Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial.

BACKGROUND: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. OBJECTIVE: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. METHODS: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. RESULTS: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (-7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. CONCLUSIONS: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/46883.

Household unclean fuel use, indoor pollution and self-rated health: risk assessment of environmental pollution caused by energy poverty from a public health perspective.

The lack of access to clean energy remains one of the major challenges in the global energy sector. Access to clean, sustainable and affordable energy, outlined in the seventh Sustainable Development Goals (SDG 7) of the United Nations, plays a crucial role in advancing health (SDG 3), as unclean cooking energy may endanger people's health by causing air pollution. However, due to endogeneity problems such as reverse causality, the health consequences of environmental pollution caused by unclean fuel usage are difficult to be scientifically and accurately evaluated. This paper aims to systematically assess the health cost of unclean fuel usage based on tackling endogeneity, using the data from Chinese General Social Survey. The ordinary least squares model, ordered regression methods, instrumental variable approach, penalized machine learning methods, placebo test, and mediation models are applied in this research. Analytical results demonstrate that households' unclean fuel use significantly damages people's health. Specifically, the use of dirty fuel leads to an average of about a one-standard-deviation decline in self-rated health, demonstrating its notable negative effect. The findings are robust to a series of robustness and endogeneity tests. The impact mechanism is that unclean fuel usage reduces people's self-rated health through increasing indoor pollution. Meanwhile, the negative effect of dirty fuel use on health has significant heterogeneity among different subgroups. The consequences are more prominent for the vulnerable groups who are female, younger, living in rural areas and older buildings, with lower socio-economic status and uncovered by social security. Therefore, necessary measures should be taken to improve energy infrastructure to make clean cooking energy more affordable and accessible as well as to enhance people's health. Besides, more attention should be paid to the energy needs of the above specific vulnerable groups faced with energy poverty.

Does exercise participation promote happiness?: Mediations and heterogeneities.

This paper uses a nationally representative and large-scale dataset from China to empirically examine the relationship between exercise participation and happiness. To address the problem of reverse causality between the two factors, the instrumental variable (IV) approach is used to deal with endogeneity to some extent. It is demonstrated that higher frequencies of exercise participation are positively related to happiness. Findings also demonstrate that physical exercise could significantly decrease depressive disorders, improves self-rated health conditions and reduces the frequency of health problems affecting people's work and life. At the same time, all of above health factors significantly influence subjective wellbeing. When these health variables are included in regressions, the correlation between exercise participation and happiness declines. This confirms that physical activity helps to improve happiness by enhancing mental and overall health conditions. In addition, results show that physical activities are more prominently related to happiness for male, older and unmarried individuals and those living in rural areas, lacking social security and with higher levels of depression as well as lower socioeconomic status. Furthermore, a series of robustness checks are carried out and exercise participation's positive role in improving happiness is further confirmed using different happiness measures and instrumental variables, various IV models, as well as penalized machine learning methods and placebo tests. With the increasing emphasis of improving happiness as an important goal in the global public health policy, findings of this paper have important policy implications for enhancing subjective wellbeing.

Have COVID-19-Related Economic Shocks Affected the Health Levels of Individuals in the United States and the United Kingdom?

This paper introduces a health index for measuring the health level of societies during the lockdown era, i. e., for the period from March 21, 2020 to April 7, 2020. For this purpose, individual-level survey data from the Global Behaviors and Perceptions in the COVID-19 Pandemic dataset are considered. We focus on cases in the United States and the United Kingdom, and the data come from 11,270 and 11,459 respondents, respectively. We then use unit root tests with structural breaks to examine whether COVID-19-related economic shocks significantly affect the health levels of the United States and the United Kingdom. The empirical results indicate that the health levels in the United States and the United Kingdom are not significantly affected by the COVID-19-related economic shocks. The evidence shows that government directives (such as lockdowns) did not significantly change the health levels of these societies.