Diet quality in association to lipidaemic profile in adults of families at high-risk for type 2 diabetes in Europe: The Feel4Diabetes study.

BACKGROUND AND AIMS: The role of diet in blood lipids is scarcely investigated in adults at risk of Type 2 Diabetes Mellitus (T2DM) and even less studied regarding their socioeconomic status (SES). This study aimed to investigate the associations of diet quality with blood lipids in adults from families at high-risk for developing T2DM from six European countries, considering their SES. METHODS AND RESULTS: In total 2049 adults (67% women) from relatively low-SES regions and high T2DM risk families were enrolled. Dietary habits, sedentary behaviour and sociodemographic characteristics were assessed using standardised questionnaires. The associations of tertiles of healthy diet score (HDS) with blood lipids were tested by univariate analysis of variance (UNIANOVA). HDL-Cholesterol (HDL-C) was positively (B 1.54 95%CI 0.08 to 2.99) and LDL-Cholesterol (LDL-C) (B -4.15 95%CI -7.82 to -0.48), ratio of total cholesterol to HDL-C (B -0.24 95%CI -0.37 to -0.10), ratio of LDL-C to HDL-C (B -0.18 95%CI -0.28 to -0.08) and Atherogenic Index of Plasma (B -0.03 95%CI -0.06 to 0.00) inversely associated with the highest tertile of diet score compared to the lowest tertile independently of age, sex, Body Mass Index, total screen time and smoking. In sub-analysis of education (<14 and ≥ 14 years of education), these findings were only significant in the high-SES group. CONCLUSION: While diet quality was poorer in the low-SES group, an association between diet quality and lipidemic profile was not found, as increased central obesity and smoking prevalence might have confounded this association. These findings indicate the need for tailor-made interventions, guided by the specific risk factors identified per population sub groups.

On-the-job vocational training of nonprofessional ethnic health workers of a primary health care team improves their sense of coherence.

OBJECTIVES: A Primary Care Model Programme had been implemented in Hungary between 2013 and 2017 in which group practices were established that employed-among others-nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme. METHODS: A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales. RESULTS: Positive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-the-job vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence. CONCLUSIONS: Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for disadvantaged groups, but also improved the mental health of mediators themselves.

Social cognitive intervention reduces stress in Hungarian university students.

Summary: A social cognitive intervention was developed and delivered as a credit course to improve mental distress of university students, based on findings in a previous health survey showing notable mental distress among future teachers in Hungary in 2007. The intervention included increasing information on psychoactive substances used for stress reduction; skills development in stress reduction methods; improving skills in communication and problem-solving. All students who participated in the previous health survey were targeted. Mental status of the participants was assessed by a questionnaire before (n: 128, 22% male, mean age 23.21 years) and after (n: 148, 30% male, mean age 23.54 years) the intervention. Specifically, self-efficacy as outcome was approximated by a trait measure (sense of coherence); psychological distress was measured by the 12-item General Health Questionnaire (Goldberg et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191­197) after the intervention compared with that before. After the intervention, psychological distress was reduced among the participants (p: 0.013). Non-significant improvement occurred in the mean score for sense of coherence (from a mean 60.8 points before to 61.4 points after, p: 0.688). The intervention produced a modest but significant decrease in psychological distress in students at a cost of 54 US$ per 1 point improvement in mental distress. The intervention, a first example of the translation of the social cognitive theory into practice among students in higher education can be integrated into the curriculum as a standardized optional course.

Impact of a Primary School Health Promotion Programme on Adolescents' Health Behaviour and Well-Being.

BACKGROUND/OBJECTIVES: Schools can play a key role in promoting health among adolescents, and Hungarian legislation gives them sufficient space to do so. In our study, we examined the impact of a multiyear school health promotion programme on pupils' health behaviour and well-being. METHODS: We carried out our investigation in an intervention and a control primary school in Hungary. All 5th and 7th grade pupils were invited to participate in the questionnaire-based survey between 2017 and 2021. The effect of the intervention was quantified using univariate and multivariate logistic regression analyses. RESULTS: Our results show that for those behaviours where pupils' personal choices had a greater influence (unhealthy eating, smoking, screen time), the health promotion programme was more effective. For those behaviours where family background and parental influence were more pronounced (healthy eating, physical activity), the intervention had less impact. Self-perceived health was better in the 7th-grade intervention group. CONCLUSIONS: Our findings are in line with the conclusion of systematic reviews that more intensive, longer-term, multi-behavioural school health promotion programmes can be effective in promoting positive behaviour. To be more effective, it would be worth using a well-structured curriculum, well-developed teaching materials, and greater involvement of teachers, parents, and various local organisations.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary.

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Residence in segregated settlements (colonies) rather than Roma identity increases the risk of unfavourable mental health in Hungarian adults.

Background: Roma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary. Methods: A cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3). Results: Residents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity. Conclusion: The study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Investigation of the relationship of general and digital health literacy with various health-related outcomes.

Background: Despite the growing number of health literacy surveys, we know little about the combined effect of the different dimensions of health literacy on various health-related outcomes. Objective: Thus, our study aimed to examine the impacts of general and digital health literacy on health behaviour, confidence in vaccination, self-perceived health, and health care utilization. Methods: Our research was part of the Health Literacy Population Survey 2019-2021, which was an international, multicentre, cross-sectional study. The data were collected via computer-assisted telephone interview in December 2020 in Hungary. Multiple multinomial logistic and multivariate linear regression models were used to analyse the separately effects of general and digital health literacy on the studied outcomes. Moreover, the combined effect of general and digital health literacy was also analysed via sensitivity analyses. In the last step, the interactions between general and digital health literacy were examined using the Johnson-Neyman procedure. Results: The results did not reveal any associations between health literacy and health behaviour. Health care use was only affected by digital health literacy; however, this effect was inconsistent. Both dimensions of health literacy were positively associated with self-perceived health and vaccination confidence. Conclusion: Our results suggest that increasing health literacy could promote health and vaccination confidence, while the potential effect of higher digital health literacy on more conscious use of the health care system should be investigated further.

A School Intervention's Impact on Adolescents' Health-Related Knowledge and Behavior.

Background: Many factors can influence health behavior during adolescence, and the lifestyle of adolescents is associated with health behavior during adulthood. Therefore, their behavior can determine not only present, but also later health status. Objective: We aimed to develop an intervention program to improve high school students' health behavior and to evaluate its effectiveness. Methods: We performed our study at a secondary school in a rural town in East Hungary between 2016 and 2020. Sessions about healthy lifestyles were organized regularly for the intervention group to improve students' knowledge, to help them acquire the right skills and attitudes, and to shape their behavior accordingly. Data collection was carried out via self-administered, anonymous questionnaires (n = 192; boys = 49.5%; girls = 50.5%; age range: 14-16). To determine the intervention-specific effect, we took into account the differences between baseline and post-intervention status, and between the intervention and control groups using individual follow-up data. We used generalized estimating equations to assess the effectiveness of our health promotion program. Results: Our health promotion program had a positive effect on the students' health-related knowledge and health behavior in the case of unhealthy eating, moderate to vigorous physical activity, and alcohol consumption. Conclusion: Our findings suggest that school health promotion can be effective in knowledge transfer and lifestyle modification. To achieve a more positive impact on health behavior, preventive actions must use a complex approach during implementation.

The HLS19-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries.

BACKGROUND: Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL. METHODS: The HLS19-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach's alpha and Person separation index were considered for reliability. RESULTS: The 11-item version (HLS19-COM-P-Q11) and its short version of six items (HLS19-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories. CONCLUSIONS: The HLS19-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL.

Mental health and behaviour of students of public health and their correlation with social support: a cross-sectional study.

BACKGROUND: Future public health professionals are especially important among students partly because their credibility in light of their professional messages and activities will be tested daily by their clients; and partly because health professionals' own lifestyle habits influence their attitudes and professional activities. A better understanding of public health students' health and its determinants is necessary for improving counselling services and tailoring them to demand. Our aim was to survey public health students' health status and behaviour with a focus on mental health. METHODS: A cross-sectional study was carried out among public health students at 1-5-years (N = 194) with a self-administered questionnaire that included standardized items on demographic data, mental wellbeing characterized by sense of coherence (SoC) and psychological morbidity, as well as health behaviour and social support. Correlations between social support and the variables for mental health, health status and health behaviour were characterized by pairwise correlation. RESULTS: The response rate was 75% and represented students by study year, sex and age in the Faculty. Nearly half of the students were non-smokers, more than one quarter smoked daily. Almost one-fifth of the students suffered from notable psychological distress. The proportion of these students decreased from year 1 to 5. The mean score for SoC was 60.1 and showed an increasing trend during the academic years. 29% of the students lacked social support from their student peers. Significant positive correlation was revealed between social support and variables for mental health. Psychological distress was greater among female public health students than in the same age female group of the general population; whereas the lack of social support was a more prevalent problem among male students. CONCLUSIONS: Health status and behaviour of public health students is similar to their non-students peers except for their worse mental health. Future public health professionals should be better prepared for coping with the challenges they face during their studies. Universities must facilitate this process by providing helping services targeted at those with highest risk, and developing training to improve coping skills. Social support is also a potentially amenable determinant of mental health during higher education.

Determinants of sleep quality in college students: A literature review.

PURPOSE: To review the various determinants of sleep quality among college students. METHODS: The PubMed, Web of Science and Cochrane Library databases were searched with the search string "sleep quality" AND "college students" for articles published between January 2007 and October 2017. Articles were excluded if they (1) examined sleep quality as a risk factor for other outcomes or (2) involved inpatients or participants under medical care. RESULTS: The 112 identified studies were classified into categories according to the investigated determinants and their effect on sleep quality. Physical activity and healthy social relations improved sleep quality, while caffeine intake, stress and irregular sleep-wake patterns decreased sleep quality. Less consistent results were reported regarding eating habits and sleep knowledge, while proper napping during the day might improve overall sleep quality. CONCLUSIONS: College students are vulnerable to different risk factors for sleep quality. When designing interventions to improve sleep quality among college students, the main determinants need to be taken into consideration.

Readability and Comprehension of Printed Patient Education Materials.

Background: Health literacy, a recently determined construct plays an important role in how individuals are able to manage their health. A useful approach for the assessment of health literacy is to measure the comprehension of available patient education materials (PEMs). Objective: We aimed at assessing the usefulness of PEMS available in Hungarian by testing comprehension of selected PEMs in different groups of users. Methods: Comprehension of patient education materials in the domain of healthcare was tested by selecting PEMs and creating questions based on their text in 3 dimensions of health literacy: understand, process/appraise, apply/use. Twenty questions were created that could be answered without pre-existing knowledge by reading the appropriate text taken from PEMs. Comprehension was examined in four groups: laypersons, non-professional healthcare workers, 1st year healthcare students, and 5th year medical students. Readability indices were calculated for the same texts to which questions were created. Results: Laypersons answered <50% of the PEMs-based questions correctly. Non-professional healthcare workers performed better with 57% of right answers but significantly worse than healthcare students or medical students. Those with at least high school qualification (maturity exam) showed significantly higher comprehension compared to those with lower educational attainment. Persons in good or very good health also had significantly better comprehension than those in less favorable health. All readability indices showed that comprehension of the tested PEMs required at least 10 years of schooling or more. Therefore, these PEMS are difficult to understand for persons with less than high school level of education. Conclusion: Rephrasing of the investigated patient educational materials would be recommended so that they better fit the educational attainment of the Hungarian population. Evaluation of the readability and comprehensibility of other PEMs also seems warranted.

Recursive Path Model for Health Literacy: The Effect of Social Support and Geographical Residence.

Background: The public health relevance of health literacy is highlighted by the fact that its higher levels can improve health outcomes and reduce health inequities. In order to design effective interventions for improving health literacy, the relationship between health literacy and other factors such as sociodemographic variables, subjective health and social support must be understood. Objective: Our aim was to test a socioecological model of the determinants of health literacy with a special focus on the effect of residence. Our study investigated geographical differences regarding the levels of health literacy and its determinants as this was not investigated before in European nationwide surveys. Methods: Data was collected by a polling company in a sample (n = 1,200) of the Hungarian adult population nationally representative by age, gender, and permanent residence in 2019 January. The questionnaire included items on sociodemographic data, subjective well-being, social support, and two health literacy scales. A recursive path model was used to outline the mediating effect of social support between sociodemographic variables and health literacy where both direct and indirect effects of the explanatory variables and multiple relationships among the variables were analyzed simultaneously. Multiple-group analysis was applied to the three pre-set categories of permanent residence (capital city, urban and rural). Results: There was no statistically significant difference by residence regarding levels of health literacy. Social support and educational attainment were the most important determinants of health literacy after adjusting for the effect of other sociodemographic variables. However, the magnitude of effect of social support and educational attainment is different between types of settlements, the strongest being in rural areas. Conclusion: Social support seems to mediate the effect of socioeconomic position on health literacy which could be taken into account when designing interventions to improve health literacy, especially in rural areas. Further studies would be needed especially in rural communities to see whether improvement of social support could be utilized in projects to increase the level of health literacy.

Validation of health literacy questionnaires in Hungarian adult sample / Egészségmuveltséget méro kérdoívek validálása hazai felnottmintán.

Összefoglaló. Bevezetés: Az eredményes gyógyítás, rehabilitáció, egészségre nevelés és egészségfejlesztés elengedhetetlen feltétele, hogy az egyén az egészségmuveltségének megfelelo módon jusson hozzá az egészségével kapcsolatos információkhoz. Célkituzés: A kutatás célja két, az egészségmuveltséget objektíven (Newest Vital Sign) és szubjektíven (Brief Health Literacy Screening Tool) méro skála validálása volt. Ezen nemzetközi felmérésekben elterjedt és önmagukban is alkalmazható rövid tesztek segítségével vizsgálható az általános populáció egészségmuveltsége. Módszer: A skálák tesztelése országos keresztmetszeti vizsgálat keretében zajlott a felnott lakosság körében. A kérdoívek megbízhatóságát és validitását az egyes kérdoíveken belüli Cronbach-α, Spearman-Brown és korrigált item-totál korrelációs együtthatók, valamint feltáró faktorelemzés (fokomponens-elemzés, varimax rotáció) segítségével értékeltük. Eredmények: A kérdoívek belso konzisztenciáját méro Cronbach-α-érték a Newest Vital Sign kérdoív esetében 0,72, a Brief Health Literacy Screening Tool kérdoív esetében 0,87, míg a Spearman-Brown-féle korrigált korrelációval számított "split-half" megbízhatóság 0,76, illetve 0,88 volt. Az item-totál korrelációs vizsgálat során kapott korrelációs együtthatók minden esetben magasabbnak bizonyultak az elvárható 0,3-as értéknél. A faktorszerkezet feltárása rávilágított, hogy a két teszt az egészségmuveltség más-más dimenzióit méri. Megbeszélés: Eredményeink alapján mindkét teszt megbízhatónak bizonyult; a Brief Health Literacy Screening Tool skála belso validitása magasabb, mint az eredeti kérdoívé. A faktorelemzés alapján a két kérdoív együttes alkalmazása is lehetséges, ha a cél a szubjektív és az objektív muveltség egyszerre történo vizsgálata. Következtetés: Eredményeink alapján javasoljuk a Brief Health Literacy Screening Tool és a Newest Vital Sign kérdoívek általunk validált változatának használatát kérdezobiztosok által felvett, egészségmuveltséget vizsgáló felmérések részeként. Orv Hetil. 2021; 162(39): 1579-1588. INTRODUCTION: Accessing health information adapted to one's health literacy level is a prerequisite for effective healing, rehabilitation, health education, and health promotion. OBJECTIVE: This research aimed to validate the Hungarian version of two instruments measuring health literacy: the performance-based Newest Vital Sign and the self-reported Brief Health Literacy Screening Tool. These short instruments, which are frequently used in international surveys, can be applied to measure health literacy among the general population. METHOD: The two instruments were tested in a nationwide cross-sectional study in the general population. The questionnaires' reliability and validity were evaluated using Cronbach-α, Spearman-Brown, corrected item-total correlation coefficients, and exploratory factor analysis (principal components analysis, varimax rotation). RESULTS: The internal consistency measured by the Cronbach-α was 0.72 for the Newest Vital Sign and 0.87 for the Brief Health Literacy Screening Tool, and the split-half reliabilities calculated with the Spearman-Brown correlation were 0.76 and 0.88, respectively. The correlation coefficients obtained during the item-total correlation analysis proved to be higher than the expected 0.3 value in all cases. Exploring the factor structure revealed that the two tests measure different dimensions of health literacy. DISCUSSION: Both tests proved to be reliable; the internal validity of the Brief Health Literacy Screening Tool is higher than that of the original questionnaire. Based on the factor analysis, their application is possible together if the goal is to examine subjective and objective health literacy together. CONCLUSION: Using the validated Hungarian version of these questionnaires is recommended as part of health literacy surveys conducted by interviewers. Orv Hetil. 2021; 162(39): 1579-1588.

Modelling Health in University Students: Are Young Women More Complicated Than Men?

The biopsychosocial model of health in a limited life course perspective was tested among students in higher education using data from a nationwide cross-sectional survey of students on track to become teachers in Hungary. Health determinants were grouped into categories of biological, psychological, and social determinants and arranged in a temporal manner from childhood to the present. The model was tested by canonical correlation analysis followed by multivariate analysis of covariance. One composite outcome of health and six determinant groups were examined out of a total of 24 variables in both genders. Separate sets of health determinants were identified for men and women. The health of men was determined by fewer variables that were more proximal in time, more centred around physical activity, and less influenced by social relations. As opposed to that of men, women's health was influenced by age; determinants were grouped around the ingestion of various substances and social support. In contrast to men, the health of women seemed to be more obviously multifactorial. The study supports the usefulness of the biopsychosocial model of health in research. The best fit models provided evidence for the importance of gender awareness when designing public health interventions aimed at students.

Determinants of mental well-being in medical students.

INTRODUCTION: Mental disorders constitute an increasingly important public health problem in the general population. Therefore, investigation of the determinants and state of mental health of those who will be treating patients, that is, future medical doctors, is justified. The paper gives an account of a mental health survey of medical students at a university in Hungary. METHODS: A representative sample of year I-V students (N = 100) filled an anonymous standardized self-administered questionnaire that included demographic and socioeconomic items, mental well-being characterized by a sense of coherence (SOC) and psychological distress, as well as health behaviour. SOC was measured by the 13-item Antonovsky questionnaire and psychological distress was measured by the 12-item general health questionnaire (GHQ). Models for estimating mental well-being in relation to various determinants were built by backward stepwise regression. RESULTS: Almost one-fifth of the students scored above the strict threshold on the GHQ indicating notable psychological distress. SOC showed significant positive correlation with perceived health and significant negative correlation with psychological distress. SOC and psychological distress were determined by different sets of explanatory variables in the regression models. Psychological distress and the use of sedative without medical prescription are inversely related to SOC; whereas social support and female gender show positive correlation to SOC according to our estimation. SOC, as expected, was a strong explanatory variable for psychological distress, forecasting an improvement in the GHQ score. CONCLUSION: Psychological distress was significantly greater in our sample of Hungarian medical students than in the same age group of the general population. Psychological distress is strongly related to SOC and can be estimated by our proposed models. Both SOC and psychological distress can be used to characterize the mental health of future medical doctors, the improvement of which needs attention even during their training.

Does Better Health-Related Knowledge Predict Favorable Health Behavior in Adolescents?

The importance of puberty on later health status and behavior is indisputable, which also means that it is worth making intervention efforts during this period of life. However, whether better health-related knowledge is correlated with favorable health behavior in adolescents is an important, still unanswered question. Our objective was to examine this relationship. The participants were ninth-grade secondary school students. Data were collected using anonymous, self-administered questionnaires. The knowledge-related questions were compiled by the authors, while the questions concerning eating habits, physical activity, demographic and socioeconomic data were taken from the Health Behavior in School-Aged Children survey. The relationship between knowledge and behavior was investigated with structural equation modeling adjusted for gender, age, and socioeconomic status. The results demonstrated a good fit to the data, but better knowledge was not related to behavior in our sample. This finding suggests that adolescents' health behavior is highly influenced by the living context; therefore, appropriate knowledge is necessary but not sufficient to improve adolescents' behavior. Hence, comprehensive health promotion programs could provide solutions for encouraging healthy behavior.

Prevalence of Insulin Resistance in the Hungarian General and Roma Populations as Defined by Using Data Generated in a Complex Health (Interview and Examination) Survey.

Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create a complex database for comparative and association studies to better understand the background of the very unfavourable health of Roma, especially the high burden of cardiometabolic diseases. A three-pillar (questionnaire-based, physical and laboratory examinations) health survey was carried out on randomly selected samples of the Hungarian general (HG, n = 417) and Roma (HR, n = 415) populations, and a database consisting of more than half a million datapoints was created. Using selected data, the prevalence rates of metabolic syndrome (MetS) and of its components were determined, and to estimate the risk of insulin resistance (IR), surrogate measures (the homeostasis model assessment of insulin resistance index, quantitative insulin sensitivity check index, McAuley and TyG indices and the TG/HDL-C ratio) were calculated. Receiver operating characteristic curve analysis and Youden's method were used to define the optimal cut-off values of each IR index. The prevalence of MetS was very high in both study populations (HG: 39.8%, HR: 44.0%) with no statistically significant difference between the two groups in females or males. The prevalence of MetS showed a very marked increase in the HR 35-49 years age group. Among surrogate measures, the TyG index showed the greatest power for predicting IR/MetS at a cut-off value of 4.69 (77% sensitivity, 84% specificity) and indicated a 42.3% (HG) and 40.5% (HR) prevalence of IR. The prevalence of MetS and IR is almost equally very unfavourable in both groups; thus, the factors underlying the high premature mortality burden of Roma should be further clarified by investigating the full spectrum of risk factors available in the database, with a special focus on the access of Roma people to preventive and curative health services.