Family as a health promotion setting: A scoping review of conceptual models of the health-promoting family

The impact of chronic pain on functional capacity in middle-aged and older adults: The mediating role of family relationships

OBJECTIVES

Investigating the impact of pain on overall functional capacity and the role of family relationships between them.

METHODS

Data was drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. Propensity score matching was used to reduce confounding factors, and a mediation model was employed to examine the mediating role of family relationships between pain and functional capacity.

RESULTS

Pain was negatively associated with overall functional capacity (P < 0.001). Within the five domains of functional capacity, the pain group and the non-pain group in meeting basic needs, mobility, and contributing to society domains were different. Family relationships partially mediated the relationship between pain and functional capacity (95 % CI: -0.011 to -0.002).

CONCLUSION

Pain's impact on functional capacity is mediated by family relationships. Interventions for healthy aging should manage pain and enhance family relationships in health practice to promote functional capacity.

Exploring the role of adolescents in healthier, more sustainable family meals: A decision study on meat consumption

OBJECTIVE

Can children's preferences make family meals healthier and more sustainable? Extending cultural evolution theory, we explored the children's role in a possible bottom-up transmission of meat preferences to their parents in the context of family meals.

METHODS

Fifty-seven parent-child dyads from Germany (age: Mchildren = 15.9 years, Mparents = 50.5 years; 67% daughters, 93% mothers; 14% of children and 0% of parents followed a vegetarian/vegan diet; 82% of children were still in school; 42% of parents had a bachelor's degree or higher) decided on a family meal through discussion, which was videotaped. Before and after discussing, dyad members separately stated their preferred meat proportion for the family meal.

RESULTS

In contrast to our hypotheses, on average children neither preferred less meat nor had a stronger influence on meat proportions in family meals than their parents. Daughters-despite a considerably lower preference for meat-did not reduce meat at family meals more than sons. Rather than demographic characteristics (i.e., age, gender), it was specific behaviors of children or dyads that predicted stronger influence on and eventually lower proportion of meat at family meals. These specific behaviors were following a vegetarian/vegan diet, general conflicts about meat-related aspects of family meals, and-in tendency-mentioning sustainability arguments in discussions.

CONCLUSIONS

Children can be part of the change toward healthier and more sustainable family foodways-which could improve the family's health-if they themselves eat accordingly and actively advocate for it.

Exploring the Experiences of Australian Fathers Who Lead School 'Dads Groups'

ISSUE ADDRESSED

Past research suggests that fathers are underrepresented in traditional parenting and child health promotion programs compared to mothers. One promising method to deliver support is a peer-facilitated approach that enables fathers to connect with their peers. This model has been adopted by several community organisations in Australia. However, limited research evaluates the implementation and impact of these services.

METHODS

This study conducted interviews with 10 Australian fathers who lead School Dads groups-a peer-based model of support for Australian fathers delivered by one not-for-profit organisation. Using interpretative description methodology, we sought to understand how these leaders approached implementing School Dads Groups, and their perception of how participation in these groups impacts their members.

RESULTS

Key findings of the thematic analysis revealed that leaders felt the key goal and benefit of participating in a School Dads Group is to build closer relationships between fathers and their children. While participants were committed to facilitating peer support, they also recognised potential barriers that prevent translating this into practice, including difficulties maintaining attendance.

CONCLUSIONS

The study's findings uncover the main motivations for peer facilitators, crucial for the expansion and success of father-focused community-based programs. SO WHAT?: The findings suggest that school-based, peer support programmes for fathers could be an effective medium for delivering health promotion, with the potential to positively influence fathers and children's well-being.

The EQ-5D and EQ-HWB fit the perceptions of quality of life from a Chinese perspective: a concept mapping study

BACKGROUND

The escalating globalization of health assessments underscores a pivotal challenge: Do Quality of Life (QoL) instruments, developed primarily in Western contexts, accurately reflect the perspectives of non-Western populations? This study evaluates the alignment of EQ-5D and EQ-HWB items with QoL dimensions identified in Chinese literature, and compares QoL perceptions between Chinese residents and those living abroad who may be influenced by Western values.

METHODS

This study employed three successive rounds of participant recruitment to refine the concept mapping process. Initially, 13 bilingual QoL experts in the Netherlands piloted the methodology, providing feedback on item translation and expression. Subsequently, 18 Chinese expatriates in the Netherlands, with partial education abroad, reviewed the revised materials to represent perspectives influenced by Western culture. Finally, 20 native Chinese residents, who were born and educated in China, formed the target group. Utilizing feedback from the pilot stage, a pool of 54 QoL items derived from Chinese literature, plus an additional eight from the EQ-HWB, were assembled. The Group Concept Mapping (GCM) method was used, with participants organizing the items to reflect their interrelationships. Data were analyzed via Groupwisdom™, an online tool supporting multidimensional scaling (MDS) and cluster analysis, culminating in visual cluster rating maps that highlighted the item associations and groupings.

RESULTS

In China, a five-cluster MDS map was identified: personal abilities, family and society, physical health, mental health, and self-cognition (stress value: 0.183), with physical health prioritized. Abroad, four clusters appeared: mental health, social connections, daily activities, and physical function (stress value: 0.185), prioritizing social connections. The EQ-5D missed the "family and society" cluster in China and "social connections" abroad. In contrast, the EQ-HWB covered all clusters in both groups.

CONCLUSIONS

The EQ-5D items align well with the somatic and partially with the mental clusters, while the EQ-HWB also covers the adaptation cluster and the remaining mental cluster aspects. Both instruments reflect the QoL perceptions of Chinese individuals, although EQ-5D focuses more on health than overall well-being. Cultural differences affect priorities: participants in China value physical health most, whereas those abroad emphasize social connections.

The Impact of Pandemic-Induced Separation and Visitation Restrictions on the Maternal-Infant Dyad in Neonatal Units: A Systematic Review

BACKGROUND

The COVID-19 pandemic affected the maternal-infant dyad, especially due to visitation restrictions in neonatal units. These changes may impact the psychological, physical, and developmental health of mothers and newborns.

PURPOSE

This systematic review evaluates the impact of enforced separation and restrictive visitation policies in neonatal units during the pandemic, focusing on the maternal-infant dyad.

DATA SOURCES

Data sources include CINAHL, MEDLINE, Web of Science, APA PsycINFO, Academic Search Ultimate, and Embase, covering studies published between 2020 and 2024.

STUDY SELECTION

A detailed search was conducted using terms related to COVID-19, maternal and neonatal health, and visitation restrictions in neonatal units. Articles were included if they were peer-reviewed, written in English, and focused on the impact of visitation restrictions on maternal and neonatal health.

DATA EXTRACTION

The data extraction process began with 789 references. After removing duplicates, we screened titles and abstracts. We then conducted a full-text assessment of the remaining studies, selecting 14 that met the inclusion criteria.

RESULTS

The analysis showed significant emotional, psychological, and developmental impacts on mothers and newborns due to pandemic-induced separation and inconsistent policies. It highlighted depressive symptoms, stress, bonding disruptions, and the effectiveness of virtual bonding.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The review emphasizes the need for family-centered care, coping strategies, and virtual bonding in neonatal units. It calls for culturally sensitive policies to support mothers and infants during crises. The review also highlights the importance of studying the long-term effects of pandemic-induced separations and improving support for future health emergencies.

Health and health literacy from the child's perspective: a qualitative study in 9-12-year olds

To promote health literacy (HL) in children, it is crucial to recognize their unique social environment, experiences, and comprehension of health and HL. This study aims to gain insight into the perspectives of children aged 9-12 years regarding health and HL within the context of health promotion. We conducted focus group discussions with children at three primary schools in the Netherlands, covering (i) What health means to children (ii) How they engage with health information (HL), and (iii) How they respond to the items of an HL questionnaire (HLS-Child-Q15-NL). Thematic analysis was used to analyze data from nine focus groups with 46 children. We identified three themes: (i) perspectives of health and healthy living, (ii) information for healthy living, and (iii) sources of information for healthy living. Children rated being yourself, physical activity, and happiness as the most important health topics. They receive health information passively, mainly from caregivers and social media, and emphasize the need for simple language. Trustworthiness of sources and usefulness of information were also important. Responses to the HLS-Child-Q15-NL varied, with some items being unclear and leading to misunderstandings, though generally seen as easy. The findings highlight children's broad perspective of health and HL. Health-promoting activities should focus on developing HL skills related to children's lived experiences and health topics that they deem important. This will present an opportunity for children to engage with health information more actively and critically.

The influence of health literacy on how preschool educators and parents perceive the continuous development of health competencies within the framework of sustainability: Lithuanian case

Preschool education is one of the most important priorities of modern educational policies and the basis of lifelong learning. Health-literate educators and parents are better equipped to instill sustainable health practices in young children. Therefore, it is important to examine health literacy and determine how preschool educators and parents perceive the continuous development of health competencies within the framework of sustainability. The quantitative survey results revealed the dominant levels of general health literacy among respondents: problematic (31.1% vs. 33.5%) and sufficient (39.8% vs. 43.3%) for parents and teachers, respectively. Parents' attitudes toward the development of children's health competence within the framework of sustainability in preschool showed that parents and educators understand that their role is one of the most important factors in strengthening children's health competence. However, most respondents spend only 2 h being active with children on healthy lifestyles (61.5% vs. 55%) for parents and teachers, respectively. A moderate correlation was found between health literacy and the weekly time spent developing children's health competencies (r = 0.526). In addition, educators and parents who always or very often focus on the development of children's health competence seek to plan daily activities in a way that would enhance health promotion (r = 0.463). Within the framework of sustainability, this influence becomes even more pronounced as sustainable health education aims to instill long-lasting, holistic health practices that benefit individuals and communities over time.

A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Extending Our Understanding of the Social Determinants of Physical Activity and Sedentary Behaviors in Families: A Systems Mapping Approach

BACKGROUND

The social environment is important to consider for effective promotion of movement behaviors like increased physical activity (PA) and reduced sedentary behavior (SB); yet, it is less often considered than individual and built environments. One way to advance social environment research is to develop system maps, an innovative, participatory, action-oriented research process that actively engages stakeholders to visualize system structures and explore how systems "work." The purpose of this research was to develop PA and SB system maps of the social environment embedded within the core/nuclear family system.

METHODS

The development process began with a 2-day multicountry, 16-researcher, in-person participatory workshop in August 2023, followed by multiple online follow-up consultations. Attendees contributed to the creation of the maps through shared development of critical determinants and their causal pathways. The structure of the final maps was analyzed using network analysis methods to identify indicators of centrality, and key feedback loops and areas for potential intervention were explored.

RESULTS

Key central determinants that were likely critical targets for systems intervention to produce changes in PA and SB and featured prominently in most of the reinforcing and balancing feedback loops included shared family interests, values and priorities, family logistical support, family cohesion/organization, and shared experiences. The maps also highlighted key determinants of the broader social environment external to the family.

CONCLUSIONS

These system maps support current evidence on movement behaviors in family systems and socioecological theories and have the utility to galvanize future research and policy to promote PA and reduce SB.

Neighborhood social environment and mental health of older adults in China: the mediating role of subjective well-being and the moderating role of green space

Introduction

With the continuous development of the global aging trend, the mental health of older adults has been a concern by the world. The living space of older adults is limited due to the decline of their activity function. Neighborhood environment, especially the neighborhood social environment, has become an important factor affecting the mental health of older adults. Therefore, this study explores the mechanism that influences the social environment of the neighborhood and the mental health of older adults, the mediating effect of subjective well-being (SWB), and the moderating effect of green space.

Methods

Based on the 2018 China Labor Dynamics Survey, this study used the structural equation model to explore the mediating effect of neighborhood social environment (neighborhood ties, social trust, community security) on the mental health of older adults through SWB and the moderating effect of green space.

Results

Social trust and community security are both directly and positively associated with older adults' mental health. At the same time, neighborhood ties, social trust, and community security can promote the mental health of older adults by positively affecting SWB, while green space has an enhanced moderating effect between neighborhood ties and mental health.

Discussion

This study enriches the empirical research on neighborhood social environment and mental health. First of all, older adults living in communities with good safety conditions and high social trust are less affected by negative emotions and tend to have good mental health. Second, deeper neighborhood ties, higher social trust, and safer community environments help older adults to be less disturbed by negative situations, have a positive effect on their SWB, and indirectly promote mental health. At the same time, green space can provide a place for older adults to socialize, enhance the positive impact of neighborhood ties on SWB, and further promote the mental health of older adults. Finally, this study suggests that the government and community managers pay attention to the construction of neighborhood social environment and green space, and provide support for "healthy community" and "healthy aging" planning.

The chain mediating effect of self-respect and self-control on the relationship between parent-child relationship and mobile phone dependence among middle school students

This study aims to examine the impact of parent-child relationship on smartphone dependence among middle school students and explore the mediating role of self-respect and self-control. A cross-sectional survey was conducted using the Parent-Child Relationship Scale, Smartphone Dependence Scale, Self-Respect Scale, and Self-Control Scale with a sample of 2,311 middle school students. Correlation analysis revealed positive correlations among parent-child relationship, self-respect, and self-control. Specifically, the parent-child relationship was positively correlated with self-respect (r = 0.454) and self-control (r = 0.423), and negatively correlated with smartphone dependence (r=-0.380). Smartphone dependence was negatively correlated with self-respect (r=-0.409) and self-control (r=-0.629). Self-respect was positively correlated with self-control (r = 0.519). Structural equation modeling indicated that self-respect and self-control partially mediated the relationship between parent-child relationship and smartphone dependence. The mediation effect of self-respect was - 0.0843 (effect size = 8.99%, 95% CI=-0.1303 to -0.0379), and the mediation effect of self-control was - 0.3149 (effect size = 33.59%, 95% CI=-0.3802 to -0.2500). The total chain mediation effect of self-respect and self-control was - 0.2499 (effect size = 26.66%, 95% CI=-0.2915 to -0.2119). Self-respect and self-control serve as a chain-mediated pathway between parent-child relationship and smartphone dependence among middle school students.

Development of the social dimensions of health behaviour framework

Despite rapid theoretical expansion in conceptualising individual and environmental processes, the examination of social processes associated with health behaviours has a less cohesive theoretical landscape. The purpose of this mapping review and content analysis was to develop a taxonomy of social dimensions applicable to health behaviours. Michie et al. (2014) 'ABC of Theories of Behaviour Change' text, which includes 83 behaviour change theories, was used as the data-set, whereby an iterative concurrent content analysis was undertaken with respect to all relational/interpersonal psychological dimensions. The analysis resulted in a social dimensions of health behaviour (SDHB) framework of 10 dimensions, including seven sub-types of social appraisal dimensions and three-sub-types of social identification dimensions. The SDHB revealed that specific dimensions, such as descriptive norm, are prevalent in behavioural theories, while other dimensions have seen less attention. Further, while most social constructs in behavioural theories are represented by only one social dimension in the SDHB, other constructs have complex representation. This version 1.0 of the SDHB framework should assist in specifying the core social dimensions in health behaviour, provide a common lexicon to discuss relational constructs in psychological theories, amalgamate the disparate social constructs literature and identify opportunities for further research to advance theory development and interventions.

Parents' practices, feelings, and support needs surrounding the development of food allergy literacy (FAL) in children before their transition to school

Children's knowledge of food allergy and risk prevention, coined as food allergy literacy (FAL), can bolster their safety in schools. Addressing research gaps on this topic, especially, parents' role, the aim of this study was to investigate Australian parents' practices, feelings, and support needs relating to building children's FAL before their transition to school. Questionnaire data from 159 parents were analysed statistically to characterise the sample and explore the association between children's FAL, parent anxiety, and parent confidence in their child's ability to stay safe at school. Results indicated that parents supported children's knowledge of food allergy and risk prevention using age and developmentally appropriate pedagogies. However, they focused less on building children's skills to read food labels, communicate symptoms, and seek help. Furthermore, the association between children's FAL and parents' feelings about children's safety in school was weak. However, the association between the child's FAL and parents' confidence in the child's ability to stay safe at school was moderate-to-strong. The implications of these findings for educators are discussed.

Examination of the psychometric properties of the short and long forms of the Family Health Scale in Turkish culture

PURPOSE

A healthy family is very important for community health. This study was conducted to test the validity and reliability of the short and long forms of the Family Health Scale (FHS) in Turkish culture.

DESIGN AND METHODS

This is a cross-cultural adaptation and validation of instruments using a methodological approach. A total of 783 individuals aged between 18 and 65 from Turkey. The test-retest reliability analysis of FHS was performed with 64 participants after four weeks.

RESULTS

Confirmed that the long form of the FHS was four-dimensional and the short form was one-dimensional. The results of the confirmatory factor analysis showed that the long and short forms fit well with the data, and it was determined that all fit indices were within acceptable limits. The Cronbach alpha of the long form of the FHS was 0.911, the cronbach alphas of the four sub-dimensions ranged from 0.833 to 0.908, and short form was 0.872. The pearson correlation coefficient between the forms was 0.919 (p = 0.000).

CONCLUSIONS

The results of the study revealed that the FHS is a valid and reliable measurement tool that can be used specifically for Turkish society.

PRACTICE IMPLICATIONS

Nurses can use both forms of the FHS to examine family health and trends in family health in the population they serve. The FHS may be an important screening tool in health care settings and family intervention programs. Nurses can use FHS when providing health care so that children grow up in a healthy family.

Is Family History for the Management of Cardiovascular Health in Youth Still Relevant in Clinical Practice?

PURPOSE OF REVIEW

Family history of premature cardiovascular disease is a strong predictor of individual cardiovascular risk. However, family history is not always available and not always reliable. Roughly 80% of health outcomes are influenced not by genetic risk but by societal factors, including adverse health behaviors and environment. Furthermore, in the present age of genetic testing, laboratory evaluations, and imaging, a key question remains: What is the contemporary relevance of family history screening in the management of cardiovascular disease in youth?

RECENT FINDINGS

Knowledge of an individual's family history can help clinicians identify not only inherited risk but also familial clustering of unhealthy behaviors and environmental adversity contributing to enhanced cardiovascular disease risk in youth. For those at greatest risk, prevention strategies can be applied sooner and more conservatively. Integrating family history into clinical practice is crucial for cardiovascular risk assessment and for optimizing outcomes, but, in some cases, is more reflective of social factors.

Health information, what do people search and where? a cross-sectional online survey study in the adult Swiss population

Health promotion and disease prevention are crucial for improving public health and alleviating the burden of illness in the population. This study aimed to investigate, the sources of health information most used and trusted, and the health topics most searched, by means of a nationwide cross-sectional online survey of a representative sample of the adult Swiss general population. Overall, complete surveys of 2020 participants were analysed (mean age 47 years old, 51% male, and matching the Swiss population regarding age, sex, and language-speaking region). Sources' use were calculated with descriptive statistics per sex and age groups. The most frequently used sources were general practitioners (min: 46% to max: 73%), government websites (40% to 55%), family and friends (37% to 63%), pharmacy (33% to 46%), and television (21% to 57%). The most trusted sources were specialised physicians (94% to 98%) general practitioners (90% to 96%), and pharmacies (81% to 89%). Based on multivariable controlled regression, age (per five years increase) was associated with increased odds of using television (Odds Ratio (OR): 1.19, 95% Confidence Interval (CI): 1.12 to 1.21), print media (OR: 1.15, 95% CI: 1.10 to 1.19), radio (OR: 1.15, 95%CI: 1.10 to 1.20), and the general practitioner (OR: 1.11, 95% CI: 1.07 to 1.15), and decreased odds of using news websites (OR: 0.94, 95% CI:0.9 to 0.98), family and friends (OR: 0.93, 95% CI: 0.9 to 0.98), foreign authorities websites (OR: 0.91, 95%CI: 0.86 to 0.97), and social media (OR: 0.88, 95% CI: 0.84 to 0.92). Women were more likely to seek health information in the pharmacy (OR: 1.39, 95% CI: 1.15 to 1.68), specialised physicians (OR: 1.39, 95% CI:1.13 to 1.72), television (OR: 1.41, 95% CI: 1.16 to 1.72), and books (OR: 1.9, 95% CI: 1.44 to 2.5). The most searched health topics, based on the International Classification of Primary Care, 2nd edition (ICPC2), were general and unspecified symptoms (20.9%) and musculoskeletal issues (19.4%). The use of these findings by policymakers and health care providers could potentially enhance the effectiveness of health-related education strategies, by aligning communication efforts with the populations' preferences and content needs, and allocating resources where they are most commonly accessed and trusted, namely in the general practice.

The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China

Background

Unhealthy lifestyles during adolescence are significant factors leading to chronic diseases in the future. Enhancing health-promoting lifestyles among young adults in China is crucial for preventing and reducing the risk factors of chronic diseases.

Objective

This study aims to explore the relationships between life satisfaction, family health, physical activity, and health-promoting lifestyles among young adults in China. It also seeks to confirm the chain mediation role of family health and physical activity in the influence of life satisfaction on health-promoting lifestyles in this population.

Methods

This study, conducted from August 2023 to November 2023, employed a random sampling method to recruit young adult participants aged 18-40 in the southwestern region of China. Variables were measured using the Satisfaction with Life Scale (SWLS), the Family Health Scale-Short Form (FHS-SF), the Physical Activity Rating Scale-3 (PARS-3), and the Health-Promoting Lifestyle Profile II Revised (HPLP-IIR). Data analysis was performed using SPSS 27.0 and the PROCESS macro version 4.1.

Results

The results indicated that life satisfaction was positively correlated with family health (r = 0.225), physical activity (r = 0.245), and health-promoting lifestyles (r = 0.506). Family health was positively correlated with physical activity (r = 0.320) and health-promoting lifestyles (r = 0.312). Physical activity was positively correlated with health-promoting lifestyles (r = 0.429). Additionally, life satisfaction could influence health-promoting lifestyles directly (effect = 0.369) and through three mediation pathways: (a) family health (effect = 0.033); (b) physical activity (effect = 0.050); (c) family health and physical activity (effect = 0.020).

Conclusion

This study supports the mediating role of family health and physical activity in the influence of life satisfaction on health behaviors among young adults in China. Therefore, we recommend that future public health initiatives place greater emphasis on family health and create conditions that facilitate physical activity for this group. This could be an important direction for further enhancing health-promoting lifestyles among young adults in China.

Expectations of and perceived need for civil war in the USA: findings from a 2023 nationally representative survey

BACKGROUND

Surveys have found concerningly high levels of agreement that the United States will experience civil war soon. This study assesses variation in expectation of and perceived need for civil war with respondent sociopolitical characteristics, beliefs, firearm ownership, and willingness to engage in political violence.

METHODS

Findings are from Wave 2 of a nationally representative annual longitudinal survey of members of the Ipsos KnowledgePanel, conducted May 18-June 8, 2023. All respondents to 2022's Wave 1 who remained in KnowledgePanel were invited to participate. Outcomes are expressed as weighted proportions and adjusted prevalence differences, with p-values adjusted for the false discovery rate and reported as q-values.

RESULTS

The completion rate was 84.2%; there were 9385 respondents. After weighting, half the sample was female (50.7%, 95% CI 49.4%, 52.1%); the weighted mean (± standard deviation) age was 48.5 (25.9) years. Approximately 1 respondent in 20 (5.7%, 95% CI 5.1%, 6.4%) agreed strongly or very strongly that "in the next few years, there will be civil war in the United States." About 1 in 25 (3.8%, 95% CI 3.2%, 4.4%), and nearly 40% (38.4%, 95% CI 32.3%, 44.5%) of those who strongly or very strongly agreed that civil war was coming, also agreed strongly or very strongly that "the United States needs a civil war to set things right." Expectation of and perceived need for civil war were higher among subsets of respondents who in Wave 1 were more willing than others to commit political violence, including MAGA Republicans, persons in strong agreement with racist beliefs or statements of the potential need for violence to effect social change, persons who strongly approved of specified extreme right-wing political organizations and movements, firearm owners who purchased firearms in 2020 or later, and firearm owners who carried firearms in public all or nearly all the time.

CONCLUSIONS

In 2023, the expectation that civil war was likely and the belief that it was needed were uncommon but were higher among subsets of the population that had previously been associated with greater willingness to commit political violence. These findings can help guide prevention efforts.

Building a predictive model for depression risk in fracture patients: insights from cross-sectional NHANES 2005-2020 data and an external hospital-based dataset

BACKGROUND

Depression represents a frequent mental health challenge in individuals with fractures, negatively impacting their recuperation and overall well-being. The purpose of this research was to formulate and corroborate a prognostic framework for pinpointing depression risk among fracture sufferers by utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020 and a separate hospital-based group.

METHODS

We analyzed records from 1,748 individuals with fractures documented in the NHANES database spanning 2005 to 2020, of which 362 were diagnosed with depression, as indicated by a Patient Health Questionnaire-9 (PHQ-9) score of 10 or higher. An additional validation group comprised 360 fracture patients sourced from a medical center. Considered variables for prediction encompassed demographic details, lifestyle habits, past medical conditions, and laboratory results. The method of least absolute shrinkage and selection operator (LASSO) regression facilitated the narrowing down of variables, while multivariate logistic regression was employed to pinpoint significant predictors. To assist in prediction, a nomogram was designed and subsequently validated.

RESULTS

Five independent predictors were identified: drinking, insomnia, poverty-to-income ratio, education level, and white blood cell count. The nomogram showed good discrimination in the NHANES cohorts (training area under the curve (AUC) 0.734, validation AUC 0.740) and hospital-based external validation (AUC 0.711). Calibration curves and decision analysis supported its predictive accuracy and clinical value.

CONCLUSION

The constructed nomogram offers a precise and clinically relevant instrument for forecasting depression risk in patients with fractures, facilitating the early detection of individuals at high risk and enabling prompt intervention.

Exploring COVID-19 Vaccine Decision Making: Insights from 'One-Shot Wonders' and 'Booster Enthusiasts'

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into "One-Shot Wonders" and "Booster Enthusiasts". Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals' needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes.

Effect of School-Based Educational Intervention on Childhood Obesity in Croatian Urban and Rural Settings

BACKGROUND

Childhood obesity is a global public health concern. Development of effective public health interventions represents the only viable option for decreasing the prevalence of childhood obesity. The objective of this study was to assess the effectiveness of a school-based "PETICA-Play for Health" obesity prevention program in urban and rural areas in Croatia.

METHODS

This before-and-after study included 28 elementary schools in Croatia focused on pupils (n = 753, 2nd grade) and their guardians (n = 753) during the school year 2022/2023. "PETICA" multicomponent lessons and workshops (10) were implemented in the school curriculum and home settings (parents) as part of the intervention. Knowledge and lifestyle habit changes were evaluated via the questionnaire on knowledge and habits regarding nutrition and physical activity pre-/post-education. The Wilcoxon test for paired samples, Student's t-test (dependent and independent samples), multiple Mann Whitney U tests (p < 0.05), Spearman's correlation, and heatmaps were used.

RESULTS

The analysis showed a significant increase in acquired knowledge among pupils (both settings) and habits in the rural setting (increase in sports activities participation, breakfast, and vegetables consumption (p < 0.001, p = 0.003, p = 0.004)), decrease of sweets and salty snacks intake (p = 0.027, p = 0.011), and also, the link between parents' and children's physical activity levels (p = 0.028 vs. p = 0.022), emphasizing the importance of parents as healthy lifestyle role-models.

CONCLUSION

The study shows that "PETICA" is an efficient school-based educational model that contributes to positive changes in children's knowledge and lifestyle habits that are a prerequisite for childhood obesity prevention.

A Pilot Study of the Coping Together Virtual Family Intervention: Exploring Changes in Family Functioning and Individual Well-Being

In this pilot study, we tested a virtual family strengthening and mental health promotion intervention, Coping Together (CT), during the COVID-19 pandemic. We explored changes at the family and individual levels, as well as mechanisms of change. Participants included 18 families (24 caregivers, 24 youth) with children aged 7 to 18 years. Community health workers delivered the 8-session CT intervention using videoconferencing software. We used qualitative semi-structured interviews with 14 of the families to explore changes and mechanisms of change using a thematic content analysis approach. We also administered pre-post surveys with the 18 families to explore the direction of changes, using only descriptive statistics in this small sample. Qualitative findings supported positive changes across family and individual level outcomes including family functioning, relationship quality, and individual psychosocial well-being. Results also confirmed several hypothesized mechanisms of change with improved communication providing the foundation for increased hope and improved problem solving and coping. Pre-post survey results were mixed, showing positive, but very small, changes in family closeness, caregiver-child communication, and levels of hope; almost no change was observed on measures of caregiver and child mental health. Families reported few problems at baseline quantitatively despite qualitative descriptions of pre-intervention difficulties. Results provide preliminary support for benefits of CT with the most consistent improvements seen across family relationships. Findings were mixed related to individual-level mental health benefits. Results have implications for revising content on mental health coping strategies and suggest the need to revise the quantitative measurement strategy for this non-clinical sample.

Exploring the Influence of Family Attitudes and Individual Psychological Factors on Antibiotic Utilization: A Pilot Study

The inappropriate use of antibiotics gives rise to detrimental consequences, both physical and emotional, with a decreased quality of life and higher levels of anxiety and depression. The current observational study aimed to investigate the association between awareness, beliefs, and behaviors toward antibiotics, highlighting the modulating role of individual and psychological factors in response to illness and medication. Through an online questionnaire, several psychological indexes, as well as knowledge of, attitude toward, and experiences with antibiotics, both individual and family-related, were assessed in a sample of 100 responders (74 females, mean age 33.37 ± 11.36). A positive association between intake behavior, awareness, and individual attitude emerged. Familial approach to antibiotics appears as a predictor of individual attitude and behavior toward these drugs, and awareness about antibiotic risks mediate the relationship between the tendency to be more compliant with prescriptions (R2 = 0.300; MSE = 1.541; F(2, 98) = 20.737; p < 0.0001). Moreover, individuals with a personality characterized by higher conscientiousness are more aware of antibiotic risks (p < 0.01), whereas individuals with a lower awareness are those with higher indexes of psychophysical discomfort (i.e., anxiety, perceived stress, somatization) and levels of emotional rebound (p < 0.05). Anxiety (F(3, 96) = 3.874; p = 0.012; R2 = 0.108) and somatization (F(2, 97) = 3.114; p = 0.030; R2 = 0.089) also significatively moderated the intake behavior, despite the family approach. Overall, the current study provides preliminary findings regarding the way in which family experiences and individual psychological aspects may be influencing factors in the behavior and attitude towards antibiotics and can be used to plan patient-centered therapeutic communication and education.

Exploring personal aptitudes and personality traits that, together with social determinants, shape health behaviors and conduct: a thematic analysis based on the Capability, Opportunity, Motivation and Behavior (COM-B) change system

Introduction

Effective implementation of strategies to promote health and prevent noncommunicable illnesses requires a profound understanding of the interaction between the individual and society. This study brings to health research the consideration of psychosocial factors that influence the maintenance and change of health behaviors and conduct. From a primary care perspective, it is crucial to propose a biopsychosocial approach for the development of health promotion and self-care programs that embrace personal aptitudes as a relevant individual aspect.

Objectives

To explore experiences related to personal aptitudes and personality traits that influence health behaviors and conduct, taking into account the social determinants of health, through a thematic analysis based on the capability-opportunity-motivation and behavior (COM-B) system.

Methods and analysis

This qualitative research is carried out from a descriptive phenomenological perspective, based on 17 focus groups in which 156 people participated. Inductive and deductive analysis techniques were used following Lincoln and Guba's criteria of methodological rigor. In addition to 7 different triangulations of analysts, 6 main categories were identified based on the COM-B system: psychological capacity, physical capacity, physical opportunity, social opportunity, reflective motivation, and automatic motivation. The importance of considering these factors to promote healthy behaviors was stressed.

Discussion

This study examined how personal experiences related personal aptitudes and personality traits influence health behaviors and conduct in Spain. It was found that personality traits such as health literacy, self-efficacy, activation, and self-determination can influence the adoption of healthy behaviors. Likewise, the need for control, overthinking, and ambivalence made it impossible. Furthermore, social determinants of health and interpersonal relationships also play an important role.

Trial registration

ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.

Transforming leisure time physical activity into a habit through social institutions

Physical activity is a positive health behavior that has been shown to reduce the risk of physical and mental illnesses; There's strong evidence suggesting that Physical activity, as one of the components of a healthy lifestyle, if transformed into a consistent behavior or habit early in life, becomes easier to sustain throughout the lifecycle and leads to valuable outcomes for the society's health in various physical, mental, and social dimensions. Each social institution, considering its unique role and characteristics, can contribute to shaping individuals' behaviors in societies. Consequently, identifying the role of social institutions in the development of leisure-time physical activity (LTPA) as a regular activity and a behavioral habit can result in the selection and implementation of highly effective intervention strategies. Therefore, this research aimed to present a model of the role of social institutions in institutionalizing leisure-time physical activity among Iranian adolescent girls. To collect data, the questionnaires were employed, and for presenting the model, structural equation modeling was utilized. Data analysis showed that the role of three social institutions in the institutionalization of physical activities including habituation, objectification and sedimentation was confirmed, although sedimentation was confirmed in all three institutions at the 0.05 level, which indicates that factors in this area can be investigated. Examining the role of social institutions in institutionalizing behaviors may vary across different ages and genders, which is open to investigation in future studies.

"Getting Moving" and Being "Active Fit": Class Differences and Similarities in Health-promoting Parenting through Children's Organized Athletic Activities

Parents are held increasingly responsible for acting intensively to protect their children's health through everyday decisions and practices. We add to this scholarship by considering how organized athletic activities, an important part of the lives of many children, help parents fulfill their responsibility to protect their children's health. Through qualitative analysis of 92 in-depth interviews with parents, we attend to how parents' class shapes their articulation of the relationship between their children's health and their extracurricular involvement, considering literature on the ubiquity of intensive parenting expectations and the possibility that health behaviors and understandings constitute health-related cultural capital. Contrary to previous research, overall, we find similarities across class in parents' understandings of the health benefits of organized athletic activities. We find that parents believe organized athletic activities protect their children's health from inactivity, excess technology usage, and fatness. We do find some class distinctions. Middle-class parents, and not working-class parents, believe that their children's athletic activities will instill a passion for exercise and staying in shape and give children the experience and knowledge to control their body size and promote their well-being through their lives. This may signal a transformation in the relationship between health-related parenting and class that could maintain middle-class children's advantage if it contributes to differences in health beliefs, narratives, or practices that are differentially rewarded by important institutions such as schools, the workplace, or the medical system.

The association between smoking and family health with the mediation role of personality among Chinese people: nationwide cross-sectional study

BACKGROUND

There may be unexplored interactions between family health, personality, and smoking that could help provide new perspectives on tobacco control.

OBJECTIVE

To examine the relationship between the health of one's family and their smoking habits, as well as investigate the potential influence of personality on this relationship.

METHODS

For this cross-sectional investigation, a national survey conducted in China in 2022 recruited a total of 21,916 individuals. The Family Health Scale was utilized to assess the health of the family. The 10-item Big Five Inventory scale was utilized to assess the Big five personality traits. The relationship between big five personality, family health, and smoking were investigated using binary and linear logistic regression. The indirect effects mediated by Big five personality were analyzed using mediation analysis with Sobel tests, and the indirect effects were composited using the Karlson-Holm-Breen method.

RESULTS

The overall prevalence of smoking in the study population was 14.87%, 26.19% for males and 3.54% for females. Urban and rural smoking prevalence was 13.81% and 16.10% respectively. Binary logistic regression analysis revealed a significant negative relationship between smoking and family health (odds ratio 0.964, 95% CI 0.959, 0.970, P < 0.001) with covariates controlled. The Karlson-Holm-Breen composition facilitated the connection between extraversion (47.81%) and nervousness (52.19%).

CONCLUSIONS

Preventive interventions for smoking behavior should prioritize family health and the Big five personality as significant areas to focus on. According to this study, in addition to implementing various interventions for different personalities, family health should be strengthened to reduce smoking behavior.

Association between having a meal together with family and smoking: a cross-sectional nationwide survey

BACKGROUND

Smoking is a major risk factor that significantly affects public health. Although the South Korean government spends significant money on smoking cessation services, the smoking rate remains stagnant. Families influence health-conscious decisions, and family meals can positively affect smoking suppression and health behaviors. Therefore, this study investigated whether family meals are correlated with adults' smoking behaviors.

METHODS

This study used data from the 2019-2021 Korean National Health and Nutrition Examination Survey. Having a meal together with family was defined as "yes" for those who have at least one meal with their family each day and "no" for those who do not. Current smoking status was classified as having smoked at least 5 packs of cigarettes (100 cigarettes) in one's lifetime and having used either conventional cigarettes or e-cigarettes in the last 30 days. Multiple logistic regression analyses were used to examine the association between eating together, smoking, and weight application.

RESULTS

When comparing the group that ate with their family compared to the group that did not, the odds ratio for current smoking status was 1.27 (95% confidence interval [CI]: 1.05-1.54) for male participants and 1.90 (95% CI: 1.33-2.71) for female participants. This showed a dose-dependent effect according to the frequency of family meals. Those who smoked conventional cigarettes had a strong association (men: OR 1.28, 95% CI 1.00-1.67; women: OR 2.22, 95% CI 1.42-3.46). However, those who only vaped e-cigarettes or used both conventional cigarettes and e-cigarettes had no statistically significant correlations.

CONCLUSION

This study provides evidence suggesting that eating meals as a family is related to smoking behavior and can positively affect smoking cessation intentions in adults. Consequently, a smoking cessation program can be developed that uses social support, such as encouraging family meals.

Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications

BACKGROUND

The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity.

PURPOSE

Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce.

METHODS

We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles.

FINDINGS

To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic.

DISCUSSION

Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.

Evidence for "Whole Family Approach" in accelerating uptake of COVID-19 and routine immunizations among integrated primary health services in Nigeria

The family is the simplest unit but possesses the strongest bond in society. These qualities - bond and proximity - that exist both within and across neighboring families, according to our research, can be instrumental in shaping a new kind of health promotion strategy that can transform health behaviors in communities. The Whole Family Approach (WFA) is a government-sanctioned approach to increase uptake of COVID-19 vaccines in Nigeria. The approach entails leveraging the high family-based demand for some primary health services, such as malaria, diabetes, hypertension, and reproductive services, to generate demand for COVID-19 and routine immunizations. However, since the announcement in 2021, there has been no available evidence to show the impact of the approach on COVID-19 vaccine uptake, though global literature generally favors family-centered health approaches. This study tests the effectiveness of the approach in increasing the utilization of target services in a Nigerian community and further provides a theoretical framework for the strategy. Two primary healthcare facilities were selected in two communities located in Abuja in a quasi-experimental design. After a small-sample landscape assessment of the communities and the facilities, family-targeting health promotion activities were facilitated in the intervention community (integrated health education by trained community health influencers) and facility (opportunistic health promotion through in-facility referrals) for one month. Anonymized service utilization data were acquired from both facilities over a period of four months to analyze their respective month-by-month service utilization trends. Time trend analysis was conducted and revealed that WFA significantly increased service utilization (N = 5870; p < 0.001, α = 0.01, 99% CI) across all the package services provided at the intervention facility. A supplementary Pearson's correlation analysis further presented a positive relationship (r = 0.432-0.996) among the services which favored the result. It can therefore be concluded that the "Whole Family Approach" of health promotion is efficacious in accelerating uptake of priority health services such as COVID-19 and routine immunizations. While there is more to be understood about this interesting approach, we recommend the improvement of communication and capacity gaps in Nigeria's primary healthcare system to ensure that promising strategies such as the WFA are adequately implemented at the community and facility levels.

Developing a Family Resource: Considerations for Family Member Research Participation

When individuals participate in health care research, the choice often affects the entire family. Researchers are responsible for protecting participants and minimizing any burdens the research may place on them. Resources to educate potential study participants about these issues from a family perspective are lacking. A family-focused, evidence-based resource was created for individuals and families to prompt discussion prior to their consenting to enrollment in research. The resource includes key relevant questions to consider related to their study participation and was revised based on input from family nurse scientists and a hospital-based family advisory group. This resource raises awareness of the importance of employing a family lens when designing research and during the recruitment and enrollment of participants. Adopting a family lens in health care research will support the participant's ability to make an informed choice regarding participation and may ultimately enhance the experience of participants and their families and study outcomes.

Hand hygiene practice and associated factors among rural communities in northwest Ethiopia

This community-based cross-sectional study was conducted among 1190 randomly selected rural households in northwest Ethiopia to assess hand hygiene practice and associated factors. Frequent handwashing with rubbing agents, drying mechanisms; and condition of fingernails were used to assess hand hygiene practice. Multivariable binary logistic regression analysis was used to identify factors associated with hand hygiene and statistically significant association was declared on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-values < 0.05. Results showed that 28.8% (95% CI 26.2, 31.4%) of the households had good hand hygiene practice. Good hand hygiene practice was significantly associated with formal education attended household heads (AOR 1.79, 95% CI 1.33, 2.40), family discussion on sanitation (AOR 1.56, 95% CI 1.08, 2.26), provision of health education (AOR 2.23, 95% CI 1.62, 3.06), and availability of water (AOR 3.51, 95% CI 1.02, 12.05). In conclusion, about one-third of the rural households had good hand hygiene practice and more than two-third had poor hand hygiene practice in the study area, and this may imply that hands in the area may play roles in spreading infections in the community. Therefore, people need to be informed to always keep their hand hygiene good.

Ethnic inequalities in child oral health behaviours among five- and eight-year-old children from England, Wales and Northern Ireland

Aim To examine whether there are ethnic inequalities in child oral health behaviours and the role of parental socioeconomic status (SES) in explaining them.Methods Data from 2,186 five- and eight-year-olds of white, Asian, Black and other ethnicity, who participated in the 2013 Children's Dental Health Survey, were analysed. Parents reported their children's toothbrushing and dental attendance. Logistic regression was used to explore ethnic inequalities in child behaviours, adjusting for demographic factors and parental SES.Results Children of Asian ethnicity were less likely to start brushing early in life (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.15-0.43), brush regularly (OR: 0.56; 95% CI: 0.32-0.97) and have a check-up last year (OR: 0.28; 95% CI: 0.16-0.49) than those of white ethnicity. Children of Black ethnicity were less likely to have a check-up last year (OR: 0.39; 95% CI 0.17-0.89) than those of white ethnicity. Children of other ethnicity were less likely to start brushing early in life (OR: 0.41; 95% CI: 0.23-0.77) and brush regularly (OR: 0.45; 95% CI: 0.23-0.87) than children of white ethnicity. Inequalities in toothbrushing frequency and regular dental attendance between children of Black and white ethnicity were fully attenuated after adjustment for parental SES.Conclusion There were ethnic inequalities in child toothbrushing and dental visiting, with children of Asian ethnicity being the most affected. Parental SES only explained part of these inequalities.

Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015

Background: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18-35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3-4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.

Child maltreatment mediates the relationship between HIV/AIDS family dysfunction trajectories and psychosocial problems among adolescents

The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial problems. A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES) and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial problems is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem (b = .59 [95%CI .32, .91]), delinquency and risky behaviours (b = .56 [95%CI .31, .86]) and peer problems (b = .74 [95%CI .48, 1.03]). Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem (b = .78 [95%CI .43, 1.23]), delinquency and risky behaviours (b = .76 [95%CI .45, 1.11]), depression/emotional problems (b = .64 [95%CI .40, .92]) and peer problems (b = .94 [95%CI .66, 1.26]). Partial mediation was found for hyperactivity. Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial problems among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychosocial problems among these children, thus enhancing their wellbeing. The findings therefore underscore the need for comprehensive psychosocial interventions that addresses both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.

The positive impact of informal spousal caregiving on the physical activity of older adults

Introduction

Although physical activity (PA) is crucial for health, the literature is mixed about how individuals' PA decisions are affected by their spouses. To fill this gap, we examined the extent to which providing care for one spouse affects the PA of the other spouse among those aged 50 or older in the United States.

Methods

We analyzed 9,173 older adults living with their spouses or partners from the 2004 to 2016 waves of the Health and Retirement Study. To identify the causal effect of spousal caregiving on the PA of older adults, we estimated individual-fixed effects models using a two-stage least squared instrumental variable approach with spousal falls as our instrument. We also estimated the models by splitting the sample by gender and race/ethnicity to identify heterogeneous impacts of spousal caregiving on PA decisions among subgroups.

Results

We found that a one percentage point increase in the probability of providing care to spouses led to an increase in the probability of initiating moderate or vigorous PA (MVPA) by 0.34-0.52 percentage points. This effect was salient, especially among female and non-Hispanic white older adults.

Discussion

Caregiving experience might provide opportunities to learn about caregiving burdens and trigger an emotional response about the salience of an event (i.e., they need care in the future). Older caregivers might start MVPA in an effort to improve or maintain their health and avoid burdening their families for caregiving in the future. This study demonstrated spousal influence on PA. Instead of delivering PA-promotion information (e.g., the harm of sedentary lifestyle and benefits of regular PA) to individuals, risk communication and education efforts on PA promotion might be more effective considering the family context. Family events such as health shocks or the emergence of caregiving needs from family members provide windows of opportunities for intervening. Subgroup differences should also be considered in targeted interventions.

The role of the family in health promotion: a scoping review of models and mechanisms

The family is an important contributor to the cultural conditions that support health. Current challenges in family health promotion interventions include programme design that is not always guided by theory and change mechanisms. Multifaceted programmes also make it hard to examine what works for whom, given different family roles and the range of lifestyle behaviour and mechanisms examined within diverse conceptual frameworks and cultures. We performed a scoping review on the heterogeneous literature to map and categorize the models and mechanisms by which a family may promote health behaviours among its members. We searched five electronic databases and grey literature up to 2020. Publications were included if they examined health-promoting behaviours, influences at the family level, and outlined the behavioural mechanisms involved. Two hundred and forty studies were identified. Ecological systems theory, social cognitive theory, family systems theory and the theory of planned behaviour were the frameworks most widely used in explaining either study context and/or mechanism. The most frequently studied family mechanisms involved aspects of family support, supervision and modelling, while some studies also included individual-level mechanisms. Majority of the studies investigated parental influence on the child, while few studies assessed the elderly family member as a recipient or actor of the influences. Studies on African, Asian and Middle Eastern populations were also in the minority, highlighting room for further research. Improving the understanding of context and behavioural mechanisms for family health promotion will aid the development of public health policy and chronic disease prevention programmes, complementing efforts targeted at individuals.

The influence of routine and leisure family activities on the ability of young Asian Americans to maintain a healthy lifestyle: findings from a nationwide survey

Family is uniquely influential in the health of young Asian Americans (AAs), yet little is known on the impact of specific shared family activities. This study explores different types and frequencies of AA young adult shared family activities on perceived familial influence on the ability to maintain a healthy lifestyle (diet, physical activity, sleep, social relationships, stress, and risky substances). A nationwide sample of 18-35-year-old AAs was surveyed in March 2021 on a list of 30 shared family activities with mothers, fathers, siblings, or extended family. Overall, 984 unique family relationships reported by 616 young AAs were analyzed. Confirmatory factor analysis synthesized a reliable two-factor (routine, leisure activities) 10-item Shared Activities with Family (SAF) scale. Mothers were most influential (mean 3.25, SD = 1.14), although shared activities among South Asians or with extended family were most associated with changes in perceived influence. Routine shared activities were more strongly associated with perceived influence on sleep, diet, and risky substances, while leisure shared activities were more associated with influence on developing healthy social relationships. Family-based, dyadic interventions for young AAs may incorporate shared activities (both routine and leisure) to promote healthy behaviors, although further research to explore mechanisms and directionality of influence is needed to inform action.

Women's participation in the prevention and control of dengue using environmental methods in the global south: a qualitative meta-synthesis

BACKGROUND

Dengue, a mosquito-borne viral disease, causes significant mortality and morbidity in low- to middle-income countries. A body of research indicates that women can be effective in implementing vector borne disease control, but they still face inequitable opportunities for participation, leadership and decision-making in the execution of dengue prevention and vector control programmes. Yet implementing informal environmental management practices to prevent mosquito vector breeding forms part of their domestic household responsibilities. Understanding the enablers and barriers to women's equitable roles with men in formal and informal disease prevention, and the benefits of their participation could help to increase their role and may be a contributing factor to reducing disease rates. The objective of this qualitative meta-synthesis was to synthesise evidence about women's roles in dengue prevention and control in the global south and generate insights around the barriers, enablers, and benefits.

METHODS

Eight databases were searched from inception to 7th December 2020. One investigator independently reviewed all titles and abstracts for relevant articles. Grey literature was searched using 34 websites of global health and international development organisations.

RESULTS

A total of 18 articles representing qualitative research or the qualitative component of mixed methods studies from Latin American and Caribbean (n = 8), Asia (n = 9), and one international review were included in the meta-synthesis. Relevant scholarship from Africa was lacking. This meta-synthesis revealed five unique themes surrounding women's participation, seven categories of barriers, six of enablers, four health, well-being and social benefits for individuals, and four for communities .

CONCLUSION

An analysis of the results confirmed that women's participation in dengue prevention was not gender equitable, gender sensitive nor transformative although women are the primary human resource for household and community-based prevention. Women demonstrated specific qualities aiding successful implementation. Corrective action is urgently needed to shift unhelpful gender norms, and empower women into leadership and decision-making roles.

Family Structure and Family Climate in Relation to Health and Socioeconomic Status for Older Adults: A Longitudinal Moderated Mediation Analysis

Family characteristics are associated with individuals' health and wellbeing. However, the link between family structure (e.g., operationalized via marital status) and health outcomes is ambiguous, and whether family climate mediates the relationship is unclear. This study uses the Biobehavioral Family Model (BBFM) to investigate the association of older adults' family structure with later health, the mediating role of family climate and mental health and how these links vary by socioeconomic status (SES). Using data from n = 29,457 respondents aged over 50 in Waves 4, 5 and 6 (2011, 2013 and 2015) of the Survey of Health, Retirement and Ageing in Europe (SHARE), the BBFM was applied in a longitudinal mediation analysis of family structure and health, including both indicators of mental and physical health. Structural equation modeling was applied, and a multigroup analysis was performed to test the role of SES in a moderated mediation. Family climate and mental health mediated the relationship between family structure and subsequent physical health. Good levels of family climate were found to be consistently associated with improved mental and physical health. These relationships were significantly moderated by SES, showing that the association of family climate and health was weaker for those in low SES positions. Family climate and mental health should be considered as potential mechanisms linking family structure to later physical health outcomes across time; however, these associations are diminished for those with low SES.

Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens

Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017-2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, "family-level multimorbidity", defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit.

Participatory Approaches in Family Health Promotion as an Opportunity for Health Behavior Change-A Rapid Review

BACKGROUND

With their influence on health behavior of children, families are important addressees in health promotion and prevention of chronic diseases. However, they are often difficult to reach, partly due to the open approach of health promotion services. Therefore, they should be addressed directly and be involved in shaping their living environment. The aim is to examine which approaches are used in participatory family health promotion and what practical experiences are made.

METHODS

A systematic literature search in PubMed, Web of Science, LIVIVO and a supplementary hand search were conducted. Ten of 718 screened publications were analyzed qualitatively.

RESULTS

Most included publications applied the community-led participatory approach CBPR. In seven publications, family actors could make decisions at any or all project phases. One finding is that positive effects on desired behavior change and improved health of target groups were observed. Frequently described success factors are the type of interaction, and a common goal.

CONCLUSION

The forms of family participation in health promotion vary widely, with the lack of participatory practices being a major challenge. Family participation is a useful approach in shaping health promotion and should be further developed. This overview provides support for planning future participatory projects with families.

Stunting Prevention in Coastal Family with Health-Promoting Family Approach

BACKGROUND: Stunting is a chronic nutritional problem that occurs worldwide, including in Indonesia. The impact of the COVID-19 pandemic has increasingly caused stunting to increase in coastal areas in particular. AIM: This study aimed to obtain a stunting prevention model with a Health-Promoting Family model approach in coastal families. METHODS: This study was quantitative research. The population in this study was mothers of toddlers aged 6–48 months in the coastal areas of Pamekasan. The sample in this study was mothers of 135 toddlers in Tlanakan and Talang villages who were selected using a simple random sampling technique. The independent variables are the history of present illness, mother’s knowledge, care patterns, literacy, cultural aspects, and family support—while the dependent variable is family prevention behavior regarding the incidence of stunting. Data collection was carried out by interview method using a questionnaire. Statistical analysis was carried out using the Logistic Regression test (=0.05) RESULTS: The factors that affect stunting prevention are knowledge p = 0.008 (CI: 1.438–11.780), literacy p = 0.000 (CI: 2.136–17.003), cultural aspects p = 0.00 (CI: 0.039–0.366) and family support p = 0.000 (CI: 1.273–20.498). CONCLUSION: Knowledge, family support, literacy, and culture affect stunting prevention in families. It takes the collaboration of the community, the government participation in strengthening maternal and child health programs that support the achievement of stunting prevention in families. There are opportunities to research what appropriate forms of literacy in families support the success of stunting prevention in toddlers for further studies.

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model

At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.

Associations between Child and Family Level Correlates and Behavioural Patterns in School-Aged Children

Identifying correlates of behavioural patterns are important to target population sub-groups at increased health risk. The aim was to investigate correlates of behavioural patterns comprising four behavioural domains in children. Data were from the HAPPY study when children were 6–8 years (n = 335) and 9–11 years (n = 339). Parents reported correlate and behavioural data (dietary intake, physical activity, sedentary behaviour, and sleep). Behavioural data were additionally captured using accelerometers. Latent profile analysis was used to derive patterns. Patterns were identified as healthy, unhealthy, and mixed at both time points. Multinomial logistic regression tested for associations. Girls were more likely to display healthy patterns at 6–8 years and display unhealthy and mixed patterns at 9–11 years than boys, compared to other patterns at the corresponding ages. Increased risk of displaying the unhealthy pattern with higher age was observed at both timepoints. At 9–11 years, higher parental working hours were associated with lower risk of displaying mixed patterns compared to the healthy pattern. Associations observed revealed girls and older children to be at risk for unhealthy patterns, warranting customisation of health efforts to these groups. The number of behaviours included when deriving patterns and the individual behaviours that dominate each pattern appear to be drivers of the associations for child level, but not for family level, correlates.