Changing trends of mental and behavioral responses and associations during the COVID-19 epidemic in China: a panel study.

This prospective observational study examined changing trends in mental and behavioral responses, and their association with perceived risk, severity, self-efficacy and isolation status during the Chinese COVID-19 epidemic. There were five waves of interviews. Descriptive statistics and non-parametric test methods were used for data analysis. Participants numbered 150 for the linkable baseline survey and 102 completed all 5 survey waves and were included in the analysis. Mental stress, emotional status and lifestyle manifested a statistically significant downwards trend across the total period of this panel study. The number of reported new confirmed patients perceived high risk and perceived severity were positively associated with mental stress, emotional status and lifestyle. Self-efficacy was negatively associated with each type of mental and behavioral response. The more time people were confined to their home, the more serious the emotional and lifestyle problems. Dose-response relationships were noted between the number of reported new confirmed patients and mental stress, emotional status and lifestyle during the five observation points. This study yielded new information about mental and behavioral responses among Chinese people during the COVID-19 epidemic. Policy changes and health education are essential for minimizing the adverse health effects of these responses.

Prevalence and behavioural associations of unintentional injuries among Chinese college students: a 50-University population-based study.

OBJECTIVE: To assess the prevalence, demographic characteristics and behavioural correlates of unintentional injuries among Chinese college students. METHODS: A cross-sectional multistage survey sampling process was conducted among 11 770 undergraduates from 50 universities in China. Students were asked to report different types of unintentional injuries that required medical attention from a doctor over the past year. The χ² test and multiple logistic regression analysis were used to identify factors associated with these injuries. RESULTS: The overall unintentional injury prevalence was 47.9% (95% CI 47.6% to 48.2%). Most injuries occurred at sport venues (24.0%), following by home/dormitory injuries (20.5%) and traffic injuries (13.0%). Some behavioural factors exhibiting significant associations with overall unintentional injuries were: sleeping less than 7 hours (OR=1.32, 95% CI 1.27 to 1.37), smoking (OR=1.28, 95% CI 1.23 to 1.32), alcohol consumption (OR=1.74, 95% CI 1.69 to 1.78) and heavy internet use (OR=1.60, 95% CI 1.52 to 1.67). Male students were more likely to be involved in traffic and sport injuries than female students. Students majoring in non-medical fields had a higher risk of sport and home injuries than students majoring in medical fields. Those who drank alcohol, slept less than 7 hours or who reported heavy internet use were more likely to experience all types of injuries than students who did not participate in these behaviours. Finally, students who smoked had a higher likelihood of traffic and sport injuries than non-smoking students. CONCLUSIONS: A substantial number of college students reported injuries in the past year, and several key behavioural factors were associated with injuries. These findings could be beneficial for the design, implementation and assessment of injury intervention programme with college students. Based on these findings, policy implications for unintentional injury prevention and control were also considered.

Individual and regional association between socioeconomic status and uncertainty stress, and life stress: a representative nationwide study of China.

BACKGROUND: Many studies have examined the association between socioeconomic status (SES) and mental stress. Uncertainty stress is a prominent aspect of mental stress. Yet no research has ever empirically analyzed the impact of SES on uncertainty stress. METHODS: Students were identified through a multistage survey sampling process including 50 universities. Each student participant completed the Global Health Professions Student Survey (GHPSS) on Tobacco Control in China. Regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were considered in the analyses. RESULTS: Among the 11,942 participants, severe uncertainty stress prevalence was 19.6%, while severe life stress prevalence was 8.6%. Multilevel logistic regression showed that most SES variables were associated with uncertainty stress. Students with "operation and commercial work" as mother's occupation and "rural or township" as family location exhibited a higher prevalence of severe uncertainty stress. Lower family income and original region gross domestic products (GDP) were also associated with higher severe uncertainty stress prevalence. However, only father's occupation was correlated with life stress. CONCLUSIONS: Based on the literature review, this is the first empirical study examining the impact of SES on uncertainty stress in China and elsewhere in the world. Our research underscores the importance of decreasing socioeconomic inequalities in controlling excessive uncertainty stress.

Violent injuries and regional correlates among women in China: results from 21 cities study in China.

BACKGROUND: Ecological models depict violent injuries against women being influenced by both individual and environmental characteristics. However, only few studies examined the association between regional variables and the likelihood of violent injuries. Our study is a preliminary assessment of the impact of regional variables on the likelihood that a woman has experienced violent injuries. METHODS: Participants were 16 866 urban residents, who were identified through a multi-stage sampling process conducted in 21 Chinese cities. Out of the sampled population, 8071 respondents were female. Subsequent analyses focused solely on the female sample. Multilevel logistic regression analyses were performed to examine regional variation in violent injuries. RESULTS: Prevalence of violent injuries against women is 10.7% (95% CI: 7.8%, 15.5%). After controlling for individual-level characteristics, higher regional male-female ratio (OR: 1.97, P < 0.05), population growth rate (OR: 4.12, P < 0.01) and unemployment rate (OR: 2.45, P < 0.01) were all associated with an elevated risk of violent injuries among Chinese women caused by physical attack. CONCLUSIONS: The results suggest violent injuries among Chinese women caused by physical attack have become an important social and public health problem. The findings point to the importance of developing effective health policies, laws and interventions that focuses on the unequal economic development between different regions.

Who smokes in smoke-free public places in China? Findings from a 21 city survey.

Efforts toward controlling secondhand smoke in public places have been made throughout China. However, in contrast to the western world, significant challenges remain for effectively implementing smoke-free regulations. This study explores individual and regional factors which influence smoking in smoke-free public places. Participants included 16 866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities. The reported smoking prevalence in smoke-free public places was 41.2%. Of those who smoked in smoke-free public places, 45.9% had been advised to stop smoking. Participants stated that no-smoking warnings/signs with 'please' in the statement had a better likelihood of gaining compliance and preventing smoking in public spaces. Multilevel logistic regression analysis showed that ethnicity, education, occupation, type of smoking, age of smoking initiation, smoking situation, stress, household smoking restrictions and city population were all associated with smoking in smoke-free public places. Interestingly local smoke-free regulations were not associated with smoking in public places. The findings underscore that efforts to restrict smoking in public places in China should emphasize strong enforcement, while simultaneously raising public awareness of the perils of second hand smoke.

Socioeconomic inequalities and mental stress in individual and regional level: a twenty one cities study in China.

OBJECTIVES: This study will examine explanatory variables including socioeconomic inequalities related to mental stress at both the individual and regional level. METHODOLOGY: A cross-sectional multistage sampling process was used to obtain participants. Data on mental stress and individual socioeconomic status were gathered via face to face interview. Regional variables were retrieved from a national database. Multilevel logistic regression analysis was used to assess socioeconomic variances in mental stress. RESULTS: Among the 16,866 participants, 27.2% reported severe levels of mental stress (95% CI: 19.4%-35.1%). Multilevel regression analysis indicated that lower individual educational attainment and income, and lower regional Per Capita GDP was associated with mental stress. The results also indicated that managers, clerks, and professional workers manifested higher stress levels than those in other occupations. CONCLUSIONS: Based on the results of this study individual and regional socioeconomic inequalities in China are associated with mental stress.

CEPH accreditation of stand-alone baccalaureate programs: a preliminary mapping exercise.

The purpose of this article is to provide a brief background of quality assurance efforts in health education, provide a brief overview of the new Council on Education for Public Health (CEPH) accreditation process for stand-alone baccalaureate public health programs that prepare health education specialists, and describe the experience of two academic programs in reviewing their curricula for coverage of the newly approved CEPH requirements. The University of Alabama and the University of North Carolina Wilmington undertook a curriculum mapping exercise identifying which courses in their programs Introduced, Reinforced, and/or Covered each of the Critical Components Elements identified by CEPH. The mapping process is described, and recommendations for other programs considering accreditation under the newly adopted CEPH standards are provided.

Changing trends of suicidal ideation, and impact of social trust and social communication during transition from quarantine to non-quarantine in the COVID-19 epidemic in China.

BACKGROUND: In order to curb the rapid spread of COVID-19, many countries have implemented lockdown or quarantine requirements, but little is known about how this impacts suicide ideation. The purpose of this study is to examine changing trends of suicidal ideation, social trust, and social communication from the quarantine to non-quarantine period during the COVID-19 epidemic in China and the effects of quarantine on suicidal ideation. METHODS: A prospective longitudinal observation design was utilized. There were six waves of interviews from the quarantine to the non-quarantine period. Two hundred and twenty-one participants completed all observation points and were included in the study. For the continuing variables, the Mann-Kendall test was used to assess changing trends across the six observation points. For categorical variables, the Cochran-Armitage test was used to examine their changing trends. A generalized estimating equation was used to examine the association between several independent variables and suicide ideation. RESULTS: The prevalence of suicide ideation was 16.7, 14.5 %, and 14.5 %, respectively, in the quarantine period, and 13.8, 10.9 %, and 10.0 %, respectively in the non-quarantine period, which there was a significant downward trend (T: -4.06, p < 0.01) across the total observation period. Negative behavioral belief, negative social trust, and low levels of social communications were positively associated with suicide ideation, with a ß of 0.0310 (P < 0.01), 0.0541 (P < 0.01), and 0.0245 (P < 0.05) respectively. The positive attitude toward lockdown was negatively associated with suicide ideation, with a ß of -0.0137 (P < 0.01) among guaranteed classmates and it was -0.0121 (P < 0.01) among unguaranteed classmates. CONCLUSIONS: This study yielded new information and may have important policy implications to design effective intervention strategies to reduce future new infectious diseases while maintaining positive mental health and reducing suicide ideation.

Career development through local chapter involvement: perspectives from chapter members.

The importance of career development in professional organizations has been noted in the literature. Personal and professional benefits of membership regardless of discipline can be found across the career spectrum from student to executive. The benefits of professional membership with respect to career development in local chapter organizations have seldom been studied. Local chapter participation may offer significant career development opportunities for the practitioner, faculty member, and student. The purpose of this study was to explore the importance of local chapter involvement to the career development of health education practitioners. An 18-item questionnaire was disseminated to the membership of three local SOPHE (Society for Public Health Education) chapters that explored the level of local chapter involvement and the impact of how specific professional development activities impacted career development. The results of the survey highlighted the importance of continuing education programs, networking, and leadership experience in developing one's career that are offered by local SOPHE chapter involvement. Making a positive impact in the community and earning the respect of one's peers were most often reported as indicators of career success. These factors can directly impact local chapter participation. Career development can certainly be enhanced by active participation in the local chapter of a professional association.

Temporal changes in mental response and prevention patterns, and their impact from uncertainty stress during the transition in China from the COVID-19 epidemic to sporadic infection.

An epidemic of a highly lethal disease can overwhelm people emotionally and physically. Little is known about how public mental and preventive patterns changed during the transition from the COVID-19 epidemic to sporadic infection. This study examined changing trends of metal response and behavioral variables, and their impact from uncertainty stress in this process in China. A prospective longitudinal observation design was utilized. There were 7 waves of surveys from COVID-19 epidemic status to the sporadic infection period. Sixty-two participants completed all observation points and were included in the study. The Mann-Kendall Test was used to assess changing trends across the seven observation points. The nonparametric linear mixed effects model was used to examine the association between uncertainty stress and mental and behavioral responses. The mean uncertainty stress did not change significantly over the observation period (Z: -0.911, p > 0.05). This trend was also true for perceived risk, perceived severity, self-efficacy for prevention, and prevention behavior. There was a statistically significant downward trend in irrational beliefs about prevention (Z: -4.993, p < 0.01), sleep (Z: -2.499, p < 0.05), emotions (Z: -5.650, p < 0.01), and lifestyle (Z: -5.978, p < 0.01). The results showed that uncertainty stress was positively associated with irrational beliefs (ß: 0.16298, p < 0.01), their sleep (ß: 0.02070, p < 0.05), emotions (ß: 0.03462, p < 0.01), and lifestyle (ß: 0.02056, p < 0.05). High levels of uncertainty stress were negatively associated with self-efficacy for prevention and prevention behavior, ß was -1.33210 (p < 0.01) and -0.82742 (p < 0.01). These results may have important policy and disease prevention in post-epidemic times.

Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study.

BACKGROUND: Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China. METHODS: Subjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH. RESULTS: The overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65). DISCUSSION: Contextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.

Regional Internet Access and Mental Stress Among University Students: A Representative Nationwide Study of China.

Background: The Internet changed the lives of average citizens in the early part of the twenty-first century, and it has now become an essential part of daily life. Many studies reported that accessibility of Internet use is associated with mental health. However, previous studies examining this association were confined to local and community subpopulations and limited at the individual level, which increases the potential bias from the selection effect at a different level. Regional variables would be a stable estimate of people's socioeconomic and cultural environments and how these variables affect mental health needed to be studied. The objective of this study was to evaluate the association between regional Internet access, and mental stress among university students. Methods: Participants were 11,954 students, who were identified through a multistage survey sampling process conducted in 50 Chinese universities. Regional Internet access was retrieved from a national database, and mental stress was measured using the Perceived Stress Scale (Chinese Version) (CPSS). Both unadjusted and adjusted methods were considered in the analyses. Results: More than one-third 36.9% (95% CI: 24.4-49.5%) of university students in this study suffered from severe mental stress (SMR). The multilevel logistic regression model found that university students studied in low-level universities had 2.52 (95% C.I. 1.17 to 6.37) times the prevalence of SMR than those in high-level universities. Compared with small cities, students in a large city had a lower prevalence of SMR (OR 0.25; 95%C.I. 0.06 to 0.77). Most importantly, regional Internet access was negatively associated with students' SMR (OR 0.25; 95%C.I. 0.08 to 0.76). Conclusions: This study indicated that regional Internet access and other environmental factors including city size and type of universities contribute to students' mental health. The findings underscore that efforts to control excessive mental stress among students in China should pay greater attention to environmental determinants of stress and particularly to improve internet access.

Uncertainty Stress, and Its Impact on Disease Fear and Prevention Behavior during the COVID-19 Epidemic in China: A Panel Study.

Objectives: We examined changing trends of uncertainty stress, and its impact on disease fear and prevention behaviors during the Chinese COVID-19 epidemic, using a prospective observational study. Methods: We employed a longitudinal design. We recruited participants for an online panel survey from chat groups on social media platforms. There were 5 waves of interviews. Information on uncertainty stress and related variables were collected via the online survey. Descriptive statistics and the GIM program were used for data analysis. Results: Participants numbered 150 for the linkable baseline survey and 102 (68%) for the final survey. Uncertainty stress (ß = -.047, SE = .118, p > .05) did not show a statistically significant temporal change trend over the observation period. Disease fear manifested a statistically significant downwards trend (ß = -.342, SE = .157, p < .05), and prevention behaviors indicated an upwards trend (ß = .048, SE = .021, p < .05) during the observation period. Uncertainty stress was positively associated with disease fear (ß = .45046, SE = .05964, p < .001), and negatively associated with self-efficacy (ß = -.6698, SE = .01035, p < .001), and prevention behaviors (ß = -.02029, SE = .00876, p =.021). Conclusion: This study yielded new information about uncertainty stress among Chinese people during the COVID-19 epidemic. Policy changes and public education are essential for minimizing the negative effects of uncertainty stress in disease prevention.

Urban Air Pollution and Mental Stress: A Nationwide Study of University Students in China.

Background: Studies exploring the relationship between air pollution levels and mental stress have rarely been done, and no studies have been done comparing university student mental stress levels based on regional air pollution levels. Objectives: The objective of this study was to evaluate the association between air pollution and mental stress among university students. Methods: Participants were 11,942 students, who were identified through a multistage survey sampling process conducted in 50 universities. Regional air pollution levels were retrieved from a national database, and mental stress was measured using a perceived stress scale. Both unadjusted and adjusted methods were utilized in the data analyses. Results: Mental stress prevalence was 36.9% (95% Confidence Interval: 24.4-49.5%). The final model indicated that regional air pollution levels were positively associated with students' mental stress. Conclusions: This study provided new and direct evidence of the health hazards of air pollution. The findings underscore the need to develop and implement stringent environmental protection policies, while simultaneously raising public awareness of environmental protection.

Association of Excessive WeChat Use with Mental Disorders: A Representative Nationwide Study in China.

OBJECTIVES: We examined associations between excessive WeChat use and mental disorders at the individual and contextual level. METHODS: We conducted a representative nationwide survey sampling process of 11,283 medical students from 30 universities in China. Mental health status was measured by the Chinese Health Questionnaire. Both unadjusted and adjusted methods were considered in the analyses. RESULTS: High frequency and long-time use prevalence was 19.1% and 31.2% respectively among WeChat users. The multilevel logistic regression model found that individual-level high frequency (OR = 1.26) and long-time use (OR = 1.24) were significantly associated with mental health disorders. University-level excessive WeChat use also was associated with the mental disorders (OR = 1.33 [high frequency use]; OR = 1.17 [long-time use]). Structural equation analysis showed that individual- and university-level high frequency and individual-level and university-level long-time WeChat use have a direct influence on poor mental health. The above variables, except individual-level long-time use, have an indirect influence on poor mental health through mental stress. CONCLUSIONS: This study provides new evidence that excessive WeChat use is associated with mental disorders. These findings underscore the importance of alerting people to the possible health risks of excessive social media use.

Charting your career path through clear professional values and purpose.

Clearly articulating one's professional purpose and professional values can clarify career direction as well as provide inspiration and ongoing career motivation for emerging, established, and senior health education professionals. Through examples and exercises, this article provides a method for clarifying and using professional values and purpose statements for health education professionals.

Violent Injuries Among College Students in China: An Exploration of Gender Mental Stress Model.

The purpose of this study was to explore the gender-specific mental stress model of violent injuries among Chinese college students. A cross-sectional, multistage sampling process was employed to recruit a total of 5025 college students from 22 universities in China. Survey respondents reported their exposure to violent injuries and noted individual and environmental factors that could relate to violent injuries. Both unadjusted and adjusted statistical methods were used to examine the relationships between selected individual and environmental variables with violent injuries among male and female college students. The overall prevalence of violent injuries among male and female college students in this study was 4.40% (95% CI [0.10%, 7.80%]) and 5.20% (95% CI [0.05%, 10.35%]). The study found that higher mental stress (OR: 3.32), lower level universities (OR: 5.99), and family location in rural areas (OR: 4.00) were associated with a higher likelihood of violent injuries, and mothers employed as professionals (OR: 0.07) was associated with lower prevalence of violent injuries among male students. Unlike male students, mental stress and mothers' occupation were not associated with violent injuries among female students. University type was also associated with violent injuries but this association was inverted (OR: 0.06) among female students. This study found gender-specific relationships affecting violent injuries among college students in China. Prevention strategies need to be developed in consideration of gender influences and should be enacted to reduce the negative impact of violent injuries on society and personal health in China.

Health Education Specialist Practice Analysis II 2020: Processes and Outcomes.

Introduction. The Health Education Specialist Practice Analysis II 2020 (HESPA II 2020) described the contemporary practice of health education specialists across work settings at entry and advanced levels. The purpose of the HESPA II 2020 manuscript was to report the research process and resulting data associated with the HESPA II 2020 and to provide recommendations for future practice analyses in health education. Method. Two data collection instruments were developed with the assistance of a 17-member Health Education Practice Panel to survey practicing health education specialists on the knowledge and skills needed in their ongoing roles. The instruments were designed to assess the degree to which the elements of the model had importance to practice (Importance), how often health education specialists performed the elements of the model (Frequency), and the point in time that health education specialists were expected to perform the various elements of the model (Performance Expectation). Composite scores for Sub-Competencies were calculated and subgroup comparisons were conducted to distinguish between levels of practice. Results. A total of 3,851 health education specialists provided usable responses. The final validated hierarchical model included eight Areas of Responsibility, 35 Competencies, and 193 Sub-Competencies. Of the Sub-Competencies, 114 were Entry level, 59 Advanced 1 level, and 20 Advanced 2 level. In addition, 145 knowledge items were verified. Discussion. HESPA II 2020 produced a validated hierarchical model descriptive of current practice of health education specialists across work settings. The results have implications for professional preparation, professional development, and certification.

Current developments in accreditation and certification for health promotion and health education: a perspective on systems of quality assurance in the United States.

The health education profession in the United States employs parallel, and overlapping, systems of voluntary credentialing to ensure quality in professional preparation. The U.S. approach to quality assurance comprises credentialing at the individual level, including certification, and at the institutional level, including regional and program-specific accreditation or approval of professional preparation degree programs. These multiple systems and levels of quality assurance have evolved during a half century but have not been uniformly available or universally embraced by the field, employers, or those in the institutional settings in which health educators now receive their professional preparation. This article reviews the current scope of credentialing systems in the United States and explains whom they serve and how they function. Recent developments that are now reshaping the landscape of quality assurance in health education and health promotion are also discussed.

Associate editors' foreword: entrepreneurship in health education and health promotion: five cardinal rules.

A career in health education or health promotion (HE/HP) can be developed in many ways. In past editions of this department, career development has been discussed in relation to distance (Balonna, 2001), consulting (Bookbinder, 2001), certifications (Hayden, 2005), graduate school (Cottrell & Hayden, 2007), and many other topics. This article looks at a less traditional means of career development-entrepreneurship. Health education is a field ripe with opportunities for consulting and for selling health-related products and services. Entrepreneurship can not only create financial rewards but can also provide high visibility and networking contacts that can advance one's career. This article combines both theory and practical applications to assist readers in developing entrepreneurial activities. The authors are experienced in entrepreneurial development and use that expertise to provide relevant examples and develop a framework using "five cardinal rules" for establishing an entrepreneurial enterprise in HE/HP.