Targeting Physical Inactivity - Effects of Three Different Consequence Frames on Population Subgroups' Health-Related Perceptions and Behavioral Intentions.

Physical inactivity constitutes a major health problem in many Western societies affecting a variety of social groups. As these groups often differ in responsivity to physical inactivity messages, the strategy of message targeting, i.e. the customization of messages toward shared characteristics of a social group provides a useful framework for designing effective communication. Whereas focusing on health consequences of physical inactivity might prove useful for some social groups, it might be more effective to emphasize its social or financial consequences for others. The current examination compares the effects of three types of consequence framing (health consequences vs. social consequences vs. financial consequences of physical inactivity) on health-related perceptions and intentions for different population subgroups. An experiment with a one-factorial between subjects design based on a quota sample was conducted. 348 respondents differing in terms of age, sex, and formal education were randomly assigned to one of the three experimental conditions and read an accordingly manipulated newspaper article. Findings show that financial and social consequence frames were more effective than health consequence frames. Both frames positively influenced behavioral intentions through perceptions of susceptibility. These effects were largely independent of sociodemographic variables, although sex and education emerged as moderators in some cases.

Health Care Seeking Behavior in a Scheduled Tribe Community in India: A Mixed Methods Research Using the Framework of Andersen's Behavioral Model.

India's scheduled tribe population very often bears the brunt of inequity in accessing health care. The mixed-method research assessed the health care seeking behavior (HSB) of a tribal community residing in the eastern fringes of Kolkata metropolis. An adult, preferably the head, in 209 households was interviewed followed by qualitative interviews with relevant stakeholders. Conceptual framework of Andersen's behavioral model helped in identifying the potential predisposing, enabling, and need factors that influenced HSB. A total of 25.4% respondents reportedly sought informal care during last illness episode. Multivariable hierarchical-regression model (Nagelkerke R2 = 0.381) showed that respondents' education level [adjusted odds ratio (AOR) = 2.52], household size (AOR = 3.14), nonenrollment to health insurance (AOR = 2.47), decision making by household head (AOR = 2.40), distance from the nearest urban primary health center (AOR = 3.18), and poor perception to illness severity (AOR = 2.24) were significantly associated to inappropriate HSB. Predominant health system barriers that emerged from qualitative interviews were irregular logistics, unfavorable outpatient timing, absence of female doctors, and nonretention of doctors at local urban primary health center. Community level barriers were poor awareness, self-medication practices, poor health insurance coverage, and poor public transportation. Recognition of these determinants may help in developing health promotion interventions tailored to their needs.

Levels of Severity of Depressive Symptoms Among At-Risk Groups in the UK During the COVID-19 Pandemic.

Importance: An immediate research priority is to investigate and monitor the psychological well-being among high-risk groups during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To examine levels of severity of depressive symptoms over time among individuals with high risk in the UK during the COVID-19 pandemic. Design, Setting, and Participants: This cohort study is part of an ongoing large panel study of adults aged 18 years and older residing in the UK, the COVID-19 Social Study, established on March 21, 2020. Data analysis was conducted in May 2020. Exposures: Sociodemographic risk factors included belonging to the Black, Asian, and minority racial/ethnic communities, low socioeconomic position (SEP), and essential worker roles (eg, workers in health and social care, education, childcare, or key public services). Health-related and psychosocial risk factors included preexisting physical and mental health conditions, experience of psychological or physical abuse, and low social support. Main Outcomes and Measures: Depressive symptoms were measured on 7 occasions from March 21 to April 2, 2020, using the 9-item Patient Health Questionnaire (PHQ-9). Group-based depressive symptom trajectories were derived using latent growth mixture modeling. Results: The analytical sample comprised 51 417 adults aged 18 years and older (mean [SD] age, 48.8 [16.8] years; 26 276 [51.1%] women; 6145 members [12.0%] of Black, Asian, and minority racial/ethnic communities). Among these, 17 143 participants (33.3%) were in the lowest SEP quartile, and 11 342 participants (22.1%) were classified as essential workers. Three levels of severity of depressive symptoms were identified: low (30 850 participants [60.0%]), moderate (14 911 participants [29.0%]), and severe (5656 participants [11.0%]). After adjusting for covariates, experiences of physical or psychological abuse (odds ratio [OR], 13.16; 95% CI, 12.95-13.37; P < .001), preexisting mental health conditions (OR, 12.99; 95% CI, 12.87-13.11; P < .001), preexisting physical health conditions (OR, 3.41; 95% CI, 3.29-3.54; P < .001), low social support (OR, 12.72; 95% CI, 12.57-12.86; P < .001), and low SEP (OR, 5.22; 95% CI, 5.08-5.36; P < .001) were significantly associated with severe depressive symptoms. No significant association was found for race/ethnicity (OR, 1.07; 95% CI, 0.85-1.28; P = .56). Participants with essential worker roles were less likely to experience severe depressive symptoms (OR, 0.66; 95% CI, 0.53-0.80; P < .001). Similar patterns of associations were found for the group of participants with moderate depressive symptoms (abuse: OR, 5.34; 95% CI, 5.15-5.54; P < .001; mental health condition: OR, 4.24; 95% CI, 4.24-4.24; P < .001; physical health condition: OR, 1.89; 95% CI, 1.80-1.98; P < .001; low social support: OR, 4.71; 95% CI, 4.60-4.82; P < .001; low SEP: OR, 1.97; 95% CI, 1.87-2.08; P < .001). Conclusions and Relevance: In this cohort study of UK adults participating in the COVID-19 Social Study, people with psychosocial and health-related risk factors, as well as those with low SEP, were at the most risk of experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.

Chinese- and English-speaking adult current smokers' perspectives on smoking and culturally and linguistically appropriate cessation: a qualitative analysis.

BACKGROUND: A lack of culturally and linguistically appropriate smoking cessation intervention programs exist among Chinese-Canadian communities. Smoking cessation programs that are provided in Canadian mainstream culture and language have shown limited effectiveness in altering smoking behaviours of smokers from these communities. Our study aimed to explore and compare smoking patterns, knowledge, beliefs, and risk perceptions of adult current smokers between Chinese- and English-speaking Canadians participating in a culturally and linguistically tailored smoking cessation program. METHODS AND DESIGN: A qualitative study embedded in an effectiveness study using an 8-month quasi-experimental design, was conducted to compare the effects of four one-on-one culturally and linguistically sensitive consultation sessions (intervention group) and three telephone follow-up assessments (control group). All participants were provided take-home educational materials (designed exclusively for this study), and completed study questionnaires at baseline and 6-month post-intervention. An 8-month post-intervention phone assessment was conducted with all participants to assess cessation progress and maintenance. PARTICIPANTS: 70 Chinese- and English-speaking adult (aged 19-80) current smokers (≥ 5 cigarettes per day) residing in the Greater Vancouver Area, Canada, were recruited between May 2018 and April 2019. DATA ANALYSIS: Thematic analysis was conducted on self-reported qualitative information from study questionnaires and verbatim transcripts of in-person consultations and telephone follow-ups. Cultural- and demographic-related themes were considered. RESULTS: Perceptions of smoking patterns, smoking status, triggers, and barriers to smoking cessation were identified. Important elements of smoking cessation program, including facilitator characteristics, duration, procedures, cultural factors, and topics were also identified. Differences in perceptions of smoking were observed between gender and language groups. Stress was a major trigger for smoking in both language groups. An individual's social network was reported as the largest barrier to successful cessation for Chinese-speaking participants. CONCLUSIONS: Our study provides knowledge and information to further examine the role of risk perception (realization of the possible harms of smoking) in smoking cessation to facilitate the development of future interventions that could more effectively promote smoking cessation among new immigrants and within ethnocultural communities. We found that our program was generally accepted by smokers in both language groups and the participants reported that they were able to apply the strategies learned in the intervention during their quit smoking plan.

Prevalence, risk factors and health seeking behaviour of pulmonary tuberculosis in four tribal dominated districts of Odisha: Comparison with studies in other regions of India.

AIM: To determine the prevalence of pulmonary tuberculosis, socio-cultural practices and health seeking behaviour of tribal people in four districts of Odisha. METHODOLOGY: This was an action research study with qualitative and quantitative design following a sequential approach implemented in a 4-phased manner. It was carried out in the 6 selected villages from July,2015 to June,2017. The screening for active TB among chest symptomatics is followed as per the guidelines of the (RNTCP) Revised National Tuberculosis Control Program in India. RESULTS: In all, 1455 households were surveyed in the 6 tribal dominated villages of 4 districts, namely Balangir, Dhenkanal, Kandhamal and Mayurbhanj. Total population of the villages was 6681. Based on the eligibility, 5144 (97.7%) individuals were screened. About 139 (2.3%) could not be screened due to non-availability in their households during day time. Out of the screened individuals (5144), 126 chest symptomatics were identified. Sputum samples were collected from them and sent to the National Reference Laboratory, RMRC, Bhubaneswar using public transport and maintaining cold chain. Out of 126 chest symptomatics, 35 patients were found to be having active TB disease and 18 were culture positive. The prevalence of pulmonary TB is 0.68%. The risk factors seemed to be ignorance about TB symptoms, addiction to alcoholic drinks, difficulty reaching the health facilities owing to the long distances, lack of communication and transport. In addition, other morbidities like Malaria, diabetes, hypertension, malnutrition, etc. were observed in the tribes of the study sites. CONCLUSION: TB control programs need further strengthening in the tribal dominated regions. This study is the first of its kind in this State.

Using the intervention ladder to examine policy influencer and general public support for potential tobacco control policies in Alberta and Quebec. / Utilisation d'une échelle d'intervention pour analyser le soutien à d'éventuelles politiques de lutte contre le tabagisme de la part du grand public et d'influenceurs en matière de politiques en Alberta et au Québec.

OBJECTIVE: To assess general public and policy influencer support for population-level tobacco control policies in two Canadian provinces. METHODS: We implemented the Chronic Disease Prevention Survey in 2016 to a census sample of policy influencers (n = 302) and a random sample of members of the public (n = 2400) in Alberta and Quebec, Canada. Survey respondents ranked their support for tobacco control policy options using a Likert-style scale, with aggregate responses presented as net favourable percentages. Levels of support were further analyzed by coding each policy option using the Nuffield Council on Bioethics intervention ladder framework, to assess its level of intrusiveness on personal autonomy. RESULTS: Policy influencers and the public considered the vast majority of tobacco control policy options as "extremely" or "very" favourable, although policy influencers in Alberta and Quebec differed on over half the policies, with stronger support in Quebec. Policy influencers and the public strongly supported more intrusive tobacco control policy options, despite anticipated effects on personal autonomy (i.e. for policies targeting children/youth and emerging tobacco products like electronic cigarettes). They indicated less support for fiscally based tobacco control policies (i.e. taxation), despite these policies being highly effective. CONCLUSION: Overall, policy influencers and the general public strongly supported more restrictive tobacco control policies. This study further highlights policies where support among both population groups was unanimous (potential "quick wins" for health advocates). It also highlights areas where additional advocacy work is required to communicate the population-health benefit of tobacco control policies.

Stressful Life Events Among New Mothers in Georgia: Variation by Race, Ethnicity and Nativity.

INTRODUCTION: Prior research has identified psychosocial stress as a risk factor for adverse maternal and infant outcomes for non-Hispanic Black and White women. However, whether psychosocial stress differs in its profile and association with preterm birth across diverse racial-ethnic-nativity groups in the Southeast remains unexamined. Both foreign-born and Hispanic women represent important proportions of new mothers in many Southeastern states. The objective of this paper is to describe the prevalence of categories of prenatal life events among Georgia mothers, the variation across race, ethnicity and nativity, and the association of prenatal stress with prevalence of preterm birth. METHODS: We calculated racial-ethnic-nativity specific prevalence of stress categories (emotional/traumatic, financial, or partner-related) with data from the 2012 to 2015 Georgia PRAMS. Maternal race, ethnicity, and nativity were reported on birth certificates. We used logistic regression to examine the association of different categories of stress with preterm birth. We conducted a bias analysis to estimate the potential impact of recall bias on observed associations. RESULTS: The sample was 20.2% foreign born overall, 15.5% non-Hispanic White, 45.7% non-Hispanic Black, 32.3% Hispanic, and 6.5% non-Hispanic other. The prevalence of specific stressors varied by race-ethnicity-nativity. Women who experienced financial stress had a slightly elevated prevalence of preterm birth (prevalence ratio: 1.32 (0.97-1.79)). DISCUSSION: Prenatal and preconception stress were common among women who gave birth between 2012 and 2015 in Georgia and may have implications for preterm and postpartum maternal mental health.

Skewed sex ratios at birth: A review of global trends.

Several cultures in the world traditionally favor the birth of sons over that of daughters. This preference drives various forms of discrimination against female births ultimately reflected in demographic imbalances. Over the last decades, modern reproductive technology has made prenatal diagnosis widely accessible to parents. In certain Asian and Eastern European countries, this has led to skewed sex ratio at birth (SRB) as a result of sex-selective abortions. After reviewing motivations and circumstances associated to prenatal sex selection, our paper analyzes global trends in sex imbalances at birth as well as their parity, regional and socio-economic differentials. We focus our attention on the experience of Azerbaijan, India, and South Korea as instances of three distinct SRB trajectories. Finally, we discuss scenarios concerning the future of these sex imbalances and the implications of a consistent number of "missing women" for affected societies.

"Something Born of the Heart": Culturally Affiliated Illnesses of Older Adults in Oaxaca.

This qualitative research identifies and analyzes emotions and interventions linked to affective experiences and cultural aspects of health/illness/care processes in 219 older adults of eight Indigenous groups in Oaxaca, Mexico. Life stories are examined from perspectives of cultural gerontology, anthropology of emotions and critical medical anthropology with a gender perspective. Significance and healing of two illnesses of cultural affiliation: tiricia (sadness of the soul) and envidia (rancor against the successful) are examined. Conditions other than diabetes and hypertension are healed by traditional remedies or spiritual cleansings. Examining tiricia and envidia permit improved knowledge and understanding of the emotional culture and the community.

Fit for fight - self-reported health in military women: a cross-sectional study.

BACKGROUND: Substantial research has found that women assess their health as poor relative to men, but the reasons for this are not fully understood. Military women are characterised by good health and the ability to work in an archetypically male culture. Thus, studies on the gender pattern of self-reported health in military personnel could generate hypotheses for future research on the possible associations between gender and health. However, such studies are rare and limited to a few countries. The aim of this study was to examine self-reported physical and mental health in Norwegian military women. METHODS: We compared responses on self-reported health of 1068 active duty military women in Norway to those of active duty military men (n = 8100). Further, we compared the military women to civilian women working in the Norwegian Armed Forces (n = 1081). Participants were stratified into three age groups: 20-29; 30-39; and 40-60 years. We used Pearson Chi-square tests, Students t-tests and regression models to assess differences between the groups. RESULTS: The military women in our study reported physical illness and injuries equal to those of military men, but more military women used pain relieving and psychotropic drugs. More military women aged 20-29 and 30-39 years reported mental health issues than military men of the same age. In the age group 30-39 years, twice as many military women assessed their health as poor compared to military men. In the age group 40-60 years, more military women than men reported musculoskeletal pain. Military women used less smokeless tobacco than military men, but there were few differences in alcohol consumption and smoking. Military women appeared to be more physically healthy than civilian women, but we found few differences in mental health between these two groups. CONCLUSION: Most military women reported physical symptoms equal to those of military men, but there were differences between the genders in mental health and drug use. More favourable health compared to civilian women was most evident in the youngest age group and did not apply to mental health.

"Our fear is finished," but nothing changes: efforts of marginalized women to foment state accountability for maternal health care in a context of low state capacity.

BACKGROUND: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. METHODS: The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. RESULTS: The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG's efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. CONCLUSION: Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition.

O ritual no âmbito do lazer de uma prova de meia maratona / The leisure ritual of a half marathon event

Neste estudo o problema investigado diz respeito às corridas de rua, em que os rituais demonstram a riqueza das formas de modus operandi dos vários participantes e grupos, que com objetivos distintos participam de provas de rua como, por exemplo, a meia maratona. Os objetivos foram identificar e analisar os significados e aspectos ritualísticos produzidos pelos corredores durante a participação em uma prova de meia maratona. A corrida de rua tem sido uma das atividades do contexto do lazer de pessoas de diferentes faixas etárias, condição de vida e de gênero. Para alguns, o lazer é um elemento da cultura não levado muito a sério diante de atividades que envolvem as obrigações sociais como o trabalho. No entanto, a partir do lazer podemos identificar particularidades de um grupo ou sociedade. A natureza da pesquisa é qualitativa. Foi realizada revisão de literatura, debate dos textos selecionados entre os investigadores e pesquisa de campo. Uma das pesquisadoras correu a prova de meia maratona e utilizou a técnica de observação participante. A partir das observações realizadas e analisadas identificou-se valores e aspectos constituintes das ações dos corredores: a competição, a honra em defesa da masculinidade e a interação social. Também foi possível observar que na corrida há grupos com interesses diversos e que o componente lúdico estava presente nas manifestações dos corredores observados, talvez pelo fator da corrida nesse caso ser uma ação realizada não como forma de obrigação.

In this study, the problem investigated refers to the street races, in which the rituals demonstrate the richness of the modus operandi of the various participants and groups, for different reasons, participating in street events such as the half marathon. The objectives of this work were to identify and analyse the meanings and ritualistic aspects produced by the runners during the participation in a half marathon event. Street racing has been one of the activities of the leisure context for people of different age groups, living conditions and gender. For some, leisure is an element of culture not taken very seriously in the face of activities involving social obligations, such as work. However, based on leisure studies, we can identify particularities of a group or society. The nature of this research is qualitative. Literature review, discussion of selected texts among researchers and field research were carried out. One of the researchers ran the half marathon race and used the participant observation technique. From the observations made and analysed, values and constituent aspects of runners actions were identified: competition, honour in defence of masculinity and social interaction. It was also possible to observe that in the race there are groups with different interests and that the play component was present in the manifestations of the observed runners, perhaps because the race in this case is an action performed not as a form of obligation.

Mental health issues among indigenous communities and the role of traditional medicine.

INTRODUCTION: Mental health in indigenous communities is a relevant issue for the World Health Organization (WHO). These communities are supposed to live in a pure, clean and intact environment. Their real condition is far different from the imaginary; they are vulnerable populations living in difficult areas, exposed to pollution, located far from the health services, exposed to several market operations conducted to extract natural resources, facing criminal groups or illegal exploitation of land resources. These factors may have an impact on mental health of indigenous population. METHODS: We reviewed all papers available on PubMed, EMBASE and The Cochrane Library until December 2018. We focused on those factors affecting the changes from a traditional to a post-modern society and reviewed data available on stress-related issues, mental distress affecting indigenous/aboriginal communities and the role of Traditional Medicine (TM). We reviewed articles from different countries hosting indigenous communities. RESULTS: The incidence of mental distress and related phenomena (e.g. collective suicide, alcoholism and violence) among indigenous populations is affected by political and socio-economic variables. The mental health of these populations is poorly studied and described even if mental illness indicators are somewhat alarming. TM still seems to have a role in supporting affected people and may reduce deficiencies due to poor access to medical insurance/coverage, psychiatry and psychotherapy. It would be helpful to combine TM and modern medicine in a healthcare model to face indigenous populations' health needs. CONCLUSION: This review confirms the impact of societal changes, environmental threats and exploitation of natural resources on the mental health of indigenous populations. Global Mental Health needs to deal with the health needs of indigenous populations as well as psychiatry needs to develop new categories to describe psychopathology related to social variance as recently proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5).

Ecological Momentary Assessment of the Breakfast, Lunch, and Dinner Family Meal Environment in Racially/Ethnically Diverse and Immigrant Households.

OBJECTIVE: To describe meal characteristics across breakfast, lunch, and dinner family meals in racially/ethnically diverse and immigrant/refugee households via ecological momentary assessment; identify real-time meal characteristics associated with family meal frequency; and identify qualitative themes regarding parents' perspectives about meal characteristics and meal types that influence family meal frequency. DESIGN: Cross-sectional study. SETTING: In-home visits. PARTICIPANTS: Children aged 5-7 years (n = 150) and their families from diverse and low-income households. MAIN OUTCOME MEASURE(S): Mixed methods. ANALYSIS: Multiple linear regression and hybrid deductive and inductive content analysis. RESULTS: Quantitative results indicated several similar meal characteristics occurring across weekdays and weekend days and by meal type (eg, parent prepared the meal, food mostly homemade, meal eaten at table) and some significant negative associations (P < .05) between meal characteristics and family meal frequency (eg, fast food for family meals). Eight main qualitative themes with several subthemes supported and expanded the quantitative findings and added depth to interpretation of the findings. CONCLUSIONS AND IMPLICATIONS: Results identified specific meal characteristics both quantitatively and qualitatively that may inform the development of interventions to increase the frequency of family meals so that more families can benefit from the protective nature of family meals.