed readiness to undertake a range of activities related to increased exercise regime, changes in their eating habits, or seeking assistance (e.g., of a personal trainer) to achieve the desired body shape. Our findings can be used as a basis for discussion and consideration in developing educational activities on nutrition, as well as on overweight- and obesity-related health issues.

Investigation of the relationships between mindfulness, emotional eating, weight control self-efficacy, and obesity in adolescents

PURPOSE

This research was conducted to examine the relationships between mindfulness, emotional eating, weight control self-efficacy, and obesity in adolescents.

DESIGN AND METHODS

The research was conducted with 198 adolescents aged 13-18 years in three high schools in the central county of a province in Türkiye. Data were collected using a sociodemographic information form, the Mindful Attention Awareness Scale-Adolescents, the Emotional Eating Scale for Children and Adolescents, and the Weight-Efficacy Lifestyle Questionnaire for Adolescents-Short Form. In this study, adolescents' height and weight were measured to determine the effects of the study variables on their body mass indexes (BMIs).

RESULTS

The variables were analyzed according to BMI. The mean age of the adolescents participating in the research was 15.25 ± 1.01 years; 52% were female, and 85% were ninth-grade high school students. Their mean height was 170.33 ± 8.59 cm, and their mean weight was 62.24 ± 12.84 kg. The adolescents' BMI was found to have a low-level, significant negative correlation with their mindfulness, a low-level, significant positive correlation with their emotional eating, and a low-level significant negative correlation with their weight control self-efficacy. Adolescents' mindfulness, emotional eating, and weight control self-efficacy scores significantly predicted their BMI and explained 14.1% of the variance in their BMI levels.

CONCLUSIONS

Mindfulness, emotional eating, and weight control self-efficacy in adolescents have a facilitating effect on the management of obesity.

IMPLICATIONS TO PRACTICE

Multidimensional programs should be developed that take into account the interaction of parents, children, and the environment, which will pave the way for the development of healthy nutrition behaviors and contribute to the prevention of obesity.

Contexts motivating protective behaviours related to Aedes-borne infectious diseases in Curaçao

BACKGROUND

Aedes aegypti, the vector of arboviral diseases such as dengue and Zika virus infections, is difficult to control. Effective interventions must be practicable, comprehensive, and sustained. There is evidence that community participation can enhance mosquito control. Therefore, countries are encouraged to develop and integrate community-based approaches to mosquito control to mitigate Aedes-borne infectious diseases (ABIDs). Health professionals must understand the contexts motivating individuals' behaviour to improve community participation and promote behavioural change. Therefore, this study aimed to determine how contexts shaped individuals' protective behaviours related to ABIDs in Curaçao.

METHODS

From April 2019 to September 2020, a multi-method qualitative study applying seven (n = 54) focus group discussions and twenty-five in-depth interviews with locals was performed in Curaҫao. The study was designed based on the Health Belief Model (HBM). Two cycles of inductive and deductive coding were employed, and Nvivo software was used to manage and analyse the data.

RESULTS

In this study, low media coverage (external cue to action) and limited experience with the symptoms of ABIDs (internal cue to action) were linked with a low perceived susceptibility and severity of ABIDs (low perceived threat). The low perceived threat was linked with reduced health-seeking behaviour (HSB) to prevent and control ABIDs. We also found that the perceived barriers outweigh the perceived benefits of ABID prevention and control interventions, obstructing HSB. On the one hand, insufficient knowledge reduced self-efficacy but contrary to expected, having good knowledge did not promote HSB. Lastly, we found that our participants believe that they are responsible for preventing ABIDs (internal locus of control) but at the same time indicated that their success depends on the efforts of the community and the health system (external locus of control).

CONCLUSIONS

This study used the HBM to explain individual changes in HSB concerning ABIDs prevention and control in Curaçao. We can conclude that the perceived threat (perceived susceptibility and severity) and perceived barriers played an essential role in changing HSB. Health professionals must consider these two concepts' implications when designing a bottom-up approach for ABIDs control; otherwise, community participation will remain minimal.

Implementing text-messaging to support and enhance delivery of health behavior change interventions in low- to middle-income countries: case study of the Lifestyle Africa intervention

The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with expertise and first-hand experience to establish specific development steps for building and implementing SMS systems to support HBC programming in LMICs. Specifically, we provide real-world examples of each development step by describing our experience in designing and delivering an SMS system to support a culturally-adapted DPP designed for delivery in South Africa. We outline eight key SMS development steps, including: 1) determining if SMS is appropriate; 2) developing system architecture and programming; 3) developing theory-based messages; 4) developing SMS technology; 5) addressing international SMS delivery; 6) testing; 7) system training and technical support; and 8) cost considerations. We discuss lessons learned and extractable principles that may be of use to other mHealth and HBC researchers working in similar LMIC contexts.Trial registration Clinicaltrials.gov, NCT03342274 . Registered 10 November 2017.

Prevalence of Obesity and the Factors Associated with Low Obesity Awareness among Urban Adolescents in Harare, Zimbabwe

Obesity is a global health problem. In developing countries such as Zimbabwe, obesity is both an emerging health problem and a grey area, particularly among adolescents. This study assessed the prevalence of obesity and factors associated with low obesity awareness among adolescents.

METHOD

A cross-sectional survey was performed using an interviewer-administered questionnaire. The participants were 423 adolescents aged 14-19 years recruited from 10 schools in Harare using a stratified random sampling technique. Data were analyzed using SPSS software (version 23) and binary logistics regression was used to examine the factors associated with low obesity awareness. The level of significance was set at p < 0.05.

RESULTS

The median± IQR age was 16 (14-18) years, and overweight and obesity affected 15.8% of the participants with higher proportions among girls (73.1%, p = 0.002). Low obesity awareness was observed in 27.1% of the adolescents with a higher proportion among girls (67.0%, p = 0.001), 14-16-year-olds (51.3%, p = 0.317), and obese adolescents (56.7%, p = 0.001). Significant factors associated with low obesity awareness were household heads lacking formal education [OR = 9.41 (2.20-40.36), p = 0.003] and inadequate (poor) food habits [OR = 2.58 (1.33-5.01), p = 0.005].

CONCLUSIONS

Our study showed that adolescents had different obesity awareness levels and diverse perceptions in terms of obesity causes, and a range of potential solutions. Obesity awareness and nutrition education should address adolescents' poor eating habits while taking cognizance of the different education levels of household heads.

Mindfulness Meditation App Abandonment During the COVID-19 Pandemic: An Observational Study

Objectives

Mindfulness meditation apps are used by millions of adults in the USA to improve mental health. However, many new app subscribers quickly abandon their use. The purpose of this study was to determine the behavioral, demographic, and socioeconomic factors associated with the abandonment of meditation apps during the COVID-19 pandemic.

Method

A survey was distributed to subscribers of a popular meditation app, Calm, at the start of the COVID-19 pandemic in March 2020 that assessed meditation app behavior and meditation habit strength, as well as demographic and socioeconomic information. App usage data were also collected from the start of each participant's subscription until May 2021. A total of 3275 respondents were included in the analyses. Participants were divided into three cohorts according to their subscription start date: (1) long-term subscribers (> 1 year before pandemic start), (2) pre-pandemic subscribers (< 4 months before pandemic start), and (3) pandemic subscribers (joined during the pandemic).

Results

Meditating after an existing routine was associated with a lower risk of app abandonment for pre-pandemic subscribers (hazard ratio = 0.607, 95% CI: 0.422, 0.874; p = 0.007) and for pandemic subscribers (hazard ratio = 0.434, 95% CI: 0.285, 0.66; p < 0.001). Additionally, meditating "whenever I can" was associated with lower risk of abandonment among pandemic subscribers (hazard ratio = 0.437, 95% CI: 0.271, 0.706; p < 0.001), and no behavioral factors were significant predictors of app abandonment among the long-term subscribers.

Conclusions

These results show that combining meditation with an existing daily routine was a commonly utilized strategy for promoting persistent meditation app use during the COVID-19 pandemic for many subscribers. This finding supports existing evidence that pairing new behaviors with an existing routine is an effective method for establishing new health habits.

Preregistration

This study is not pre-registered.

An Exploration of Sedentary Behavior, Physical Activity, and Quality of Life During the COVID-19 Outbreak

Objectives: Staying physically active is a cost-efficient strategy for disease prevention during a pandemic. The purposes of this study were to explore precautionary behaviors, psychological factors associated with physical activity and sedentary behavior, and impacts of active and sedentary lifestyles on the quality of life in the early stage of the coronavirus disease 2019 (COVID-19) outbreak. Methods: Participants were community-dwelling adults aged over 20 years who had not been infected with COVID-19 and who lived in the United States. A study with a cross-sectional design was conducted between July and October 2020. Quantitative data were collected by a self-reported questionnaire. Results: In total, 467 valid responses were obtained. Participants who engaged in an active lifestyle had significantly higher scores on all domains of quality of life compared to those who engaged in an inactive lifestyle. Participants with a non-sedentary lifestyle had significantly higher scores of psychological and social domains of quality of life than those with a sedentary lifestyle. Conclusion: Engaging in an active lifestyle and avoiding a sedentary lifestyle are recommended when facing future, unpredictable pandemics similar to COVID-19.

Exploration of COVID-19 Pandemic Prevention Behaviors among Healthcare Workers

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers stand on the frontline for pandemic prevention, and preventive behaviors are essential measures to protect their health and safety. The purpose of this study was to propose an integrative model that explained and predicted COVID-19 preventive behaviors among healthcare workers. The study integrated workplace safety climate and the health belief model (HBM) to verify the impact of workplace safety climate and health belief factors on the safety attitude, safety compliance, and safety satisfaction of healthcare workers performing COVID-19 pandemic prevention behaviors. A cross-sectional study was conducted from March to August 2021 with a self-administered online questionnaire. The sample of the study was drawn from healthcare workers of a famous medical institution in Taipei City as research subjects. After collecting 273 valid questionnaires and verifying them through the analysis of structural equation modeling (SEM), the findings revealed that workplace safety climate had an impact on health belief factors, and then health belief factors had impacts on safety attitudes. In addition, safety attitude affected safety compliance, while safety compliance further affected safety satisfaction. The study showed that workplace safety climate can strengthen healthcare workers' health beliefs and further affect their safety attitudes, safety compliance, and safety satisfaction. The study attempted to propose a model of healthcare workers' pandemic prevention behaviors as a reference for medical facility administrators in real practice.

Perceptions of sulphadoxine-pyrimethamine use among pregnant women in sub-Saharan Africa: a scoping review

Background

Malaria is a major global public health issue that disproportionately affects pregnant women in sub-Saharan Africa. The World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) for its control. Despite its proven efficacy, drug uptake remains low. Sulphadoxine-pyrimethamine (SP) safety concerns have been cited as one of several reasons for this low uptake.

Methods

We conducted a scoping review using the Arksey and O'Malley framework and the health belief model to investigate perceptions of SP use among pregnant women in sub-Saharan Africa. We looked for peer-reviewed publications in five international databases.

Results

The review included 19 articles out of a total of 246. It showed that pregnant women in sub-Saharan Africa have a good understanding of malaria and its consequences, but this does not necessarily translate into increased IPTp-SP uptake. It is worrisome to know that some pregnant women (from 2 studies) did not believe that SP use is beneficial, and several participants (from 4 studies) were unsure or did not see the drug as an effective intervention. Many pregnant women believe SP harms them, their partners, or their unborn children.

Conclusions

Healthcare professionals should continue prescribing and encouraging pregnant women to use SP for malaria prevention until a better substitute becomes available.

A framework for adopting gamified learning systems in smart schools during COVID-19

The outbreak of COVID 19 has increased the anxiety and stress among teachers and students. This has increased the need for gamified learning systems (GLS) to make the educational process more attractive and increase the engagement as well as the participation of all stakeholders. The use of GLS in teaching and learning has not been deployed effectively in the educational systems in developing countries. The purpose of this study was to examine the predictors of using GLS in Iraqi smart schools. Building on the literature, a framework of GLS is proposed. Data used in this study were collected from 394 teachers and managerial staff in Iraqi smart schools and analysed using Partial Least Square. The findings showed that individuals and organizations are important predictors of using GLS, and their effects on BI are mediated by satisfaction. Readiness and performance expectancy are critical for adopting and using GLS by smart schools. In addition, the findings showed that gamification and self-efficacy are moderating variables. Important implications of the predictability of GLS using a combination of theories as well as the practical suggestions for decision makers to enhance the adoption of GLS among smart schools in Iraq are discussed. In the time of COVID-19, decision makers have suggested increasing gamification features of teaching and learning to reduce anxiety and achieve a better learning process.

A health promoting-lifestyle prediction model for dementia prevention among chinese adults: based on the health belief model

BACKGROUND

People's health belief is an important factor affecting health behavior. However, there has been little use of the health belief model (HBM) in determining the pathway effect of patients' beliefs on health behavior in dementia prevention in China. The aim of our study was to evaluate the impact of dementia prevention beliefs on health promoting lifestyle among Chinese adults.

METHODS

A cross-sectional study was conducted on line by convenience sampling from January to March 2020. A survey about dementia prevention knowledge, health belief of dementia prevention and health-promoting lifestyle was completed by 1201 adults in China. Data was analyzed using a structural equation model with the analysis of moment program.

RESULTS

The participants were aged 40.50 ± 12.72 years. About 70.3% of participants were female. The purposed model fit the data from the study well. Perceived barriers (total effect-0.322, P < 0.01) and perceived susceptibility (total effect -0.242, P < 0.01) had negative effects on lifestyle. Self-efficacy had promoting effects on lifestyle (total effect 0.207, P < 0.01). Perceived severity had positive effects both on perceived benefits (total effect 0.137, P < 0.01) and perceived barriers (total effect 0.202, P < 0.01), which had a contradictory effect in the formation of health belief. Perceived benefits, cues to action and self-efficacy played a partial mediating role between knowledge and health behavior. The belief of changing lifestyle to reduce the risk of dementia could explain 24.5% of health behavior (P < 0.05).

CONCLUSIONS

The findings indicate that in dementia prevention, dementia prevention health belief has important influences on health behavior. Community medical staff can develop targeted dementia prevention interventions based on the health belief model in the future.

Translation, cross-cultural adaptation and validation of the Health Belief Model Questionnaire (HBMQ) for weight management behaviour for use in a Southeast Asian country

Objectives

In the past 50 years, obesity and being overweight have become significant health concerns that cause a rise in the risk of illness, impairing quality of life and increasing financial burdens worldwide. The purpose of the study is to conduct translation and cross-cultural adaptation of a Health Belief Model Questionnaire (HBMQ) for weight management behaviour into the Malay language and to validate the questionnaire.

Methods

The HBMQ was adapted and translated into the Malay language based on published international guidelines. The content validity and the face validity were analysed by a panel of 10 experts. A pilot test was conducted with 35 students from Universiti Sains Malaysia to evaluate internal consistency. A cross-sectional study was carried out by distributing the self-administered HBMQ to the general public in Malaysia and 505 subjects were successfully recruited. The construct validity was evaluated by exploratory factor analysis. The first 112 participants completed the survey again one week later for the evaluation of test-retest reliability.

Key findings

In total, 79 questions had an item-level content validity index (I-CVI) score of &gt;0.80 and have been evaluated as excellent inferring acceptable content validity. The remaining seven items in the instrument had an I-CVI score &lt; 0.80 and were removed based on the experts’ consensus. The item-level face validity index value for each item range was between 0.8 and 1.0, indicating a satisfactory level of face validity. For construct validity, eight factors were requested and 74 items had a significant to strong factor loading of &gt;0.4. The rotation of items showed five items had factor loadings &lt;0.4 (item numbers 14, 57, 77, 78 and 79) and have been removed.

Conclusions

The findings in this study conclude that the translated Health Belief Model-Malay version has adequate content validity, face validity, construct validity and reliability.

Optimal BMI cutoff points in obesity screening for Chinese college students

Objective

An accurate BMI classification system specific to the population is of great value in health promotion. Existing studies have shown that the BMI recommended cut-off value for adults is not suitable for college students. Thus, the current study aims to identify optimal BMI cutoff points in obesity screening for Chinese college students.

Methods

Anthropometric assessments were performed on 6,798 college students (Male = 3,408, Female = 3,390) from three universities in Jiangsu, China. Exploratory factor analysis (EFA) was conducted to establish the standardized models to estimate anthropometry for male and female students. Further indices were derived from the assessments, including body mass index (BMI), relative fat mass (RFM), obesity degree percentage (OBD%), waist-to-hip ratio (WHR), waist circumference (WC), and body fat percentage (BF%). The anthropometric index with the highest correlation to the models for male and female students were selected as the gold standard for obesity screening. Receiver operating characteristic (ROC) curve was applied to evaluate diagnostic value of each anthropometric index according to the area under curve (AUC). Youden index maximum points determined the optimal cutoff points with the highest accuracy in obesity screening.

Results

The anthropometric models for both male and female students consisted of three factors. Vervaeck index was selected as the gold standard for obesity screening. By comparing AUC of the anthropometric indices, we found BMI provided the highest value in obesity screening. Further analysis based on Youden index identified the optimal BMI of 23.53 kg/m² for male and 23.41 kg/m² for female. Compared with the universal standard recommended by World Health Organization (WHO), the adjusted BMI criteria were characterized by high sensitivity as well as specificity.

Conclusion

BMI is the most appropriate anthropometric index of obesity screening for Chinese college students. The optimal cutoff points were lower than the WHO reference. Evidence substantiated the adjusted BMI criteria as an effective approach to improve accuracy of obesity screening for this population.

Quasi-experimental design for using an interactive social media intervention program to improve truck drivers' health beliefs and eating behaviors

Background

Truck drivers have difficulties participating in health education programs delivered at a fixed time and place due to the mobility of their workplace. Interventions conducted via social media can overcome these limitations of time and place. This study aimed to investigate the effect of a nutrition education intervention program delivered via a social media platform on the healthy eating behaviors of truck drivers.

Methods

This study adopted a quasi-experimental design. A 12-week intervention program was conducted for a social-media group (n = 125) and a conventional-teaching group (n = 117) from February to May 2020. The social-media group participated in a social-media-based health intervention on the LINE application. The intervention involved the provision of online messages, online instant responses, a picture-based food log, an audio e-book, and a loyalty e-card. The conventional-teaching group participated in a healthy diet course and a hygiene education manual. The generalized estimation equation (GEE) was applied to evaluate the intervention effects on the outcome measures derived from the Health Belief Model.

Results

The results of the GEE showed the social-media-based intervention strategies significantly decreased perceived barriers of consuming a healthy diet (p =  < 0.001), increased willingness to follow cues of action (p = 0.036), improved the self-efficacy of healthy eating behaviors (p = 0.001), and increased the score of healthy eating behaviors (p < 0.001) compared with the conventional teaching strategies. For the social-media and conventional-teaching groups, no significant changes occurred in self-perceived health status, self-perceived susceptibility, or self-perceived severity after the intervention. More than 90% of the participants in the social-media group believed the social-media-based intervention strategies could help implement and maintain healthy eating behaviors.

Conclusions

The results indicate social-media-based intervention strategies can facilitate approaching a population without a fixed workplace, such as truck drivers. Health promoters and planners focusing on occupational health can consider developing social-media-based intervention strategies for improving truck drivers' health status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13883-6.

Associations between Awareness of the Risk of Exposure to Pollutants Occurring at Fire Scenes and Health Beliefs among Metropolitan Firefighters in the Republic of Korea

Firefighters are repeatedly exposed to various pollutants that occur at fire scenes. There are three levels of exposure: primary exposure to pollutants, secondary exposure to pollutants on personal protective equipment (PPE), and tertiary exposure to contaminated fire stations and fire engines due to pollutants on PPE. Therefore, it is important for firefighters to be aware of the risk of exposure to pollutants and to practice health behaviors such as appropriate PPE management. No clear association has been established in the existing literature between firefighters’ risk perception level and their health beliefs about the health impact of awareness of exposure to hazardous substances at fire scenes. This study aims to evaluate the relationship between awareness of the exposure risk to primary, secondary, and tertiary pollutants and health beliefs. It was designed as a cross-sectional study, in which a web-based survey was conducted from 13 May to 31 May 2021. The analysis was conducted in 1940 firefighters working in the Seoul metropolis who agreed to participate in the research. Participants who perceived susceptibility were likely to be aware of the primary (adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI) 1.16–3.80), secondary (AOR = 2.77, 95% CI 1.77–4.32), and tertiary (AOR = 2.73, 95% CI 1.85–4.03) exposure risks. Participants who perceived barriers were unlikely to be aware of the risk of exposure to primary (AOR = 0.67, 95% CI 0.49–0.91), secondary (AOR = 0.77, 95% CI 0.61–0.96), and tertiary (AOR = 0.75, 95% CI 0.62–0.91) pollutants. Educational intervention is recommended to improve perceived susceptibility and awareness of the risk of exposure to pollutants and reduce perceived barriers. Consequently, educational intervention is expected to positively impact firefighters’ management of appropriate PPE. We confirmed an association between occupational exposure risk and firefighters’ health beliefs. In the health belief model (HBM), health beliefs that affect health behavior also affect awareness of the exposure risk level. Therefore, an intervention for health beliefs can also be used to raise job-related exposure risk awareness. Regular training on the health impacts of fire scenes is necessary for both newcomers and incumbents to enable firefighters to better recognize the risks of each occupational exposure level. Additionally, laws and regulations are necessary for the removal of harmful substances that contaminate PPE, such as self-contained breathing apparatus (SCBA), during exposure to a fire scene. Our research can be used as a basis for improving fire policies and education programs in the future.

A comparison of behavioural models explaining cervical cancer screening uptake

BACKGROUND

Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.

METHODS

A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.

RESULTS

CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.

CONCLUSION

Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

"Not me!": Optimistic bias and college students' perceived susceptibility, severity, benefits, and self-efficacy in following COVID-19 preventive guidelines

Objective The COVID-19 pandemic has created unprecedented challenges for university administrators and health professionals to keep doors open and students safe. Optimistic bias and the Health Belief Model serve as foundations for understanding students' perceived susceptibility and severity for contracting the virus and their perceived benefits and self-efficacy for following prevention recommendations. Participants: A total of 1,773 undergraduate and graduate students from a large mid-western university participated. Methods: Students were emailed an online survey examining their perceptions and knowledge of COVID-19 and their adherence to recommended preventive measures. Results: Almost one-half of students do not think they will get COVID-19 but said their friends are at risk. The majority are following most Centers for Disease Control and Prevention recommendations and understand the perceived benefits of doing so. Conclusions: Results could aid university officials in developing effective COVID-19 messages that could lead to reductions in cases numbers, deaths, and spread of the virus.

Positive Effects of Extra-Virgin Olive Oil Supplementation and DietBra on Inflammation and Glycemic Profiles in Adults With Type 2 Diabetes and Class II/III Obesity: A Randomized Clinical Trial

Background

Evidence on the effects of dietary interventions on inflammatory markers in individuals with obesity and type 2 diabetes mellitus (T2DM) is scarce. Our study evaluated the effects of extra-virgin olive oil alone and in combination with a traditional Brazilian diet on inflammatory markers and glycemic profiles in adults with both T2DM and class II/III obesity.

Methods

Adults aged 18-64 years with T2DM and class II/III obesity were randomized into two intervention groups: 1) extra-virgin olive oil only and 2) extra-virgin olive oil + a traditional Brazilian diet (OliveOil+DietBra). Data on sociodemographic characteristics, lifestyle, anthropometry, biochemical markers and inflammatory markers were collected. The primary outcomes were glycemic parameters and inflammatory markers. The body mass index (BMI) and weight were the secondary outcomes.

Results

Forty individuals with T2DM and class II/III obesity were enrolled, and 34 (85%) completed the intervention course. The intake of olive oil was 37.88 ± 12.50 mL/day in the olive oil group and 37.71 ± 12.23 mL/day in the OliveOil+DietBra group, with no significant difference between groups (p = 0.484). Compared to the olive oil only group, the OliveOil+DietBra group had significantly lower levels of fasting insulin (p = 0.047) at the end of the intervention, whereas the other glycemic parameters were not altered. In the OliveOil+DietBra group, serum levels of inflammatory cytokines, IL-1α (p = 0.006) and adiponectin (p = 0.049) were lower and those of TNFα were higher (p = 0.037). There was a significant reduction in BMI and weight compared to the baseline values in the OliveOil+DietBra group (p = 0.015).

Conclusions

The intervention with OliveOil+DietBra effectively decreased the levels of fasting insulin, IL-1α and adiponectin, suggesting its beneficial role in improving the inflammatory profiles and fasting insulin levels in adults with class II/III obesity and T2DM.

Clinical Trial Registration

ClinicalTrials.gov, identifier: NCT02463435.

Nutritional and food education as a complementary treatment approach in severe obese individuals

Background: The treatment for obesity, specifically severe obesity, is a challenge for health professionals and services. It requires a multidisciplinary and holistic approach covering the complexity and difficulties of incorporating healthy habits to prevent associated diseases and mortality. Individual intervention's methods are not enough to change eating habits. Objective: To describe and investigate the contribution of nutritional and food education as a complementary therapeutic approach in the treatment of individuals with severe obesity and their family members. Methods: A multidisciplinary team adopted a group approach. A different topic was addressed at each therapeutic meeting to assist in the nutritional treatment of obesity, such as diet and healthy habits i.e. barriers to lifestyle changes. The topics were developed based on different methodological and teaching approaches to facilitate adherence to non-drug treatment. Results: Overall, there was a greater understanding towards the adoption of healthy eating habits of the whole family, greater motivation to adhere to dietary changes and adoption of a more physical active lifestyle. This interventional educational support methodology had been accepted in such a positive way for patients and their relatives. Family member participation expands the possibilities of establishing necessary and lasting changes in the lifestyle of not only the patients, but their whole families. Conclusion: Health education actions constitute an important complementary therapeutic approach in promoting health and preventing complications in individuals with severe obesity. This article can be useful to enlarge the debate on the subject and face the challenges related to the effective treatment of obesity, notably severe obesity.

Barriers to physical activity and markers of adiposity in university students

ABSTRACT In this study the objective was to establish the association between physical activity barriers and adiposity markers in university students. A cross sectional descriptive study was executed. Anthropometric assessment, sociodemographic data survey and physical activity barrier perception questionnaire were applied to 211 students. The most frequent barriers were lack of time, energy and free will. It was found greater value in indicators of adiposity in men and association between the barriers lack of time, skills and fear of injury, with a higher body mass index. It was found a relationship between barriers to physical activity and adiposity markers, relevant aspects in the strategies of promotion of physical activity and weight control.

Nutritional and Socioeconomic Determinants of Overweight and Obesity in the French Amazon: The Health Barometer Study

OBJECTIVES

French Guiana is a multicultural overseas territory where obesity is a major public health problem. This study aimed to highlight the nutritional and socioeconomic determinants of overweight and obesity in different populations in French Guiana.

METHODS

A two-stage random sample of 1390 individuals aged 15 to 75 years was surveyed by telephone, and the participants were initially screened for diabetes. Logistic regression was fitted on the sample to adjust for potential confounding factors.

RESULTS

Overweight and obesity were found in 54.7% of the respondents, a higher proportion than in mainland France. There was a significant body image discrepancy in our population, with a higher risk of obesity among single women, often immigrants from the non-French Caribbean and South America, unemployed or low education.

CONCLUSIONS

The main factors associated with obesity were being a precariousness immigrant; there was often a mismatch between body image and overweight/obesity, which is a major obstacle to the improvement of dietary behaviors and lifestyle. This information provides operational clues as to where to act and the necessary adaptations to attempt to modify behaviors in a culturally-adapted manner.

Development and validation of an instrument to measure beliefs in physical activity among (pre)frail older adults: An integration of the Health Belief Model and the Theory of Planned Behavior

OBJECTIVE

To develop and evaluate the psychometric properties of an instrument assessing beliefs in physical activity based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) among (pre)frail older adults.

METHODS

A literature review and semi-structured interviews were conducted to generate the initial item pool of the instrument. A rural sample of 611 (pre)frail older adults was enrolled to examine the validity and reliability of the instrument.

RESULTS

The exploratory factor analysis extracted eight factors for this instrument, explaining 71.3% of the variance in beliefs in physical activity. The confirmatory factor analysis confirmed the eight-factor structure. Linear regression models found that the integrated HBM-TPB constructs explained 65.9% of the variance in physical activity intention and 13.6% in physical activity. The Cronbach's alpha coefficients for the factors ranged from 0.80 to 0.98, and ICCs ranged from 0.71 to 0.85.

CONCLUSION

This instrument has satisfactory construct validity, predictive validity, internal consistency reliability and test-retest reliability, and it can be used in (pre)frail older adults to measure beliefs in physical activity.

PRACTICE IMPLICATIONS

This instrument may help health care providers understand beliefs in physical activity and facilitate targeted interventions among (pre)frail older adults.

Associations of sugar-sweetened beverage knowledge, self-efficacy, and perceived benefits and barriers with sugar-sweetened beverage consumption in adolescents: A structural equation modeling approach

This study was performed to investigate the predictors of sugar-sweetened beverage (SSB) consumption in adolescents, including knowledge of SSBs, self-efficacy, and perceived benefits and barriers, using the structural equation modeling approach. This cross-sectional study was conducted from March to June 2019 in New Taipei City, Taiwan. The participants were 633 adolescents from 23 classes at three junior high schools in New Taipei City. A structured self-administered questionnaire was developed for data collection. The overall model predicted SSB consumption well, suggesting that SSB consumption was associated with self-efficacy and perceived barriers and benefits. Self-efficacy was the strongest predictor of SSB consumption. Both perceived barriers and self-efficacy sequentially and fully mediated the effect of knowledge on SSB consumption. This study confirms that self-efficacy is associated with SSB intake in both male and female adolescents. However, knowledge of SSBs was not associated with SSB consumption. Relying on nutritional education alone may not be adequate to change SSB consumption. The results suggest that future health promotion programs should improve self-efficacy to decrease SSB consumption in adolescents.

Do associations between education and obesity vary depending on the measure of obesity used? A systematic literature review and meta-analysis

Background

Consistent evidence suggests a relationship between lower educational attainment and total obesity defined using body mass index (BMI); however, a comparison of the relationships between educational attainment and total obesity (BMI ≥30 kg/m²) and central obesity (waist circumference (WC) > 102 cm for men and WC > 88 cm for women) has yet to be carried out. This systematic literature review (SLR) and meta-analyses aimed to understand whether i) the associations between education and obesity are different depending on the measures of obesity used (BMI and WC), and ii) to explore whether these relationships differ by gender and region.

Methods

Medline, Embase and Web of Science were searched to identify studies investigating the associations between education and total and central obesity among adults in the general population of countries in the Organisation for Economic Co-operation and Development (OECD). Meta-analyses and meta-regression were performed in a subset of comparable studies (n=36 studies; 724,992 participants).

Results

86 eligible studies (78 cross-sectional and eight longitudinal) were identified. Among women, most studies reported an association between a lower education and total and central obesity. Among men, there was a weaker association between lower education and central than total obesity (OR central vs total obesity in men 0.79 (95% CI 0.60, 1.03)). The association between lower education and obesity was stronger in women compared with men (OR women vs men 1.66 (95% CI 1.32, 2.08)). The relationship between lower education and obesity was less strong in women from Northern than Southern Europe (OR Northern vs Southern Europe in women 0.37 (95% CI 0.27, 0.51)), but not among men.

Conclusions

Associations between education and obesity differ depending on whether total or central obesity is used among men, but not in women. These associations are stronger among women than men, particularly in Southern European countries.

Trends in Eating Habits and Body Weight Status, Perception Patterns and Management Practices among First-Year Students of Kaunas (Lithuania) Universities, 2000-2017

Students' transition from high school to university is accompanied by lifestyle changes. This study aimed to assess trends in students' body weight status, perception, management practices and eating habits from 2000 to 2017. Three cross-sectional surveys were carried out among the first-year students of five Kaunas (Lithuania) universities in 2000, 2010 and 2017. The self-administered questionnaires were filled in during lectures. Altogether, 3275 students aged 20.0 (1.5) years participated in the survey. The prevalence of self-reported overweight increased among male students from 11.3% in 2000 to 24.3% in 2017 and female students from 5.2 to 9.6%. The intake frequency of fruits, vegetables and cereals increased, and red meat decreased. At a normal BMI, more female than male students perceived themselves as being 'too fat' (19.4% and 8.8% in 2017), while more male than female students perceived themselves as being 'too thin' (37.2% and 4.5% in 2017). More females than males were dissatisfied with their weight, worried about gaining weight and tried to lose weight. Weight-management practices were associated with body weight, self-perception, dissatisfaction, worries about weight gain and eating behaviours. Our study highlights the need for interventions to increase the accuracy of weight perception and to promote the appropriate weight-management methods, addressing gender differences.

Modelling knowledge, health beliefs, and health-promoting behaviours related to cardiovascular disease prevention among Malaysian university students

Background

Healthy lifestyle habits formed during young adulthood may have a sustaining impact on health across later life. The current study aimed to test the theoretical model of factors (selected demographic variables, knowledge of heart disease, health belief related to cardiovascular disease (CVD), self-efficacy, cues to action, and screening intention) influencing health-promoting behaviours among Malaysian university students.

Methods

In a cross-sectional survey, the undergraduate students in Universiti Sains Malaysia were invited to complete the self-administered questionnaires. Participants were selected using a purposive sampling method. The proposed hypothesised model was analysed using a structural equation modelling with Mplus 7.3 program. A total of 788 (70.7% female) undergraduate students with a mean age of 20.2 (SD = 1.02) participated in the study. The primary outcome of knowledge, health beliefs, and health-promoting behaviours related to CVD were measured by questionnaires namely: Knowledge of Heart Disease, Health Beliefs Related to CVD, and Health Promoting Lifestyle Profiles-II.

Results

The final hypothetical structural model showed a good fit to the data based on several fit indices: with comparative fit index (CFI) at .921, standardised root mean square residual (SRMR) at .037, and root mean square error of approximation (RMSEA) at .044 (90% CI: .032, .054). The final structural model supported 13 significant path estimates. These variables explained 12% of the total variance in health-promoting behaviours. Through perceived benefits, total knowledge had an indirect effect on health-promoting behaviours.

Conclusion

The results suggest that perceived barriers, perceived benefits, family history of CVD, and screening intention enable young adults to engage in health-promoting behaviours.

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic

COVID-19 has become a global pandemic, with over 81 million cases worldwide. To assess changes in tobacco use as a result of the pandemic, we surveyed a convenience sample of current tobacco users between April and June 2020. The sample was taken from a tobacco user research registry (n = 3396) from the Penn State College of Medicine in Hershey, Pennsylvania, USA. Participants who responded to the survey and were eligible for this study (n = 291) were 25.6% male, 93% white, and had a mean age of 47.3 (SD = 11.6) years. There were no reports of participants testing positive for COVID-19, but 21.7% reported experiencing symptoms associated with the virus. Most participants (67%) believed that their risk of contracting COVID-19 was the same as non-tobacco users, but 57.7% believed that their risk of serious complications, if infected, was greater compared to non-tobacco users. A total of 28% reported increasing their cigarette use during the pandemic. The most common reasons for increased use were increased stress, more time at home, and boredom while quarantined. Nearly 15% reported decreasing their tobacco use. The most common reasons for reduced use were health concerns and more time around non-smokers (including children). A total of 71 (24.5%) users reported making a quit attempt. Characterizing these pandemic-related changes in tobacco use may be important to understanding the full scope of subsequent health outcomes resulting from the pandemic. Tobacco cessation resources should be tailored to allow for safe, appropriate access for those interested in quitting.

Prevalence of overweight and obesity and their associated factors among health sciences college students, Saudi Arabia

CONTEXT

The healthcare sciences college students have a lifestyle with low physical activity and disordered eating habits, which exposes them to a higher risk of obesity. Health science college students were the target group of particular interest in this study as they are future physicians. If they are overweight or obese, they will carry the wrong impression to the general population.

AIM

To assess the prevalence of overweight and obesity among healthcare science college students at private university in Saudi Arabia. Also, it assesses the relationship between the sociodemographic characteristics and risk of overweight and obesity in this population.

METHODS

A cross-sectional study was conducted among healthcare science college students. A validated, structured, closed-ended questionnaire was self-administered through the Monkey survey. All data were analyzed using SPSS.

RESULTS

401 students participated, in which 33.4% were male and 66.6% were female students; and the mean age was 22 years. The study showed that 23.7% of participants were overweight, and 11% were obese. The prevalence of obesity was higher among males. Family history of obesity and fatigue were risk factors for obesity.

CONCLUSION

The healthcare Science College students showed a high prevalence of obesity and overweight. This is strengthening the need to encourage a healthy lifestyle, healthy food habits, and physical activities to avoid obesity-related complications.

The association of dietary patterns with endocannabinoids levels in overweight and obese women

BACKGROUND

Higher levels of anandamide (AEA) and 2-arachidonoylglycerol (2-AG), the main arachidonic acid-derived endocannabinoids, are frequently reported in overweight and obese individuals. Recently, endocannabinoids have become a research interest in obesity area regarding their role in food intake. The relationship between dietary patterns and endocannabinoids is poorly understood; therefore, this study evaluated the association of the dietary patterns with AEA and 2-AG levels in overweight and obese women.

METHODS

In this cross sectional study, 183 overweight and obese females from Tabriz, Iran who aged between 19 and 50 years old and with mean BMI = 32.44 ± 3.79 kg/m² were interviewed. The AEA and 2-AG levels were measured, and the dietary patterns were assessed using food frequency questionnaire. To extract the dietary patterns, factor analysis was applied. The association between AEA and 2-AG levels and dietary patterns was analyzed by linear regression.

RESULTS

Three major dietary patterns including "Western", "healthy", and "traditional" were extracted. After adjusting for age, physical activity, BMI, waist circumference, and fat mass, higher levels of AEA and 2-AG were observed in participants who were in the highest quintile of the Western pattern (P <  0.05). Also, in both unadjusted and adjusted models, significantly lower levels of AEA and 2-AG were detected in the women of the highest quintile of the healthy pattern (P <  0.01). Moreover, there was no significant association between "traditional" pattern and AEA and 2- AG levels in both unadjusted and adjusted models (P > 0.05).

CONCLUSION

In regard with the lower levels of endocannabinoids in healthy dietary pattern, adherence to healthy pattern might have promising results in regulating endocannabinoids levels.