Relative validity of an intelligent ordering system to estimate dietary intake among university students from a medical school in Shanghai, China.

BACKGROUND: Dietary assessment methods have limitations in capturing real-time eating behaviour accurately. Equipped with automated dietary-data-collection capabilities, the "intelligent ordering system" (IOS) has potential applicability in obtaining long-term consecutive, relatively detailed on-campus dietary records among university students with little resource consumption. We investigated (1) the relative validity of IOS-derived nutrient/food intakes compared to those from the 7-day food diary (7DFD); (2) whether including a supplemental food frequency questionnaire (SFFQ) improves IOS accuracy; and (3) sex differences in IOS dietary intake estimation. METHODS: Medical students (n = 221; age = 22.2 ± 2.4 years; 38.5% male and 61.5% female) completed the 7DFD and SFFQ. During the consecutive 7-day survey period, students weighed and photographed each meal before and after consumption. Then, students reviewed their 3-month diet and completed the SFFQ, which includes eight underprovided school-canteen food items (e.g., dairy, fruits, nuts). Meanwhile, 9385 IOS dietary data entries were collected. We used Spearman coefficients and linear regression models to estimate the associations among the different dietary intake assessment methods. Individual- and group-level agreement was assessed using the Wilcoxon signed-rank test, cross-classification, and Bland‒Altman analysis. RESULTS: IOS mean daily energy, protein, fat, and carbohydrate intake estimations were significantly lower (-15-20%) than those of the 7DFD. The correlation coefficients varied from 0.52 (for added sugar) to 0.88 (for soybeans and nuts), with fruits (0.37) and dairy products (0.29) showing weaker correlations. Sixty-two (milk and dairy products) to 97% (soybeans and nuts) of participants were classified into the same or adjacent dietary intake distribution quartile using both methods. The energy and macronutrient intake differences between the IOS + SFFQ and 7DFD groups decreased substantially. The separate fruit intake measurements from each assessment method did not significantly differ from each other (p > 0.05). IOS and IOS + SFFQ regression models generally yielded higher R2 values for males than for females. CONCLUSION: Despite estimation differences, the IOS can be reliable for medical student dietary habit assessment. The SFFQ is useful for measuring consumption of foods that are typically unavailable in school cafeterias, improving the overall dietary evaluation accuracy. The IOS assessment was more accurate for males than for females.

Association between alcohol use and frailty among elder adults in three Chinese cities.

BACKGROUND: Frailty is often described as a condition of the elderly and alcohol use is associated with frailty. The aim of this study is to examine the associations between alcohol use and frailty in three cities in elder adults. METHODS: A cross-sectional study was conducted in three cities in China from June 2017 to October 2018. In total, 2888 residents aged ≥65 years old were selected by using a multi-level stage sampling procedure. Alcohol use was assessed by Focusing on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers (CAGE) four-item questionnaire. Frailty was measured by a validated Chinese version of the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. Multinomial logistic regressions were used to examine the association of alcohol use with pre-frailty and frailty after controlling for varied covariates. RESULTS: In general, the prevalence of pre-frailty and frailty was 38.64 and 20.26%, respectively. After controlling for covariates and interaction of age and problematic drinking, non-problematic drinkers neither had association with pre-frailty (OR: 1.15, 95%CI:0.86-1.52) nor with frailty (OR:0.90, 95%CI:0.60-1.36), and problematic drinkers neither had association with frailty (OR: 1.21, 95%CI:0.83-1.76), while problematic drinkers had high odd ratios of frailty (OR:3.28, 95%CI:2.02-5.33) compared with zero-drinker. CONCLUSIONS: Our study found a positive association between problematic drinking and frailty, no relationship between non-problematic drinking and (pre-)frailty compared with zero-drinking among Chinese elder adults. Based on previous findings and ours, we conclude it is important for the prevention of frailty to advocate no problematic drinking among elder adults.

How COVID-19 lockdown and reopening affected daily steps: evidence based on 164,630 person-days of prospectively collected data from Shanghai, China.

BACKGROUND: COVID-19 lockdowns may lead to physical inactivity, a major risk factor for non-communicable diseases. This study aims to determine: 1) the trajectory in daily step counts before, during and after the lockdown in China, and 2) the characteristics associated with the trajectories. METHODS: From December 2019 to July 2020, smartphone-based step counts were continuously collected in 815 Chinese adults residing in Shanghai over 202 days across three phases: before, during, and after the lockdown. Participant characteristics were reported, and height, weight and body composition measured before the lockdown. A 'sharp' regression discontinuity design with cluster robust standard errors was used to test the effect of the lockdown and reopening on daily steps and a linear mixed model was used to examine the characteristics associated with trajectories during the observed period. RESULTS: Based on 164,630 person-days of data, we found a sharp decline in daily step counts upon the lockdown (24/01/2020) by an average of 3796 (SE = 88) steps, followed by a significant trend of increase by 34 steps/day (SE = 2.5; p < .001) until the end of the lockdown (22/03/2020). This increasing trend continued into the reopening phase at a slower rate of 5 steps per day (SE = 2.3; p = 0.029). Those who were older, married, university educated, insufficiently active, had an 'at risk' body composition, and those in the control group, were slower at recovering step counts during the lockdown, and those who were older, married, without university education and with an 'at risk' body composition recovered step counts at a slower pace after the reopening. CONCLUSIONS: Despite later increases in step counts, COVID-19 lockdown led to a sustained period of reduced physical activity, which may have adverse health implications. Governments and health professionals around the world should continue to encourage and facilitate physical activity during the pandemic.

The association between obesity and problematic smartphone use among school-age children and adolescents: a cross-sectional study in Shanghai.

BACKGROUND: The study aimed to investigate the association between content-based problematic smartphone use and obesity in school-age children and adolescents, including variations in the association by educational stage and sex. METHODS: Two-stage non-probability sampling was used to recruit 8419 participants from nineteen primary schools, five middle schools, and thirteen high schools in Shanghai in December 2017. Obesity was identified by body mass index (BMI), which was obtained from the school physical examination record, while problematic smartphone use was measured by the Revised Problematic Smartphone Use Classification Scale as the independent variable. RESULTS: The rates of obesity varied with educational stages, while problematic smartphone use increased with educational stages. Male students reported higher obesity rates (37.1%vs19.4%, P < 0.001) and greater problematic smartphone use scores (25.65 ± 10.37 vs 22.88 ± 8.94, P < 0.001) than female students. Problematic smartphone use for entertainment (smartphone users addicted to entertainment games, music, videos, novels and other applications) was positively associated to obesity status for primary school [odds ratio (OR), 1.030; 95% confidence interval (95% CI), 1.005-1.057] and high school students (OR, 1.031; 95% CI, 1.004-1.059). For female students, problematic smartphone use for entertainment was positively associated with obesity status (OR, 1.046; 95% CI, 1.018-1.075). CONCLUSIONS: Problematic smartphone use may be associated with obesity in children and adolescents. The association differed based on the educational stage and sex, and the difference possessed dimensional specificity.

Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak.

BACKGROUND: Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak. METHODS: A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates. RESULTS: The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43-4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47-2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36-2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75-3.33), worried about delays in working (AOR 1.71, 95%CI 1.27-.31), or worried about decreased income (AOR 1.45, 95%CI 1.14-1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51-0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence. CONCLUSION: It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.

Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study.

BACKGROUND: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. OBJECTIVE: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. METHODS: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. RESULTS: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=-0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=-0.45, P<.001) via vaccine hesitancy (SSC=-0.32, P<.001). CONCLUSIONS: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function.

Impact of a group-based intervention program on physical activity and health-related outcomes in worksite settings.

BACKGROUND: The benefits of physical activity (PA) have been well documented, and the worksite is a promising setting for PA promotion. The aims of this study were as follows: 1. To evaluate the effect of a group-based worksite intervention on PA and health-related outcomes by using pedometers. 2. To examine the associations between the change in vigorous physical activity (VPA)/moderate physical activity (MPA)/walking and health related outcomes. METHODS: A total of 398 participants (221 in the intervention group (IG) and 177 in the control group (CG)) from 17 worksites were recruited for a prospective self-controlled trial of a worksite physical activity intervention program in China. In the IG, a pedometer was utilized to self-monitor the PA, together with group competition, goal setting, and other incentives. No intervention was applied to the CG. Physical activity, sedentary behavior, and health-related outcomes were measured at baseline and immediately after the 100-day period intervention. RESULTS: A total of 262 participants completed the program (68.3% adherence). Adherence in the intervention group was 67.9% (n = 150/221). Improvements between baseline and follow-up among intervention participants were observed in the following parameters: VPA (+ 109.7 METs/week; p < 0.05), walking (+ 209.2 METs/week; p < 0.01), systolic blood pressure (SBP; - 2.1 mmHg; p < 0.01), waist circumference (WC; - 2.3 cm; p < 0.01), body fat percentage (BF); - 1.0%; p < 0.01), and body mass index (BMI; - 0.5 kg/m2; p < 0.01). VPA was related to changes in body fat percentage (p < 0.05) and body mass index (p < 0.05). CONCLUSION: This integrated group-based intervention program contributed to comprehensive improvement in health-related outcomes. The study was useful for establishing associations between change in VPA/MPA/walking and health-related outcomes in a natural setting. Long-term evaluation is required to examine the potential of such an integrated intervention to promote PA. REGISTRATION: This study was prospectively registered in the Chinese Clinical Trial Registry. TRIAL REGISTRATION NUMBER: ChiCTR-1,800,015,529. Date of registration: April 5, 2018.

The roles of health culture and physical environment in workplace health promotion: a two-year prospective intervention study in China.

BACKGROUND: To understand the potential influencing factors on the effectiveness of workplace health promotion interventions and examine whether workplace health culture and physical environment can mediate the relationship between workplace health promotion and intervention effectiveness. METHODS: A total of 719 participants from 10 Chinese government agencies were recruited for a prospective self-controlled trial. Questionnaires, qualitative interviews, and direct observation were used for the baseline evaluation, process evaluation, and effectiveness evaluation. Based on the results of the need assessment and risk assessment at each workplace, a two-year comprehensive health intervention was conducted by each workplace. Health outcomes including self-rated health (SRH) and mental health were measured at baseline and 24 months. Health culture was measured at 24 months. Physical environment and intervention implementation were measured at 12 months and 24 months. RESULTS: Compared with the baseline, the means of SRH and mental health increased significantly by 0.302 and 2.698, respectively. The SRH scores were different before and after intervention; furthermore, the differences varied by workplace. Health culture mediated the relationship between intervention implementation and intervention effectiveness, including SRH and mental health improvement, but physical environment did not. Physical environment quality was significantly negatively correlated with SRH improvement and mental health improvement. Under the relatively high-quality interventions with scores higher than 4.047 or 4.151 (out of 5), better health culture may led to greater SRH and mental health improvements. CONCLUSIONS: Health culture may mediate the relationship between intervention implementation and intervention effectiveness, whereas physical environment does not seem to mediate this relationship. Under relatively high-quality interventions, a better health culture may lead to more positive improvements in SRH and mental health. Future studies will need to examine the physical environment as a moderating effect rather than mediating effect. TRIAL REGISTRATION: This study was retrospectively registered in Chinese Clinical Trial Registry. TRIAL REGISTRATION NUMBER: ChiCTR-OOC-16010059 . Date of registration: Dec 1, 2016.

Association between social and built environments and leisure-time physical activity among Chinese older adults--a multilevel analysis.

BACKGROUND: Social and physical environments are not only hypothesized to influence physical activity (PA), they are also interrelated and influence each other. However, few studies have examined the relationships of PA with social and physical environments simultaneously. Accordingly, the current study aims to examine the association between physical and social attributes of neighborhood with leisure-time physical activity (LTPA) among the Chinese elders. METHODS: By employing a two-stage stratified random sampling procedure, 2783 elders were identified from 47 neighborhoods in Shanghai during July and September in 2014. Social and physical attributes of neighborhood were assessed using a validated and psychometrically tested measures, and the Chinese version of the International Physical Activity Questionnaire--Long Form was used to assess LTPA. Control variables included sex, age, marital status, education level, self-rated health and chronic conditions. Multilevel logistic regression analysis was conducted to explore whether individual- and neighborhood-level social and physical attributes were associated with LTPA. RESULTS: The overall prevalence of leisure-time active (LTA) was 46.6%. After controlling for individual covariates, 1) compared to participants with the first quartile of social participation, the odds ratios of LTA for participants with the second, third and fourth quartile of social participation were 1.86 (95% CI: 1.44-2.41), 2.37 (95% CI: 1.82-3.08) and 4.27 (95% CI: 3.27-5.58); 2) compared to participants with the first quartile of social cohesion, the odds ratios of LTA for participants with the second, third and fourth quartile of social cohesion were 1.09 (95% CI: 1.07-1.20), 1.14 (95% CI: 1.08-3.50) and 1.31 (95% CI: 1.11-1.58); 3) compared to participants living in neighborhoods with the first quartile of walkability, the odds ratios of LTA for participants living in neighborhoods with the second, third and fourth quartile of walkability were 1.13 (95% CI: 1.03-2.02), 1.73 (95% CI: 1.12-3.21) and 1.85 (95% CI: 1.19-3.35). CONCLUSIONS: Both social and physical attribute of neighborhood associate with LTPA among Chinese older adults. It may promote LTPA among Chinese older adults to encourage them to participate in social activities, meanwhile, building walkable and cohesive neighborhoods.

Associations between perceived and observational physical environmental factors and the use of walking paths: a cross-sectional study.

BACKGROUND: How to promote physical activity is an important public health problem that is attracting increasing attention. Although the application of environmental approaches is believed to promote resident walking, there remains insufficient evidence of the effectiveness of these interventions. METHODS: This study employed direct observation and questionnaires. Observations were performed on each Tuesday, Thursday, Saturday, and Sunday from April 13th to May 16th. Fourteen trained observers observed six community walking paths, and an additional walking path in a park. The trained observers filled out 2388 observation forms in the field, including 228 forms rating the permanent environment, and 1080 forms assessing the current environment and counting the number of walkers. A total of 1800 questionnaires were administered to community residents. RESULTS: The results of both observation and questionnaires showed good association regarding the characteristics of walking path users (for observation, female = 54.4%; for questionnaire interviews, female, OR = 1.441), and the environmental features associated with walking path utilization (for observation, positive associations were observed between the utilization index and observational environmental variables; for questionnaire interviews, roads and aesthetics were important, OR = 1.044). There were positive associations between path use and time, a preference for brisk walking, and the observed current and permanent environmental variables. Female participants were more likely to use walking paths than males (OR = 1.441, 95% confidence interval [CI] 1.126-1.846). BMI and traffic hazard safety were significantly negatively associated with walking path use (OR = 0.948, 95% CI 0.915-0.981, and OR = 0.933, 95% CI 0.887-0.981, respectively). Roads, aesthetics, and knowledge of physical activity were significantly positively correlated with use of walking paths (OR = 1.044, 95% CI 1.017-1.072, and OR = 1.175, 95% CI 1.043-1.323). Participants that resided further than 1 km from the park were less likely to use walking paths (OR = 0.703, 95% CI 0.530-0.933). Gender-specific associations were also found. CONCLUSIONS: Both perceived and objective environmental factors were associated with walking path use. Data suggested that the permanent and current conditions of the paths might influence walking path utilization, and that gender-specific promotion strategies should be considered.

Difference of the associations between self-rated health and demographic characteristics, lifestyle, and psychosocial work environment between two types of Chinese worksite.

BACKGROUND: Although studies of self-rated health (SRH) are conducted widely in developed countries, comprehensive assessments of the determinants of SRH in Chinese are scarce, particularly for working Chinese individuals. Determinants of SRH might differ among worksites based on differences in the nature and stress associated with different jobs, work intensity, and the lifestyles of employees. METHODS: Two thousand and forty questionnaires that addressed SRH, demographic characteristics, lifestyle, and the psychosocial work environment were administered to employees at two worksites. A total of 1644 subjects provided complete data for analysis (80.6% response rate). RESULTS: Participants from government departments had significantly better SRH than did those from high-tech enterprises (61.1% vs. 67.5%, respectively). Lifestyles were significantly less healthy at government departments compared with high-tech enterprises, whereas the psychosocial work environment was better. The results of unadjusted and adjusted models revealed differences between the potential health-influencing factors of participants based on their type of worksite. In logistic regression models, gender was strongly associated with SRH in all participants, whereas length of service was correlated with SRH only in participants from high-tech enterprises. In high-tech enterprises, good SRH was less common in physically inactive subjects vs. physically active participants (OR = 0.561). In government departments, passive smoking was negatively associated with SRH significantly. Social capital (OR = 1.073) and job control (OR = 1.550) were positively correlated with SRH in high-tech enterprises. Job control was the only psychosocial factor significantly associated with SRH in government departments. CONCLUSIONS: Participants from different types of worksite reported different SRH, healthy lifestyles, and psychosocial work environments. Moreover, the association between SRH and demographic characteristics, lifestyle, and the psychosocial work environment significantly differed by type of worksite.

Workplace social capital and smoking among Chinese male employees: a multi-level, cross-sectional study.

OBJECTIVES: The present study sought to investigate the associations between workplace social capital and smoking status among Chinese male employees. METHODS: A cross sectional study with a two-stage stratified sampling procedure was conducted in Shanghai in 2012. In total, 1603 male workers from 35 workplaces were involved. Workplace social capital was assessed using a validated and psychometrically tested eight-item measure. Multilevel logistic regression analysis was conducted to explore whether individual-level social capital and aggregated workplace-level social capital were associated with smoking. RESULTS: Overall, 54.2% of the subjects smoked currently. After controlling for individual covariates (age, education level, marital status, occupational status and job stress), compared to workers in the highest quartile of individual-level social capital, the prevalence ratios of smoking for workers in the third quartile, second quartile and lowest quartile were 1.26 (95% CI: 1.11-1.38), 1.35 (95% CI: 1.19-1.50) and 1.39 (95% CI: 1.24-1.51) respectively. However, there was no relationship between workplace-level social capital and smoking status. CONCLUSIONS: Higher individual-level social capital was associated with a lower likelihood of smoking among Chinese male employees. By contrast, no clear association was found between workplace-level social capital and smoking. Further longitudinal studies are warranted to examine the possible link between workplace social capital and smoking cessation in Chinese workplaces.

Education level modifies parental hesitancy about COVID-19 vaccinations for their children.

It is important to encourage parental acceptance of children's vaccination against COVID-19 to ensure population immunity and mitigate morbidity and mortality. This study drew upon protection motivation theory (PMT) to explore the factors of parental hesitancy about vaccinating their children. A national online survey was performed in China. A total of 2054 Chinese parents of children aged 6-12 years were included in this study. They reported on measures that assessed hesitancy about children's vaccination against COVID-19, PMT constructs (susceptibility, severity, response efficacy, self-efficacy, and response costs) and sociodemographic characteristics. Chinese parents reported a hesitancy rate of 29.4% for children's vaccination. Parents with higher level education were more likely to hesitate to vaccinate their children against COVID-19. After controlling for parents' and children's demographic variables, logistic regression showed that parents' hesitancy about their children's vaccination increased if parents had lower levels of susceptibility, response efficacy or self-efficacy, as well as higher levels of response costs. In addition, a high educational level can significantly increase the promotive effect of response cost and the protective effect of response efficacy on vaccine hesitancy. In conclusion, our findings suggested that PMT can explain parents' vaccine hesitancy and that education level can modify the effect of copying appraisal, but not threat appraisal, on parental hesitancy. This study will help public health officials send targeted messages to parents to improve the rate of COVID-19 vaccination in children aged 6-12 years and thus reach a higher level of immunity in the population.

The associations between problematic smartphone use and blood pressure among 2,573 aged 9-17 years students in Shanghai, China.

Objectives: This study aimed to (1) examine the cross-sectional association between problematic smartphone use (PSU) and blood pressure (BP) in children and adolescents and (2) determine whether the association between PSU and BP differs by the grade of students. Methods: We recruited a total of 2,573 participants from 14 schools in Shanghai by a two-stage sampling method. We derived BP data from the participant's most recent medical examination data, including systolic blood pressure (SBP) and diastolic blood pressure (DBP). We measured PSU by a modified PSU Classification Scale. We also assessed demographic characteristics, body mass index, behavioral variables, and physiological characteristics. Results: High school students had higher BP and PSU scores than primary and middle school students. PSU on the dimension of information collection was associated positively with both SBP and DBP among primary and middle school students, with the ß (95% CI) values of 0.282 (0.018, 0.546) and 0.229 (0.031, 0.427). Meanwhile, the dimension of the relationship of social network was associated positively with SBP among primary and middle school students, with a ß (95% CI) value of 0.390 (0.062, 0.717). PSU on the dimension of information collection was positively associated with the development of high BP, with a OR (95% CI) value of 1.072 (1.011, 1.137) among primary and middle school students. Conclusions: PSU might be a potential correlate of high BP among school-age children and adolescents. The associations between PSU and BP differed by the grade of students as well as according to the four dimensions of PSU.

Smartphone Use Time and Total Screen Time Among Students Aged 10-19 and the Effects on Academic Stress: A Large Longitudinal Cohort Study in Shanghai, China.

Objective: This study aimed to assess smartphone use time and total screen time among students aged 10-19 in Shanghai, China, and examine their effects on academic stress. Methods: Baseline and follow-up surveys were conducted in December 2017 and December 2018, respectively, using a cohort study design with 1,771 participants. Questionnaire surveys and physical examinations of participants were conducted by trained investigators and professional school physicians, respectively. The self-administered questionnaire mainly covered demographic information, academic stress, smartphone use time, total screen time, and other lifestyle behaviors. Results: The average smartphone use time of primary, middle, and high school students was 0.76 ± 0.90, 1.34 ± 1.29, and 2.39 ± 1.66 h/day, respectively; total screen time was 2.60 ± 2.63, 2.65 ± 3.39, and 3.52 ± 2.7 h/day, respectively (P < 0.001). The academic stress scores of primary, middle, and high school students were 9.25 ± 3.96, 11.97 ± 4.58, and 15.06 ± 5.10 (out of 30), respectively. The smartphone use time and total screen time were positively associated with academic stress score, with ß values of 0.307 (95% CI: 0.164-0.450) and 0.171 (95% CI: 0.088-0.255), respectively. The longer the smartphone use time and total screen time, the higher the risk of abnormal academic stress, with OR values of 1.199 (95% CI: 1.103-1.303) and 1.104 (95% CI: 1.056-1.154), respectively. After stratifying by grade group, positive associations between smartphone use time or total screen time and abnormal academic stress were observed in primary and middle school students; for high school students; however, only smartphone use time had a positive association. Conclusions: This study confirmed that the academic stress is widespread among students aged 10-19 in Shanghai, China. From a public health perspective, smartphone use time and total screen time should therefore be restricted for reducing academic stress and preventing related problems among adolescents in Shanghai, China, in school, family, and other environments.

Evaluation of Dietary Quality Based on Intelligent Ordering System and Chinese Healthy Eating Index in College Students from a Medical School in Shanghai, China.

We intended to precisely evaluate the dietary quality of male and female medical college students using canteen data from the "Intelligent Ordering System" (IOS), combined with the supplemental food frequency questionnaire (SFFQ) and the Chinese Healthy Eating Index (CHEI) in Shanghai, China, to explore the potential factors influencing dietary quality. A total of 283 college students with the average age of 24.67 ± 3.21 years and Body Mass Index of 21.46 ± 3.49 kg/m2 in the medical school were enrolled in this study, and an online questionnaire investigation was conducted to collect the general information, lifestyle behavior, and SFFQ. The dietary data of the study participants from the school canteen were exported from the IOS of the Information Office of Fudan University. The CHEI consists of 17 components and the total score is 100, with a maximum score of each component of 5 or 10. We calculated each component score of the CHEI and aggregated the total score for male and female study participants. The Chi-square test and Wilcoxon rank sum test were employed in comparing the differences between the demographic characteristics and CHEI component scores of males and females. Univariate and multiple linear regression models were employed to examine the potential influencing factors of the total CHEI score. The CHEI median score was 66.65, and the component score for total grains was relatively low. Added sugars was the most overconsumed CHEI component. There were relatively serious deficiencies, based on the CHEI component scores, in fruits, soybeans, fish and seafood, and seeds and nuts in both sexes. Females had significantly higher CHEI scores than males (68.38 versus 64.31). The scores for tubers, total vegetables, dark vegetables, fruits, fish and seafood, dairy, and red meats were significantly higher in females than in males. Influencing factors including sex, education, dietary health literacy, and amount of time spent sedentarily were significantly associated with CHEI score. Our research revealed that the overall dietary quality needs to be further improved for college students at the medical school in Shanghai, China, with low intakes of total grains, fruits, soybeans, fish and seafood, and seeds and nuts, and high intakes of added sugars. Compared with males, females showed higher diet quality and conformed more strongly with the recommended Dietary Guideline for Chinese. Education, dietary health literacy, and amount of time spent sedentarily should be noted for improving the dietary quality of college students.

Accuracy of steps measured by smartphones-based WeRun compared with ActiGraph-GT3X accelerometer in free-living conditions.

Objectives: The purpose of this study was to evaluate the accuracy and reliability of steps tracked by smartphone-based WeChat app compared with Actigraph-GT3X accelerometer in free-living conditions. Design: A cross-sectional study and repeated measures. Methods: A total of 103 employees in the Pudong New Area of Shanghai, China, participated in this study. The participants wore an ActiGraph-GT3X accelerometer during the period of August to September 2019 (Time 1), December 2019 (Time 2) and September 2020 (Time 3). Each time, they wore the ActiGraph-GT3X accelerometer continuously for 7 days to assess their 7-day step counts. The smartphone-based WeRun step counts were collected in the corresponding period when subjects wore accelerometers. The subjects were invited to complete basic demographic characteristics questionnaires and to perform physical examination to obtain health-related results such as height, body weight, body fat percentage, waist circumference, hip circumference, and blood pressure. Results: Based on 103 participants' 21 days of data, we found that the Spearman correlation coefficient between them was 0.733 (P < 0.01). The average number of WeRun steps measured by smartphones was 8,975 (4,059) per day, which was higher than those measured by accelerometers (8,462 ± 3,486 per day, P < 0.01). Demographic characteristics and different conditions can affect the consistency of measurements. The consistency was higher in those who were male, older, master's degree and above educated, and traveled by walking. Steps measured by smartphone and accelerometer in working days and August showed stronger correlation than other working conditions and time. Mean absolute percent error (MAPE) for step counts ranged from 0.5 to 15.9%. The test-retest reliability coefficients of WeRun steps ranged from 0.392 to 0.646. A multiple regression analysis adjusted for age, gender, and MVPA/step counts measured during Time 1 showed that body composition (body weight, BMI, body fat percentage, waist circumference, and hip circumference) was correlated with moderate-to-vigorous intensity physical activity, but it was not correlated with WeRun step counts. Conclusions: The smartphone-based WeChat app can be used to assess physical activity step counts and is a reliable tool for measuring steps in free-living conditions. However, WeRun step counts' utilization is potentially limited in predicting body composition.

Socioeconomic mechanisms of myopia boom in China: a nationwide cross-sectional study.

OBJECTIVES: To assess the association between socioeconomic development and the myopia boom in China. DESIGN: Nationwide cross-sectional study. SETTING: We used data from the China Family Panel Study (CFPS 2010), and the Chinese National Survey on Students' Constitution and Health (CNSSCH 2010). PARTICIPANTS: Participants included 33 600 individuals and 14 226 families from the CFPS 2010, and 86 199 students aged 7-12 years from the CNSSCH 2010. MEASURES: The main measure was students' visual impairment (defined as Snellen visual acuity ≤20/25 (0.8) in the worse eye) rate of each province (or municipality or autonomous region); other measures included the Gini coefficient of property, logarithm of average property, Gini coefficient of education, average education duration and return-to-education rate of each province (or municipality or autonomous region). The visual impairment rate was calculated using students' data, aged 7-12 years, from the CNSSCH 2010. The Gini coefficient of property and logarithm of average property were calculated using the families' data from the CFPS 2010; the Gini coefficient of education, average education duration and return-to-education rate were calculated using individuals' data aged 18-44 years from the CFPS 2010. RESULTS: The urban environment (coefficient: 0.209; p<0.001), Gini coefficient of property (coefficient: 1.979; p=0.005), logarithm of average property (coefficient: 0.114; p<0.001), average education duration (coefficient: 0.041; p<0.001) and return-to-education rate (coefficient: 0.195; p<0.001) were positively associated with the logit function of visual impairment rate. CONCLUSIONS: Economic development may promote an increased desire to pursue wealth. Regarding high return to education and a fairly competitive education system, individuals are likely to pursue wealth through education, which is associated with a heavier education burden and higher prevalence rates of myopia.

Association between Mobile Phone Addiction Index and Sugar-Sweetened Food Intake in Medical College Students Stratified by Sex from Shanghai, China.

This study's objective was to depict sugar-sweetened food (SSF) consumption in medical college students stratified by sex from Shanghai, China, and to explore the association between the Mobile Phone Addiction Index (MPAI) and SSF intake. The data were obtained from 1121 medical college students from the Fudan University, Shanghai, China, who took an online questionnaire investigation in December 2020. Data included demographics, the MPAI, the Nutrition Literacy Assessment Questionnaire (NLAQ), total and food expenditure per month, the International Physical Activity Questionnaire (IPAQ), and a food frequency questionnaire (carbonated beverages (CB), other sugar-based beverages (OSBB), sugar/chocolate). We evaluated the association between the MPAI and three types of SSF intake according to multivariate logistic regression analysis stratified by sex. The mean CB, OSBB, and sugar/chocolate intakes were, respectively, 65.66 mL/d, 74.20 mL/d, and 4.96 g/d in men and 30.42 mL/d, 71.48 mL/d, and 4.99 g/d in women. The MPAI was positively associated with SSF intake, regardless of sex. In men, the CB and OSBB odds ratios (ORs) were, respectively, 1.023 (95% CI: 1.004-1.042), 1.019 (95% CI: 1.001-1.038); and in women, the CB, OSBB, and sugar/chocolate ORs were, respectively, 1.026 (95% CI: 1.013-1.039), 1.020 (95% CI: 1.007-1.033), and 1.019 (95% CI: 1.006-1.032). Age, NLAQ, total expenditure, food expenditure, and total physical activity also were related to SSF intake. Age and the application capacity of the NLAQ were negatively associated with SSF intake, whereas comprehension capacity of the NLAQ, total and food expenditure, and total physical activity were positively associated with SSF intake. This study confirmed that SSF intake is widespread among medical college students from Shanghai, China, even if they have relatively high nutrition health literacy. From a public health perspective, it is necessary to reduce SSF intake in medical college students by decreasing the MPAI, controlling the total and food expenditure per month in high-consumption areas, and improving the application ability of the NLAQ. Further studies are needed to explore the MPAI and other potential factors that may influence SSF intake of college students by expanding the sample size of college students throughout China, and the causal association between them.

How can the uptake of preventive behaviour during the COVID-19 outbreak be improved? An online survey of 4827 Chinese residents.

OBJECTIVES: The aims of this study were to assess the uptake of preventive behaviour during the COVID-19 outbreak and to investigate the factors influencing the uptake of preventive behaviour based on the theory of planned behaviour (TPB）. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional online survey was conducted among Chinese residents aged ≥18 years and 4827 participants from 31 provinces and autonomous regions were included in the current study. Uptake of preventive behaviour, attitude towards the spread of COVID-19 and preventive behaviour, subjective norms, perceived behavioural control, demographic characteristics and the information attention and processing mode were measured. Multivariate logistic regressions were used to identify associations between the potential influencing factors and uptake of preventive behaviour. RESULTS: There were 2393 (52.8%) respondents reported high uptake of preventive behaviour. Multivariate analyses demonstrated that attitude towards the behaviour, subjective norms and perceived behavioural control were significantly correlated with uptake of preventive behaviour, and perceived behavioural control was the strongest influencing factor (OR=4.09, 95% CI 3.57 to 4.69). Furthermore, systematic information processing mode was positively associated with high uptake of preventive behaviour compared with heuristic information processing mode (OR=2.16, 95% CI 1.67 to 2.81). CONCLUSIONS: These findings are helpful for developing education and interventions to promote high uptake of preventive behaviour and enhance public health outcomes during pandemic.