The eating model in contemporary Taiwan: Destructuration or a new insight into compressed food modernity in Asia.

In contemporary societies with diverse but often conflicting values attached to eating, it is important to scrutinise what eating well means to a given population. While such attempts have been pioneered, mostly in Western countries, Asia has been rarely explored. Moreover, food scholars in Western countries have called for in-depth analysis of the impacts of food modernisation on our everyday eating models, but empirical data about Asia and its implications for the plurality of food modernisation have been limited. To narrow this knowledge gap, we replicated Ueda's previous survey in Japan by utilising the same web-based questionnaire in a study of the Taiwanese population (n = 920, aged 20-69) to elucidate their eating model across all dimensions; that is, not only meal content but also the temporal, spatial, social, qualitative and affective facets. It was found that, similarly to other parts of the world, the Taiwanese have experienced the so-called 'destructuration' of their eating model, including two out of five habitually skipping meals; one out of four eating out 14 times or more in a week; and three out of five eating alone for breakfast. The destructuration also extended to their dietary norms, which marked a sharp contrast with other countries, such as Japan and France, where many eaters experience dilemmas due to high ideals and reality. We argue that this interesting phenomenon is due to the 'compressed' food modernity that Taiwan experienced. This study is the first attempt to provide comprehensive data about the eating model in Taiwan. Further empirical studies, particularly in other Asian regions, are expected to advance our thinking about a complex relationship between food modernity and well-being.

Effects of the digital divide on the prevention of food risk in Taiwan.

Given the frequent occurrence of various food incidents, food safety is a significant public health concern worldwide. Health information plays an important role in risk prevention. As its reach continues to broaden, the Internet is emerging as a major source of health information for the public, although some social groups continue to have limited access. This study investigates the relation between the digital divide and practices for preventing food incidents in Taiwan. Using a nationally representative survey of 2098 adults, the results of our multinomial logistic regression and bootstrapped mediation analysis indicate the existence of second- and third-level digital divides. The association between socioeconomic status and Internet use time and digital skills results in disparities in food risk prevention behaviors and is partially mediated by online food safety information acquisition. Our findings reveal that the digital divide exacerbates health inequalities in food risk prevention. In addition to providing useful food safety information online, communication interventions should address the digital inequality by delivering food safety information through alternative networks for disadvantaged members of the public.

The amount of television that infants and their parents watched influenced children's viewing habits when they got older.

AIM: Excessive television (TV) exposure has negative impacts on a child's development, health and behaviour. This study examined the under-researched area of what impact infant and parental TV viewing during a child's infancy had on the child's later viewing habits. METHODS: Data on 18 577 babies born in 2005 were collected from the Taiwan Birth Cohort Study, a prospective longitudinal study of a nationally representative cohort. Group-based trajectory analysis was conducted to identify childhood TV viewing trajectories at 18, 36 and 66 months of age. Multinomial logistic regression was used to examine the influence of parents' TV behaviour on their children's TV viewing trajectories. RESULTS: The percentage of children falling into the TV viewing trajectories that were identified were low (20%), increasing (46.5%) and high (33.5%). The child's TV viewing trajectory was significantly associated with the child's sex, parent's monthly household income, child's day care arrangements, maternal and paternal education, maternal and paternal TV viewing time and whether the child's TV viewing time was restricted. CONCLUSION: The amount of TV that children watched when they were older was associated with a range of factors, and the results particularly highlight the need to restrict child and parental viewing time in infancy.

Probing, impelling, but not offending doctors: the role of the internet as an information source for patients' interactions with doctors.

The Internet has become a major health information source for many patients, and they might discuss the information they get from the Internet with their doctors. I explored how the Internet as an information source influences cancer patients' communication with their doctors in Taiwan, where the doctor-patient relationship is traditionally doctor dominated. Forty-six cancer patients or families participated in seven focus group discussions. I conducted inductive analysis to examine themes emerging from discussions. Participants searched for information on the Internet to probe and verify their doctors' competence. Participants took responsibility for understanding the doctors' jargon, and the Internet helped them to do that. The Internet also helped participants spur doctors to think further about their condition, but these patients did so cautiously, with an effort not to offend doctors. The Internet as an information source did help participants talk to doctors, but the effect on changing the doctor-dominant nature of the relationship was limited.

Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality?

OBJECTIVES: The main aim of this study was to examine how physical activity in combination with physical frailty and cognitive impairment affects risk of mortality in older adults. STUDY DESIGN: A national sample of community-dwelling Taiwanese aged 65 years or older (n=2678) was followed for 5 years. MAIN OUTCOME MEASURES: Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. The Mini-Mental State Examination was used to assess cognitive impairment. Information on self-reported physical activity was collected at baseline. The study cohort was followed until the date of death or the end of the study period (31 December 2018). Deaths were confirmed by the computerized data files of the National Register of Deaths. RESULTS: A total of 417 deaths were recorded after 12415.2 person-years of follow-up. After adjustment for other factors, compared with active participants who were physically robust with normal cognition, inactive participants who were with either frail/pre-frail or cognitively impaired had hazard ratios for mortality of 2.65 (95% CI=[1.88-3.74]) and 3.09 (95% CI=[2.08-4.59]), respectively. Inactive participants with coexisting frailty/pre-frailty and cognitive impairment had the highest hazard ratio for mortality of 3.85 (95% CI=[2.73-5.45]). Being active was associated with a mortality reduction of 31%, 38%, and 42% in physically robust participants with normal cognition, those who were frail/pre-frail only, and those with cognitive impairment only, respectively. CONCLUSIONS: Having a physically active life style has beneficial effects on survival in older persons with either frailty/pre-frailty or cognitive impairment.

Gifts, bribes and solicitions: print media and the social construction of informal payments to doctors in Taiwan.

The Taiwanese practice of patients giving informal payments to physicians to secure services is deeply rooted in social and cultural factors. This study examines the portrayal of informal payments by Taiwanese print news media over a period of 12 years-from prior to until after the implementation of national health insurance (NHI) in Taiwan in 1995. The goal of the study was to examine how the advent of NHI changed the rationale for and use of informal payments. Both before and after the introduction of NHI, Taiwanese newspapers portrayed informal payments as appropriate means to secure access to better health care. Newspaper accounts established that, although NHI reduced patients' financial barriers to care, it did not change deeply held cultural beliefs that good care depended on the development of a reciprocal sense of obligation between patients and physicians. Physicians may have also encouraged the ongoing use of informal payments to make up revenue lost when NHI standardized fees and limited income from dispensing medications. In 2002, seven years after the implementation of NHI, the use of informal payments, though illegal, was still being justified in the print media through allusions to its role in traditional Taiwanese culture.

Media alcohol advertising with drinking behaviors among young adolescents in Taiwan.

OBJECTIVES: To investigate potential effects of alcohol ads in six major marketing channels on drinking behaviors among young adolescents in Taiwan. METHODS: The data were derived from the Alcohol-Related Experiences among Children study. The baseline sample was comprised of 1926 seventh-eighth graders from 11 public middle schools in Taipei in 2010; follow-up was conducted one year later (follow-up rate=97%). Information concerning individual sociodemographics, family characteristics, exposure to media portrayals of drinking and alcohol ads on major marketing channels, and drinking experience was collected through web-based self-administered questionnaires. Complex survey analyses were used to evaluate the association estimates, with stratification by prior drinking experiences in childhood. RESULTS: Television, in-store displays, and websites are the three most common marketing channels for young adolescents to report past-month alcohol advertising exposure. With statistical adjustment for potential confounders and six market channels, exposure to alcohol ads on television was associated with subsequent increased drinking initiation (adjusted odds ratio [aOR]=2.62; 95% CI=1.14-6.02). For those who have initiated alcohol use in childhood, the exposure to ads on the web (aOR=1.50; 95% CI=1.04-2.15) and radio (aOR=2.58; 95% CI=1.60-4.15) may elevate subsequent risk of occasional drinking. Exposure to media drinking portrayals was not related to subsequent drinking behaviors in this sample. CONCLUSIONS: Our results demonstrated that the effects of alcohol advertising on drinking behaviors in early adolescence may differ by marketing channels. Preventive strategies targeting underage drinking should consider restraining marketing channels (e.g., websites and radio) from certain advertising content and placement.

Television viewing and alcohol advertising with alcohol expectancies among school-aged children in Taiwan.

OBJECTIVES: This study is aimed to examine the strength of association between television watching and potential exposure to alcohol advertising with multidimensional alcohol expectancies in school-aged children. METHODS: A total of 779 4th (age 10) and 768 6th (age 12) grade students were recruited from 17 public elementary schools in northern Taiwan in 2006, with two waves of follow-up at 6 months apart. Self-administered questionnaires were used to collect information concerning individual characteristics, parental attributes, past-week screen time, drinking behaviors, and alcohol expectancies. Data of aired alcohol advertisements at baseline were obtained from the Nielsen Media Research Advertising Information Services; parenting styles were ascertained from the 1st follow-up. Alcohol Expectancies Questionnaire-Children version was used to measure alcohol expectancies (AEs) at baseline and the 2nd follow-up. RESULTS: Nearly 27% of students reported watching television for more than two hours per day and 58% watching television after 9 p.m. Dimension-related heterogeneity exists in the relationship between TV viewing and alcohol advertising with AEs. With statistical adjustment for covariates, spending more than two hours watching TV per day was associated with increased levels of positive AEs "Promoting Relaxation or Tension Reduction [PRTR]" (ß=1.52, 95% CI=0.92, 2.12; p<0.001); the exposure to alcohol advertising was associated with decline in negative AEs "Deteriorated Cognitive and Behavioral Function" (e.g., >8.0 ads: ß=-1.06, 95% CI=-1.66, -0.47, p<0.01). CONCLUSIONS: Greater screen time is associated with elevated positive expectancies of PRTR and alcohol advertising exposure is linked with lowered negative expectancies in late childhood. School-based anti-underage drinking programs may consider integrating the media literacy curriculum.

Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors.

This qualitative research explored how cancer patients' writing and reading on the Internet play a role in their illness experience. Focus-group interviews were conducted, with 34 cancer patients participating. A grounded qualitative analysis method was applied to analyze the interview transcripts. The results show that by writing personal blogs, cancer patients reconstructed their life story, expressed their closure of life, and expected to be remembered after death. Reading fellow cancer patients' stories online significantly influenced cancer patients' perceptions and expectations of their own illness prognosis, and that influence was sometimes greater than that of the doctors' influence.

What drives patients to sue doctors? The role of cultural factors in the pursuit of malpractice claims in Taiwan.

Many studies have investigated the reasons for patients' claiming physician malpractice. However, few have explored the patients' motivations for filing malpractice claims from a cultural perspective, particularly in Eastern societies. This study inspects why patients claimed malpractice after an adverse outcome and their rationales in relation to cultural factors in Taiwan. The goal was to comprehend the patients' view of the meaning of filing malpractice lawsuits. Using qualitative in-depth interviews with claimants, this study found that taking revenge, feelings of guilt, and the practice of filial piety are important factors that motivate people to pursue litigation. However, the driving force behind the malpractice claims made by the people interviewed in this study was the need for a jiau dai either for their injured or deceased family member or for themselves. A jiau dai is a resolution presented by the hospital/physician that satisfies the family involved and thus comforts them. In the process of negotiation, the decision of patients or families to file malpractice lawsuits is also strongly influenced by the attitude of physicians and hospitals. This study suggests that legal consultation and emotional support are needed to assist patients and their families in forming an appropriate plan of action for conducting negotiations or litigation, and for dealing with the guilt, grief, and bereavement that may ensue.