Lessons From Leading During a Pandemic: An Exploratory Study of Public Health Leadership Insights on Training, Preparation, and Experiences From the Field During COVID-19.

CONTEXT: The public health workforce encountered challenges during the COVID-19 pandemic that exposed areas for improvement in preparation for future public health threats. Key among these is well-trained public health leaders equipped with an array of crisis leadership skills. OBJECTIVES: To examine the training background, assess the perceived preparedness, and garner recommendations for training of the future public health workforce from public health leaders who navigated the COVID-19 pandemic. DESIGN: This exploratory research gleaned information by utilizing an online questionnaire and interviews to provide lessons learned regarding improvements needed for public health leader preparedness. SETTING: Three California public health departments representing urban, suburban, and rural populations. PARTICIPANTS: Thirty public health leaders who were directly involved in public health work for ≥3 years in a leadership/management role and involved in COVID-19-related work for at least 6 months participated. RESULTS: Questionnaire findings revealed gaps in crisis leadership, communication, and collaboration training. Interview results supported and expanded upon the quantitative findings, including the value of various competencies and recommendations to improve the preparedness of future public health leaders. CONCLUSIONS: The findings suggested that although many of the skills needed are competencies for accredited public health training programs, effective leadership during public health emergencies may require additional training beyond what is generally provided. Recommendations include integrating study findings into public health training programs to address competency gaps, leveraging results to enhance leadership skills, and promoting collaboration between public health departments and academic institutions to develop evidence-informed crisis leadership training. These findings inform strategies to ensure the preparedness of the public health workforce for future crises.

Associations between psychological characteristics and indicators of metabolic syndrome among Chinese adults.

Current knowledge about the relationship between psychological characteristics and metabolic syndrome (MetS) components is limited in Asian populations. The purpose of this study is to investigate linkages between physiological markers of MetS and life satisfaction, hostility, and depression in Chinese adults. Secondary analyses were conducted using cross-sectional data from parents of randomly selected middle school students participating in a pilot study in Qingdao, China. Among 440 parents who consented to participate (237 women, 203 men), 368 provided valid responses in all three categories of psychological characteristics, and only those subjects were included in these analyses. General linear models and logistic regressions were run separately by gender, controlling for covariates. Among women, life satisfaction was inversely associated with triglyceride levels (p = .04), LDL-C (p < .01), risk of hypertriglyceridemia (OR[.53], p < .01), HDL-C (OR[.78], p = .03), and MetS (OR[.52], p = .03). No associations were found between life satisfaction and any psychological characteristics among men. Among women, hostility was positively associated with triglyceride level (p = .04) and risk of hypertriglyceridemia (OR[2.12], p < .05). Among men, hostility was positively associated with waist circumference (p = .04), waist-hip ratio (p < .05), and fasting plasma insulin (p < .01). Depression was not associated with any physiological measurement in either gender. These findings indicate that relationships exist between certain psychological characteristics and physiological indicators of MetS among Chinese adults, although there may be important differences between genders.

Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults.

OBJECTIVES: According to a recent national survey, tobacco use is a critical public health issue in China, with more than two-thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS). METHODS: Male adults (n = 12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking. RESULTS: After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex-, or current smokers (p < 0.05). CONCLUSIONS: Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.

A Longitudinal Analysis of the Effects of Socioeconomic Factors, Foreign Media, and Attitude toward Appearance on General and Central Adiposity in Chinese Adolescents.

OBJECTIVE: This paper explores the longitudinal effects of socioeconomic factors (i.e., parent education and family income level), foreign media, and attitude toward appearance on general and central adiposity among Chinese adolescents. METHOD: A longitudinal analysis was performed using data from the China Seven Cities Study, a health promotion and smoking prevention study conducted in seven cities across Mainland China between 2002 and 2005. Participants included 5,020 middle and high school students and their parents. Explanatory variables included foreign media exposure, attitude toward appearance, parent education, and family income. Three-level, random-effect models were used to predict general adiposity (i.e., body mass index) and central adiposity (i.e., waist circumference). The Generalized Estimating Equation approach was utilized to determine the effect of explanatory variables on overweight status. RESULTS: Among girls, foreign media exposure was significantly negatively associated with general adiposity over time (ß=-0.06, p=0.01 for middle school girls; ß=-0.06, p=0.03 for high school girls). Attitude toward appearance was associated with lesser odds of being overweight, particularly among high school girls (OR=0.86, p<0.01). Among boys, parental education was significantly positively associated with general adiposity (ß=0.62, p<0.01 for middle school boys; ß=0.37, p=0.02 for high school boys) and associated with greater odds of being overweight (OR=1.55, p<0.01 for middle school boys; OR=1.26, p=0.04 for high school boys). Across all gender and grade levels, family income was significantly negatively associated with central adiposity over time. CONCLUSION: Interventions addressing Chinese adolescent overweight/obesity should consider these factors as potential focus areas.

The Association between Family Structure and Adolescent Smoking among Multicultural Students in Hawaii.

OBJECTIVE: The purpose of this study was to examine whether the prevalence of smoking was associated with family structure among multicultural adolescents and whether there was gender disparity on the association. METHODS: Data were collected from a sample of 7th graders in Hawaii who completed in-class questionnaires in 2004. The final sample included 821 multicultural students from different family structures. Descriptive analyses, Chi-square tests and logistic regression were performed to examine the prevalence of smoking and the association between family structure and smoking prevalence. RESULTS: This sample contained students who lived in intact (61.7%), single-parent (16.5%), step-parent (15.6%), and no-parent (6.2%) families. The overall prevalence of ever/lifetime smoking was 24.0%, and was not significantly different between genders in each family structure (p>0.05). Compared with living in intact families, living in single-parent, step-parent, or no-parent families was significantly associated with higher odds of ever/lifetime smoking among all students (p<0.05) and living in single-parent and stepparent families was significantly associated with higher odds of ever/lifetime smoking among females (p<0.05) and among males (p<0.05) respectively, after adjusting for covariates. CONCLUSIONS: These findings suggest that family structure is a risk factor for smoking among multicultural students. Anti-smoking programs should consider this factor.

Biomarkers of tobacco smoke exposure in racial/ethnic groups at high risk for lung cancer.

OBJECTIVES: We examined biomarkers of tobacco smoke exposure among Native Hawaiians, Filipinos, and Whites, groups that have different lung cancer risk. METHODS: We collected survey data and height, weight, saliva, and carbon monoxide (CO) levels from a sample of daily smokers aged 18-35 (n = 179). Mean measures of nicotine, cotinine, cotinine/cigarettes per day ratio, trans 3' hydroxycotinine, the nicotine metabolite ratio (NMR), and expired CO were compared among racial/ethnic groups. RESULTS: The geometric means for cotinine, the cotinine/cigarettes per day ratio, and CO did not significantly differ among racial/ethnic groups in the adjusted models. After adjusting for gender, body mass index, menthol smoking, Hispanic ethnicity, and number of cigarettes smoked per day, the NMR was significantly higher among Whites than among Native Hawaiians and Filipinos (NMR = 0.33, 0.20, 0.19, P ≤ .001). The NMR increased with increasing White parental ancestry. The NMR was not significantly correlated with social-environmental stressors. CONCLUSIONS: Racial/ethnic groups with higher rates of lung cancer had slower nicotine metabolism than Whites. The complex relationship between lung cancer risk and nicotine metabolism among racial/ethnic groups needs further clarification.

The cognitive processes underlying affective decision-making predicting adolescent smoking behaviors in a longitudinal study.

This study investigates the relationship between three different cognitive processes underlying the Iowa Gambling Task (IGT) and adolescent smoking behaviors in a longitudinal study. We conducted a longitudinal study of 181 Chinese adolescents in Chengdu City, China. The participants were followed from 10th to 11th grade. When they were in the 10th grade (Time 1), we tested these adolescents' decision-making using the IGT and working memory capacity using the Self-ordered Pointing Test (SOPT). Self-report questionnaires were used to assess school academic performance and smoking behaviors. The same questionnaires were completed again at the 1-year follow-up (Time 2). The Expectancy-Valence (EV) Model was applied to distill the IGT performance into three different underlying psychological components: (i) a motivational component which indicates the subjective weight the adolescents assign to gains vs. losses; (ii) a learning-rate component which indicates the sensitivity to recent outcomes vs. past experiences; and (iii) a response component which indicates how consistent the adolescents are between learning and responding. The subjective weight to gains vs. losses at Time 1 significantly predicted current smokers and current smoking levels at Time 2, controlling for demographic variables and baseline smoking behaviors. Therefore, by decomposing the IGT into three different psychological components, we found that the motivational process of weight gain vs. losses may serve as a neuropsychological marker to predict adolescent smoking behaviors in a general youth population.

Developmental trajectories of cigarette use and associations with multilayered risk factors among Chinese adolescents.

INTRODUCTION: We aimed to identify developmental trajectories of cigarette use and risk factors associated with the distinct developmental courses of smoking in Chinese early adolescents from age 12 to 16 years. METHODS: Analysis was conducted with secondary data from a longitudinal, prospective cohort of 3,521 Chinese adolescents randomly selected from 4 rural and 7 urban middle schools in Wuhan, China. A group-based growth mixture modeling approach was adopted to identify developmental trajectories of cigarette use. Multilayered intrapersonal (e.g., attitudes toward smoking) and interpersonal (e.g., parental smoking and perceived parental disapproval of smoking) risk factors selected from an ecological perspective were prospectively linked to the identified patterns of smoking trajectory. RESULTS: Three trajectory patterns were identified from the whole cohort: nonsmokers (48.7%), stable light/occasional smokers (48.6%), and accelerating smokers (2.7%). After adjustments for gender, urban residence, and family socioeconomic status, adolescents with higher levels of problems in parent-child relationships and family disharmony, higher perceived norms of peer smoking, higher proportion of good friend smoking, having more troubles with teachers, poorer academic performance, and reporting more frequent depressive symptoms were significantly more likely to be in the trajectory group of either stable light/occasional smokers or accelerating smokers than in the group of nonsmokers. The probability of being in the accelerating smoking trajectory group was positively and significantly related to parental smoking and lack of school bonding. CONCLUSIONS: Study findings help to advance knowledge of the distinct developmental courses of smoking behavior and their associations with multilayered risk factors among Chinese early adolescents.

Serum 25-hydroxyvitamin d levels and C-reactive protein in persons with human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection has frequently been associated with vitamin D deficiency as well as chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D [25(OH)D] and high-sensitivity C-reactive protein (CRP) in a cohort of HIV-positive people. A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 16 to 60 years residing in the Kathmandu Valley, Nepal. Serum high-sensitivity CRP concentrations and serum 25(OH)D levels were measured by the latex agglutination nephelometry method and the competitive protein-binding assay, respectively. The relationship between serum CRP concentrations and 25(OH)D serum level was assessed using multiple logistic regression analysis with adjustment of potential cardiovascular and HIV-related factors. The proportions of participants with 25(OH)D serum levels <20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were 83.2%, 15.5%, and 1.3%, respectively. The mean 25(OH)D serum levels in men and women were 15.3 ng/ml and 14.4 ng/ml, respectively. Participants with a 25(OH)D serum level of <20 ng/ml had a 3.2-fold higher odds of high CRP (>3 mg/liter) compared to those with a 25(OH)D serum level of ≥20 ng/ml (p=0.005). Men and women with a 25(OH)D serum level of <20 ng/ml had 3.2- and 2.7-fold higher odds of high CRP (>3 mg/liter), respectively, compared to those with a 25(OH)D serum level of ≥20 ng/ml. The relationships remained significant only in men (p =0.02) but not in women (p=0.28). The risk of having a high level of inflammation (CRP>3 mg/liter) may be high among HIV-positive men and women with a 25(OH)D serum level of <20 ng/ml.

Tobacco smoking, quitting, and relapsing among adult males in Mainland China: the China Seven Cities Study.

INTRODUCTION: Despite an estimated 1 million tobacco-related deaths annually in China, public health officials face overwhelming barriers to implementing effective tobacco control policies and programs. Models of effective tobacco control can be adapted for Chinese tobacco use and culture based on reliable and valid data regarding predictors of smoking and abstaining. METHODS: As part of the China Seven Cities Study to assess the role of rapid social, economic, and cultural change on tobacco use and related health practices and outcomes, 4,072 adult male smokers provided data in 3 annual waves. Measures included current smoking, nicotine dependence, readiness for quitting, perceived stress, hostility, depressive symptoms, as well as covariates (e.g., age, marital status, educational attainment, and family income). RESULTS: Odds of being abstinent at Wave 3 were increased by: lower nicotine dependence at Wave 1 and becoming less dependent between Waves 1 and 3; progressing beyond the contemplation stage between Waves 1 and 3; perceiving less stress, whether initially at Wave 1 or over time from Wave 1 to Wave 3; and lower hostility scores at Wave 1 and decreased hostility from Wave 1 to Wave 3. Among those who quit, odds of remaining abstinent rather than relapsing by Wave 3 were higher among those who were less dependent at Wave 1 and who became less dependent from Wave 1 to Wave 3; and those who showed decreases in hostility from Wave 1 to Wave 3. CONCLUSIONS: The public health challenge posed by very high prevalence of male smoking in China can be met by policies and programs that lead to successful long-term cessation. This can only be done successfully by designing interventions based on knowledge of the country's smokers and the current study suggests several elements.

Abnormal affective decision making revealed in adolescent binge drinkers using a functional magnetic resonance imaging study.

The goal of this study was to investigate the neural correlates of affective decision making, as measured by the Iowa Gambling Task (IGT), which are associated with adolescent binge drinking. Fourteen adolescent binge drinkers (16-18 years of age) and 14 age-matched adolescents who had never consumed alcohol--never drinkers--were recruited from local high schools in Chengdu, China. Questionnaires were used to assess academic performance, drinking experience, and urgency. Brain regions activated by the IGT performance were identified with functional magnetic resonance imaging. Results showed that, compared to never drinkers, binge drinkers performed worse on the IGT and showed higher activity in the subcomponents of the decision-making neural circuitry implicated in the execution of emotional and incentive-related behaviors, namely, the left amygdala and insula bilaterally. Moreover, measures of the severity of drinking problems in real life, as well as high urgency scores, were associated with increased activity within the insula, combined with decreased activity within the orbitofrontal cortex. These results suggest that hyperreactivity of a neural system implicated in the execution of emotional and incentive-related behaviors can be associated with socially undesirable behaviors, such as binge drinking, among adolescents. These findings have social implications because they potentially reveal underlying neural mechanisms for making poor decisions, which may increase an individual's risk and vulnerability for alcoholism.

The role of cognitive attributions for smoking in subsequent smoking progression and regression among adolescents in China.

Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents' future smoking behaviors, especially transitions to more advanced stages of smoking. Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders. Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression. This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.

Trait mindfulness helps shield decision-making from translating into health-risk behavior.

PURPOSE: The cognitive tendency toward mindfulness may influence the enactment of health and risk behaviors by its bringing increased attention to and awareness of decision-making processes underlying behavior. The present study examined the moderating effect of trait mindfulness on associations between intentions to smoke (ITS)/smoking refusal self-efficacy (SRSE) and smoking frequency. METHODS: Self-reports from Chinese adolescents (N = 5,287; mean age = 16.2 years, standard deviation = .7; 48.8% female) were collected in 24 schools. Smoking frequency was regressed on latent factor interactions Mindful Attention Awareness Scale*ITS and Mindful Attention Awareness Scale*SRSE, adjusting for school clustering effects and covariates. RESULTS: Both interaction terms were significant in cross-sectional analyses and showed that high ITS predicted higher smoking frequency among those low, relative to high, in trait mindfulness, whereas low SRSE predicted higher smoking frequency among those low, relative to high, in trait mindfulness. CONCLUSIONS: Findings suggest trait mindfulness possibly shields against decision-making processes that place adolescents at risk for smoking.

Multiple peer group self-identification and adolescent tobacco use.

Associations between peer group self-identification and smoking were examined among 2,698 ethnically diverse middle school students in Los Angeles who self-identified with groups such as Rockers, Skaters, and Gamers. The sample was 47.1% male, 54.7% Latino, 25.4% Asian, 10.8% White, 9.1% Other ethnicity, and 59.3% children of immigrant parents. Multiple group self-identification was common: 84% identified with two or more groups and 65% identified with three or more groups. Logistic regression analyses indicated that as students endorsed more high-risk groups, the greater their risk of tobacco use. A classification tree analysis identified risk groups based on interactions among ethnicity, gender, and group self-identification. Psychographic targeting based on group self-identification could be useful to design more relevant smoking prevention messages for adolescents who identify with high-risk peer groups.

A qualitative exploration of youth in the "new" China: perspectives on tobacco use from adolescents in southwest China.

School-based prevention programs are not common in China and the attempts to modify successful Western prevention programs have largely shown little effect. Distinct cultural and social systems differences could explain why modified programs have been unsuccessful. Smoking behavior is examined from the perspective of Chinese adolescents as part of the development of a large intervention trial. A total of 16 focus groups with 128 participants were conducted in Chengdu in Sichuan province of China. Impressions of adolescent smokers were mixed, most seeing the behavior as common among boys. Smokers were seen as being overwhelmed and stressed. Girls' smoking was mostly seen as universally "bad" and reflecting poorly on a girl's character. However, a small portion of focus group participants suggested that female smoking was fashionable and trendy. With social norms changing rapidly in the "new" China, understanding what the new generation of Chinese youth thinks about smoking is critical in determining how to address and tailor prevention efforts.

Do cognitive attributions for smoking predict subsequent smoking development?

To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals' cognitive attributions for smoking were associated with subsequent smoking development and through which pathways. Middle and high school students in seven large cities in China (N=12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008). Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (ß=0.11, p<0.001) and autonomy (ß=0.08, p=0.019) were associated with smoking initiation among baseline non-smokers. Coping (ß=0.07, p<0.001) and social image (ß=0.10, p=<.0001) were associated with smoking progression among baseline lifetime smokers. Social image (ß=0.05, p=0.043), engagement (ß=0.07, p=0.003), and mental enhancement (ß=0.15, p<0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%. This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.

Psychometric assessment of the Mindful Attention Awareness Scale (MAAS) among Chinese adolescents.

The Mindful Attention Awareness Scale (MAAS) has the longest empirical track record as a valid measure of trait mindfulness. Most of what is understood about trait mindfulness comes from administering the MAAS to relatively homogenous samples of Caucasian adults. This study rigorously evaluates the psychometric properties of the MAAS among Chinese adolescents attending high school in Chengdu, China. Classrooms from 24 schools were randomly selected to participate in the study. Three waves of longitudinal data (N = 5,287 students) were analyzed. MAAS construct, nomological, and incremental validity were evaluated as well as its measurement invariance across gender using latent factor analyses. Participants' mean age was 16.2 years (SD = 0.7), and 51% were male. The 15-item MAAS had adequate fit to the one-dimensional factor structure at Wave 1, and this factor structure was replicated at Wave 2. A 6-item short scale of the MAAS fit well to the data at Wave 3. The MAAS maintained reliability (Cronbach's α = .89-.93; test-restest r = .35-.52), convergent/discriminant validity, and explained additional variance in mental health measures beyond other psychosocial constructs. Both the 15- and 6-item MAAS scales displayed at least partial factorial invariance across gender. The findings suggest that the MAAS is a sound measure of trait mindfulness among Chinese adolescents. To reduce respondent burden, the MAAS 6-item short-scale provides an option to measure trait mindfulness.

Testing the indirect effect of trait mindfulness on adolescent cigarette smoking through negative affect and perceived stress mediators.

Mindfulness refers to an enhanced attention to and awareness of present moment experience. This study examined how trait mindfulness, as measured with six items from Mindfulness Attention Awareness Scale, might influence adolescent cigarette smoking frequency through its impact on depressive affect, anger affect and perceived stress mediators. Self-reported data from Chinese adolescents (N = 5287, mean age = 16.2 years, SD = 0.7; 48.8% females) were collected within 24 schools. The product of coefficients test was used to determine significant mediation paths. Results from baseline cross-sectional data indicated that trait mindfulness had a significant indirect effect on past 30-day smoking frequency through depressive affect, anger affect and perceived stress mediators. Results from 13-month longitudinal data indicated that these indirect effects remained significant for depressive affect and perceived stress but not for anger affect. Findings from this study may suggest that heightening mindfulness among adolescents may indirectly reduce cigarette smoking perhaps by improving affect regulation competencies.

Relative income inequality and selected health outcomes in urban Chinese youth.

Self reported cross-sectional data gathered in 2002 from 12,449 middle and high school students from seven major cities in China were examined to explore the association of self-perceived relative income inequality (SPRII) with general health status, depression, stress, and cigarette smoking. Two types of self-perceived relative income were evaluated: household income relative to peers (SPRII-S) and relative to their own past (SPRII-P). SPRII-S and SPRII-P were coded as three-level categorical variables: lower, equal, and higher. As hypothesized, the youth in the "Lower" SPRII-S or SPRII-P groups reported the worst general health and the highest levels of depression and stress; the youth in the "Higher" groups reported the best general health. Unexpectedly, the youth in the "Higher" groups did not report the lowest levels of depression and stress, and the relationship between SPRII and cigarette smoking was even less straightforward. The expected positive relationship between SPRII and the general health status is consistent with previous research, but the relationships between SPRII and depression, stress, and cigarette smoking behavior are not. Further studies are needed to elucidate the complex associations between SPRII and health outcomes in rapidly transforming economies such as China.

Correlates of overweight status in Chinese youth: an East-West paradox.

OBJECTIVE: To examine the odds of overweight and related correlates in Chinese adolescents. METHOD: Cross-sectional study in 9023 adolescents. RESULTS: Chinese youth were more likely to be overweight if they spent more time being sedentary; slept <7 hours/night; were male; were younger; participated more in vigorous physical activity; and had higher levels of parental education, a higher frequency of vegetable intake, and a lower frequency of sweet/fast food intake. CONCLUSIONS: Overweight-related correlates seem to play different roles in the Chinese culture than in Western cultures. This may be due to culture-specific perceptions and changes in lifestyle accompanying socioeconomic transitions.