Ecological momentary assessment of digital food and beverage marketing exposure and impact in young adults: A feasibility study.

Unhealthy food marketing is contributing to the obesity epidemic, but real-time insights into the mechanisms of this relationship are under-studied. Digital marketing is growing and following food and beverage (F&B) brands on social media is common, but measurement of exposure and impact of such marketing presents novel challenges. Thus, this study aimed to evaluate the feasibility of collecting data on exposure and impact of digital F&B marketing (DFM) using a smartphone-based ecological momentary assessment (EMA) methodology. We hypothesized that DFM-induced food cravings would vary based on whether (or not) participants engaged with F&B brands online. Participants were Singapore residents (n = 95, 21-40 years), recruited via telephone from an existing cohort. Participants were asked to upload screenshots of all sightings of online F&B marketing messages for seven days, and answer in-app contextual questions about sightings including whether any cravings were induced. Participants provided a total of 1310 uploads (median 9 per participant, Q1-Q3: 4-21) of F&B marketing messages, 27% of which were provided on Day 1, significantly more than on other days (P < 0.001). Followers of food/beverage brands on social media encountered 25.6 percentage points (95% CI 11.4, 39.7) more marketing messages that induced cravings than participants who were not followers. University education was also associated with more (18.1 percentage points; 95% CI 3.1, 33.1) encounters with marketing messages that induced cravings. It was practical and acceptable to participants to gather insights into digital F&B marketing exposure and impact using EMA in young adults, although a shorter study period is recommended in future studies. Followers of food and beverage brands on social media appear to be more prone to experience cravings after exposure to digital F&B marketing.

The Singaporean foodscape - Convenience, choice, entertainment, and sociality for young workers.

Singapore is famous for its diverse, affordable, and exciting foodscape. This paper focuses on understanding the multifaceted role that the Singaporean food environment plays in working young adults' lives, and how young adults interact with this environment to make food choices. Using a focused ethnographic approach, including 33 semi-structured interviews and participant-observation, we explore the ways in which busy working young adults interact with the foodscape. The food environment provides young adults, who eat out frequently, with highly accessible food options that cater to their budgets and palates. They often dine at hawker centres and similar food establishments with colleagues, friends and family. These establishments offer accessible, affordable, and appealing food. Overall, the foodscape provides a source of popular entertainment through the exploration of diverse cuisines and novel shared social experiences. Young adults are heavy users of social media to maintain social networks and to explore the food environment. Capitalizing on this, food marketing on social media targets this group with the promotion of food-related experiences. While it may not always promote healthy eating, the Singaporean foodscape offers convenience, choice, entertainment, and sociality. In the process, it facilitates the formation of cultural and national identity and the protection of mental well-being through the maintenance and development of relationships, and a sense of belonging.

"You know what, I'm in the trend as well" - Understanding the inter-play between digital and real-life social influences on the food and activity choices of young adults.

OBJECTIVE: To understand young adults' perceptions of online and real-life social influences on their food and activity choices. DESIGN: A qualitative study involving seven focus groups. Thematic analyses using both deductive and inductive techniques were performed. SETTING: A polytechnic and a university in Singapore. PARTICIPANTS: A total of 46 full-time students, 19-24 years of age. RESULTS: Participants revealed that social media meets multiple needs, contributing to its ubiquitous use and facilitating content spread between social networks. Food-related content shared on social media were mostly commercial posts, marketing foods and eateries showcasing price-promotions, emphasizing sensory properties of foods, or creating narratives that activated trends. Subsequently, real-life social activities frequently revolve around marketed foods that were not necessarily healthy. In contrast, physical activity posts were rarely being followed up in real life. Portrayals describing a toxic gym culture could contribute to negative perceptions of peers' physical activity posts and a disinclination towards sharing such posts. Participants expressed that close, supportive social networks in real-life strongly influenced initiating and maintaining healthy lifestyles. However, in a society that highly values academic achievements, participants prioritized studying and socializing over healthy eating and physical activity. CONCLUSIONS: Overall, our findings reveal that virtual and real-life social influences have complex interactions affecting Asian young adults' behavioral choices and should be considered when designing interventions for this group. Regulations related to the digital marketing of unhealthy food, and improving the availability, accessibility, and affordability of healthier food options, particularly in the foodservice sector, would be of value to consider.

Understanding children's perspectives of the influences on their dietary behaviours.

OBJECTIVE: This study aimed to examine the intrapersonal, interpersonal, environmental and macrosystem influences on dietary behaviours among primary school children in Singapore. DESIGN: A qualitative interpretive approach was used in this study. Focus group discussions guided by the socio-ecological model (sem), of which transcripts were analysed deductively using the sem and inductively using thematic analysis to identify themes at each sem level. SETTING: Two co-educational public primary schools in Singapore. PARTICIPANTS: A total of 48 children (n 26 girls) took part in the semi-structured focus group discussions. Their mean age was 10·8 years (sd = 0·9, range 9-12 years), and the majority of the children were Chinese (n 36), along with some Indians (n 8) and Malays (n 4). RESULTS: Children's knowledge of healthy eating did not necessarily translate into healthy dietary practices and concern for health was a low priority. Instead, food and taste preferences were pivotal influences in their food choices. Parents had a large influence on children with regards to their accessibility to food, their attitudes and values towards food. Parental food restriction led to some children eating in secrecy. Peer influence was not frequently reported by children. Competitions in school incentivised children to consume fruits and vegetables, but reinforcements from teachers were inconsistent. The proximity of fast-food chains in the neighbourhood provided children easy access to less healthy foods. Health advertisements on social media rather than posters worked better in drawing children's attention. CONCLUSIONS: Findings highlighted important factors that should be considered in future nutrition interventions targeting children.

Diet Quality and Lower Refined Grain Consumption are Associated With Less Weight Gain in a Multi-Ethnic Asian Adult Population.

BACKGROUND: The prevalence of obesity is increasing in many Asian countries. However, longitudinal data on the impacts of dietary factors on weight gain in Asian populations are sparse. OBJECTIVES: We evaluated the relationship between changes in intakes of nutrients, foods, and beverages and diet quality and long-term changes in body weight. METHODS: We used data (n = 3064) from the Singapore Multi-Ethnic Cohort, a prospective cohort including Chinese, Indian, and Malay residents aged 21-65 years. Dietary intakes were assessed using an FFQ, and body weight and waist circumference were measured during health examinations. Diet quality was evaluated using the Dietary Approaches to Stop Hypertension (DASH) and Alternative Healthy Eating Index (AHEI-2010) scores. Data were collected at baseline (2004-2010) and follow-up (2011-2016), with a mean follow-up of 6.0 years. Linear regression was used to assess the associations between dietary changes and weight change, adjusted for socio-demographic and lifestyle variables. RESULTS: Improvements in dietary quality scores (DASH, -0.34 kg per 5 points; AHEI-2010, -0.35 kg per 10 points) and replacement of carbohydrates with protein (-0.44 kg per 5% of energy) were significantly associated with less weight gain. Increased intakes of white rice (+0.25 kg per serving/d), soft drinks (+0.69 kg), red meat (+0.58 kg), and poultry with skin (+0.74 kg) were directly associated with weight gain. The replacement of 1 serving per day of white rice with whole grains (-0.68 kg), vegetables (-0.33 kg), poultry without skin (-0.79 kg), and eggs (-0.87 kg) was associated with less weight gain. Similar associations were observed between changes in dietary factors and changes in waist circumference. CONCLUSIONS: Among Asian adults, increasing dietary quality, reducing soft drink consumption, and replacing white rice with whole grains, vegetables, and selected high-protein foods was associated with less weight gain.

Making novel staple foods the norm: perspectives from adult consumers with and without diabetes.

Novel staple foods are staple foods that are modified with the purpose of improving their nutritional properties. However, consumers' acceptance towards novel staple foods remains to be evaluated, especially in Asian populations where staple foods like white rice are a major source of energy. The objective of this study was to explore consumers' attitudes and perceptions towards novel staple foods in a multi-ethnic Asian population. We conducted 11 focus group discussions, with 37 healthy participants and 22 participants with diabetes recruited through newspaper, email and poster advertisement and in-person recruitment at a clinic. Thematic analysis using the general inductive approach was performed. We found that participants' conceptual understanding of the modification process affected their acceptance towards novel staple foods. Plant-based modifications were considered natural and acceptable while genetic modification and use of chemicals were unnatural and undesirable. Participants expected novel staple foods to be more expensive and less tasty and this was largely due to their perceptions and experiences with healthy eating. Participants with diabetes or family history of diabetes were generally more willing to compromise taste and cost for healthier staple foods, and this appeared to be driven by concerns about diabetes and its related co-morbidities. The appearance of food was an important influence on participants' initial impression of the food, which appeared to be mediated by taste expectations. Participants' trust of novel staple foods was largely influenced by their trust in food industry, governmental authorities and nutrition science that was mediated through pathways of information and food safety.

Identifying implementation gaps and priorities for the Singapore government to improve food environment policies: perspectives from a local expert panel.

OBJECTIVE: Singapore, an urbanised, developed nation, with a high reliance on food importation and a high prevalence of eating out is facing rising rates of obesity and diabetes. The objective of the current study was to characterise and evaluate the Singapore government's policies to improve the food environment and to identify and prioritise concrete actions. DESIGN: The Healthy Food Environment Policy Index tool and process were used. An expert panel rated the Singapore government's implementation of forty-seven indicators compared with international best practice in 2018. Indicators were prioritised, and specific recommendations were proposed by panel. SETTING: Singapore. PARTICIPANTS: Twenty experts primarily from academia. RESULTS: As compared with international benchmarks, the level of implementation of most indicators (thirty-three indicators, 70 %) by the Singapore government was evaluated as being at least moderate. Highly rated indicators included those related to provision of healthier meals at school, supporting the use of healthier ingredients by food vendors and governmental leadership. More policy indicators (6, 26 %) as compared with infrastructure support indicators (2, 8 %) received a 'very little or no implementation' rating. After rating, the experts prioritised eleven indicators and proposed thirty-one actions informed by several considerations including those of effectiveness, political acceptability, feasibility and unique characteristics of food retail in Singapore. CONCLUSIONS: Supported by documented evidence, an independent expert panel identified areas of strengths and provided specific recommendations to meaningfully improve the Singapore food environment to facilitate healthier eating. Fundamental recommendations including improving nutrition profiling and strengthening monitoring systems have the potential to positively influence environments across policy domains.

A Healthy Asian A Posteriori Dietary Pattern Correlates with A Priori Dietary Patterns and Is Associated with Cardiovascular Disease Risk Factors in a Multiethnic Asian Population.

Background: Healthful dietary patterns are associated with cardiovascular disease risk factors in Western populations. However, a consistent healthful dietary pattern across major Asian ethnic groups has yet to be identified. Objective: We aimed to identify a posteriori dietary patterns for Chinese, Malay, and Indian ethnic groups in an urban Asian setting, compare these with a priori dietary patterns, and ascertain associations with cardiovascular disease risk factors including hypertension, obesity, and abnormal blood lipid concentrations. Methods: We used cross-sectional data from 8433 Singapore residents (aged 21-94 y) from the Multi-Ethnic Cohort study of Chinese, Malay, and Indian ethnicity. Food consumption was assessed using a validated 169-item food-frequency questionnaire. With the use of 28 food groups, dietary patterns were derived by principal component analysis, and their association with cardiovascular disease risk factors was assessed using multiple linear regression. Associations between derived patterns and a priori patterns (aHEI-2010-Alternative Healthy Eating Index-2010, aMED-alternate Mediterranean Diet, and DASH-Dietary Approaches to Stop Hypertension) were assessed, and the magnitude of associations with risk factors compared. Results: We identified a "healthy" dietary pattern, similar across ethnic groups, and characterized by high intakes of whole grains, fruit, dairy, vegetables, and unsaturated cooking oil and low intakes of Western fast foods, sugar-sweetened beverages, poultry, processed meat, and flavored rice. This "healthy" pattern was inversely associated with body mass index (BMI; in kg/m2) (-0.26 per 1 SD of the pattern score; 95% CI: -0.36, -0.16), waist circumference (-0.57 cm; 95% CI: -0.82, -0.32), total cholesterol (-0.070 mmol/L; 95% CI: -0.091, -0.048), LDL cholesterol (-0.054 mmol/L; 95% CI: -0.074, -0.035), and fasting triglycerides (-0.22 mmol/L; 95% CI: -0.04, -0.004) and directly associated with HDL cholesterol (0.013 mmol/L; 95% CI: 0.006, 0.021). Generally, "healthy" pattern associations were at least as strong as a priori pattern associations with cardiovascular disease risk factors. Conclusion: A healthful dietary pattern that correlated well with a priori patterns and was associated with lower BMI, serum LDL cholesterol, total cholesterol, and fasting triglyceride concentrations was identified across 3 major Asian ethnic groups.

Impact of tax and subsidy framed messages on high- and lower-sugar beverages sold in vending machines: a randomized crossover trial.

OBJECTIVE: Framing of fiscal incentives has been suggested to be important in influencing purchase decisions. We aimed to examine the effect of framing a modest price difference between high- and lower-sugar beverages as a tax or a subsidy respectively, using messages placed on vending machines to influence beverage purchases. DESIGN/SETTING: This is an 11-week randomized crossover trial conducted between August and November 2015, with a two-week run-in period before intervention, targeted at students, staff and faculty of a university campus in Singapore. Twenty-one beverage vending machines were used to implement the intervention involving 'tax message', 'subsidy message' and 'no message (control)'. The former two messages suggest 'a tax for high sugar beverages' or 'a subsidy for lower sugar beverages' respectively. Prices of the beverages offered were fixed at baseline and remained the same in all three experimental conditions: lower-sugar beverage options were priced ~ 10% lower than the corresponding high-sugar option. The machines were randomized to one of the 6 sequences of intervention. Each message intervention period was 3 weeks. The effect of messages was assessed by comparing average weekly units of beverages sold between interventions using mixed effects model. RESULTS: The average weekly units of high and lower-sugar beverages sold per vending machine were 115 and 98 respectively in the control condition. The percentage of high-sugar beverages sold was 54% in the control, 53% in the tax, and 54% in the subsidy message condition. There was no difference in the weekly units of high-sugar beverages sold for the tax message (- 2, 95% CI -8 to 5, p = 0.61) or the subsidy message (0, 95% CI -10 to 10, p = 0.96) conditions as compared with the control condition. Similarly, there was no difference in the weekly units of lower-sugar beverages sold for the tax message (4, 95% CI -4 to 13, p = 0.32) or the subsidy message (7, 95% CI -4 to 18, p = 0.18) conditions as compared with the control condition. CONCLUSIONS: The use of tax and subsidy messages to highlight modest price differences did not substantially reduce high-sugar beverage sales in vending machines on an Asian university campus.

Relative validity and reproducibility of dietary quality scores from a short diet screener in a multi-ethnic Asian population.

OBJECTIVE: Short screeners for assessing dietary quality are lacking in Asia. We recently developed a short thirty-seven-item diet screener (DS). The present study aimed to evaluate reproducibility and relative validity of the DS in assessing a priori dietary quality indices (DQI; i.e. the Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet (aMed) and Dietary Approaches to Stop Hypertension (DASH) diet) and intakes of selected foods. DESIGN: DS administration and biomarker measurement took place twice within a 4-month interval. A 163-item FFQ was administered one month after the second DS administration. SETTING: Singapore, a multi-ethnic urban Asian country. SUBJECTS: Singapore residents (n 161) aged 18-79 years, of Chinese, Malay and Indian ethnicity. RESULTS: Reproducibility coefficients for the two DS were 0·71 (DQI) and 0·65 (food groups). Correlations (ρ) between mean DS and FFQ DQI scores were 0·51 (AHEI-2010), 0·50 (aMed) and 0·61 (DASH; all P<0·05). Cohen's weighted kappa indicated moderate agreement between the two measures (κ w=0·48-0·58). DS DQI scores were associated with concentrations of ß-cryptoxanthin (AHEI-2010, ρ=0·26; P<0·05), odd-chain SFA (aMed, ρ=0·24; DASH, ρ=0·25; both P<0·05), and enterolactone, total carotenoids, PUFA and α-linolenic acid (all scores, ρ=0·17-0·30; all P<0·05). Scores were not associated with isoflavone or long-chain n-3 PUFA concentrations. CONCLUSIONS: A short screener can be used to assess DQI with good reproducibility and relative validity compared with a longer FFQ in an Asian population.

Determinants of eating at local and western fast-food venues in an urban Asian population: a mixed methods approach.

BACKGROUND: Like several Southeast Asian countries, Singapore has a complex eating-out environment and a rising eating-out prevalence. However the determinants and drivers of eating-out in urban Asian environments are poorly understood. METHODS: We examined the socio-demographic characteristics of persons who frequently ate away from home in local eateries called hawker centres and Western fast-food restaurants, using data from 1647 Singaporean adults participating in the National Nutrition Survey (NNS) 2010. We also assessed the underlying drivers of eating out and evaluated if these were different for eating at local eateries compared to Western fast-food restaurants using 18 focus group discussions of women (130 women). RESULTS: Participants reported a high eating-out frequency with 77.3% usually eating either breakfast, lunch or dinner at eateries. Main venues for eating-out included hawker centres (61.1% usually ate at least 1 of 3 daily meals at this venue) and school/workplace canteens (20.4%). A minority of participants (1.9%) reported usually eating at Western fast-food restaurants. Younger participants and those of Chinese and Malay ethnicity compared to Indians were more likely to eat at Western fast-food restaurants. Chinese and employed persons were more likely to eat at hawker centres. The ready availability of a large variety of affordable and appealing foods appeared to be a primary driver of eating out, particularly at hawker centres. CONCLUSIONS: Our findings highlight the growing importance of eating-out in an urban Asian population where local eating venues play a more dominant role compared with Western fast-food chains. Interventions focusing on improving the food quality at venues for eating out are important to improve the diet of urban Asian populations.

Rice and noodle consumption is associated with insulin resistance and hyperglycaemia in an Asian population.

High consumption of refined grains, particularly white rice, has been reported to be associated with a higher risk of type 2 diabetes. Therefore, in the present study, we evaluated the association between rice and noodle consumption and markers of glucose homeostasis, inflammation and dyslipidaemia in an Asian population. We carried out a population-based cross-sectional study in 2728 Singaporean Chinese men and women aged between 24 and 92 years. Rice and noodle intake was assessed using a validated FFQ and studied in relation to glycaemic (fasting glucose, glycated Hb, homeostasis model assessment (HOMA) index for insulin resistance (HOMA-IR) and HOMA index for ß-cell function (HOMA-ß)), inflammatory (plasma adiponectin and C-reactive protein (CRP)) and lipid (fasting TAG and HDL-cholesterol (HDL-C)) markers. We used multiple linear regression analyses with adjustment for total energy intake and sociodemographic, anthropometric (BMI and waist:hip ratio) and lifestyle factors. Higher rice consumption was found to be associated with higher fasting glucose concentrations (0·81 % higher values per portion increment; 95 % CI 0·09, 1·54) and HOMA-IR (4·62 %; 95 % CI 1·29, 8·07). Higher noodle consumption was also found to be significantly associated with higher fasting glucose concentrations (1·67 %; 95 % CI 0·44, 2·92), HOMA-IR (6·17 %; 95 % CI 0·49, 12·16) and fasting TAG concentrations (9·17 %; 95 % CI 3·44, 15·22). No significant association was observed between rice and noodle consumption and adiponectin, CRP and HDL-C concentrations or HOMA-ß in the fully adjusted model. These results suggest that high consumption of rice and noodles may contribute to hyperglycaemia through greater insulin resistance and that this relationship is independent of adiposity and systemic inflammation.

Working young adults' engagement with public and workplace health promotion efforts in Singapore: A qualitative study.

Young adults entering the workforce are at increased risk of becoming overweight or obese. Yet, internationally, young adults are rarely targeted in health campaigns, and little is known on how to improve their interest and participation in health promotion efforts. Through 33 semi-structured interviews with young adults working in Singapore, we explored their engagement with existing public and workplace health promotion efforts that encouraged healthy eating and increased physical activity, and their subjective health in the context of their daily lives. Interviews were coded and thematically analysed, taking an inductive and deductive approach. Despite some interest in health messaging, participating working young adults rarely adopted health-promoting activities such as meeting daily recommended servings of fruits and vegetables and exercising regularly. Participants reported that the health promotion campaigns they were aware of, suggested actions that they couldn't incorporate in their lives as they did not address the barriers that they are facing from socio-environmental contributors such as long working hours, personal and social commitments, and the food environment. Furthermore, some considered their health to be good enough and therefore had little reason to change existing practices. Affordable and accessible health screenings were an objective way for young adults to re-evaluate their perceptions of their own health which motivated some to favourably change their behaviours. Our findings suggest that future health promotion campaigns would benefit from more fully addressing some of the existing barriers that young working adults face, in tandem with policy changes to directly tackle the socio-environmental conditions for young workers.

Corrigendum: Hard work, long hours, and Singaporean young adults' health-A qualitative study.

[This corrects the article DOI: 10.3389/fpubh.2023.1082581.].

Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study.

BACKGROUND: Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. OBJECTIVE: This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. METHODS: University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. RESULTS: Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%). CONCLUSIONS: The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56749.

Coffee consumption and cardiovascular health: getting to the heart of the matter.

As coffee-consumption is a widespread tradition, its possible impact on health has been of considerable interest. This review examines the effects of coffee on cardiovascular risk, outlines underlying biological mechanisms, and discusses implications for public health. In the past, coffee was often viewed as a cardiovascular risk-factor. However, in meta-analyses of recent well-controlled prospective epidemiologic studies, coffee-consumption was not associated with risk of coronary heart disease and weakly associated with a lower risk of stroke and heart failure. Also, available evidence largely suggests that coffee-consumption is not associated with a higher risk of fatal cardiovascular events. In randomized trials coffee-consumption resulted in small increases in blood pressure. Unfiltered coffee increased circulating LDL cholesterol and triglycerides concentrations, but filtered coffee had no substantial effects on blood lipids. In summary, for most healthy people, moderate coffee consumption is unlikely to adversely affect cardiovascular health. Future work should prioritize understanding the effects of coffee in at-risk populations.

Hard work, long hours, and Singaporean young adults' health-A qualitative study.

Background: As young adults in their 20s to 30s transitioning toward new careers and independence, their dietary and physical activity practices often change, increasing their risk of weight gain. This study explored the ways that Singaporean young adults perceived and experienced the interaction between their working hours, work, and health practices. Methods: This research used semi-structured interviews to explore the perspectives and experiences of participants. Purposive and snowball sampling was used to recruit 15 men and 18 women, aged 23 to 36, who had worked full-time at their respective jobs in Singapore for at least 1 year. An inductive and deductive thematic analysis approach was employed. Results: Young working adults' commitment to work was driven by a hard-working culture, a desire to attain better jobs and remuneration, and to fulfill cultural expectations to support their multi-generation families. Their non-work time was largely spent recuperating from work by socializing over food and in sedentary activities. Conclusion: For young working adults, long work hours are normalized, even though they are a barrier to healthy diets and physical activity. Existing social and institutional norms support a culture that values commitment to work and encourages young adults to devote long hours to building a sound financial future and achieving personal and cultural aspirations. These findings have implications for long-term population health and should be considered in health promotion activities targeting young adults and barriers.

Advancing understanding of dietary and movement behaviours in an Asian population through real-time monitoring: Protocol of the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA).

Background: Modifiable risk factors for non-communicable diseases, including eating an unhealthy diet and being physically inactive, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real life is essential to enable the design of precision public health interventions. Objective: This paper describes the protocol for the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). The study uses real-time data capture methods to gain a comprehensive understanding of eating and movement behaviours, including how these differ by socio-demographic characteristics and are shaped by people's interaction with their social and physical environment. Methods: COBRA is an observational study in free-living conditions. We will recruit 1500 adults aged 21-69 years from a large prospective cohort study. Real-time data capture methods will be used for nine consecutive days: an ecological momentary assessment app with a global positioning system enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA surveys per day between 8 a.m. and 9.30 p.m. to capture information on behavioural risk factors including eating behaviours and diet composition movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. The second wave of ecological momentary assessment surveys with a global positioning system enabled will be sent 6 months later. Data will be analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants. Discussion: Findings from this study will advance our understanding of dietary and movement behaviours as they occur in real-life and inform the development of personalised interventions to prevent chronic diseases.

Coffee and tea consumption in relation to inflammation and basal glucose metabolism in a multi-ethnic Asian population: a cross-sectional study.

BACKGROUND: Higher coffee consumption has been associated with a lower risk of type 2 diabetes in cohort studies, but the physiological pathways through which coffee affects glucose metabolism are not fully understood. The aim of this study was to evaluate the associations between habitual coffee and tea consumption and glucose metabolism in a multi-ethnic Asian population and possible mediation by inflammation. METHODS: We cross-sectionally examined the association between coffee, green tea, black tea and Oolong tea consumption and glycemic (fasting plasma glucose, HOMA-IR, HOMA-beta, plasma HbA1c) and inflammatory (plasma adiponectin and C-reactive protein) markers in a multi-ethnic Asian population (N = 4139). RESULTS: After adjusting for multiple confounders, we observed inverse associations between coffee and HOMA-IR (percent difference: - 8.8% for ≥ 3 cups/day versus rarely or never; Ptrend = 0.007), but no significant associations between coffee and inflammatory markers. Tea consumption was not associated with glycemic markers, but green tea was inversely associated with plasma C-reactive protein concentrations (percent difference: - 12.2% for ≥ 1 cup/day versus < 1 cup/week; Ptrend = 0.042). CONCLUSIONS: These data provide additional evidence for a beneficial effect of habitual caffeinated coffee consumption on insulin sensitivity, and suggest that this effect is unlikely to be mediated by anti-inflammatory mechanisms.

Cholesterol-raising diterpenes in types of coffee commonly consumed in Singapore, Indonesia and India and associations with blood lipids: a survey and cross sectional study.

BACKGROUND: To measure the content of cholesterol-raising diterpenes in coffee sold at the retailer level in Singapore, Indonesia and India and to determine the relationship of coffee consumption with lipid levels in a population-based study in Singapore. METHODS: Survey and cross-sectional study in local coffee shops in Singapore, Indonesia and India to measure the diterpene content in coffee, and a population-based study in Singapore to examine the relationship of coffee consumption and blood lipid levels. Interviews and coffee samples (n=27) were collected from coffee shops in Singapore, Indonesia and India. In addition, 3000 men and women who were Chinese, Malay, and Indian residents of Singapore participated in a cross-sectional study. RESULTS AND DISCUSSION: The traditional 'sock' method of coffee preparation used in Singapore resulted in cafestol concentrations comparable to European paper drip filtered coffee (mean 0.09±SD 0.064 mg/cup). This amount would result in negligible predicted increases in serum cholesterol and triglyceride concentrations. Similarly low amounts of cafestol were found in Indian 'filter' coffee that used a metal mesh filter (0.05±0.05 mg/cup). Coffee samples from Indonesia using the 'sock' method (0.85±0.41 mg/cup) or a metal mesh filter (0.98 mg/cup) contained higher amounts of cafestol comparable to espresso coffee. Unfiltered coffee from Indonesia contained an amount of cafestol (4.43 mg/cup) similar to Scandinavian boiled, Turkish and French press coffee with substantial predicted increases in serum cholesterol (0.33 mmol/l) and triglycerides (0.20 mmol/l) concentrations for consumption of 5 cups per day. In the Singaporean population, higher coffee consumption was not substantially associated with serum lipid concentrations after adjustment for potential confounders [LDL-cholesterol: 3.07 (95% confidence interval 2.97-3.18) for <1 cup/week versus 3.12 (2.99-3.26) for ≥3 cups/day; p trend 0.12]. CONCLUSIONS: Based on the low levels of diterpenes found in traditionally prepared coffee consumed in Singapore and India, coffee consumption in these countries does not appear to be a risk factor for elevation of serum cholesterol, whereas samples tested from Indonesia showed mixed results depending on the type of preparation method used.