The efficacy of sleep lifestyle interventions for the management of overweight or obesity in children: a systematic review and meta-analysis.

BACKGROUND: Childhood obesity remains a significant public health concern. Sleep duration and quality among children and youth are suboptimal worldwide. Accumulating evidence suggests an association between inadequate sleep and obesity risk, yet it is unclear whether this relationship is causal. This systematic review examines the efficacy of sleep interventions alone or as a part of lifestyle interventions for the management of overweight or obesity among children and adolescents. METHODS: A keyword/reference search was performed twice, in January 2021 and May 2022 in MEDLINE/PubMed, EMBASE/Ovid, PsycINFO/EBSCO, The Cochrane Library, Web of Science Core Collection/Web of Science, SciELO/Web of Science, and CINAHL/EBSCO. Study eligibility criteria included youth with overweight or obesity between 5 and 17, were RCTs or quasi-randomized, and focused on the treatment of overweight and obesity with a sleep behavior intervention component. Risk of bias was assessed using the Cochrane Risk of Bias assessment tool (RoB2). A Meta-analysis was conducted to estimate the effect of interventions with a sleep component on BMI. The study protocol was registered in PROSPERO (CRD42021233329). RESULTS: A total of 8 studies (2 quasi-experiments, 6 RCTs) met inclusion criteria and accounted for 2,231 participants across 7 countries. Only one study design isolated the effect of sleep in the intervention and reported statistically significant decreases in weight and waist circumference compared to control, though we rated it at high risk of bias. Our meta-analysis showed no significant overall effect on children's BMI as a result of participation in an intervention with a sleep component (Cohen's d = 0.18, 95% CI= -0.04, 0.40, Z = 1.56, P = .11), though caution is warranted due to substantial heterogeneity observed across studies (Tau2 = 0.08; X2 = 23.05, df = 7; I2 = 83.73%). CONCLUSIONS: There were mixed results on the effect of sleep interventions across included studies on BMI, other weight-related outcomes, diet, physical activity, and sleep. Except for one study at low risk of bias, three were rated as 'some concerns' and four 'high risk of bias'. Findings from this study highlight the need for additional RCTs isolating sleep as a component, focusing on children and adolescents living with overweight and obesity.

Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children.

BACKGROUND: This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS: Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS: During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS: Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03334669 , Registered October 2017.

Residential urban food environment profiles and diet outcomes among adults in Brooklyn, New York: a cross-sectional study.

OBJECTIVE: To assess the clustering properties of residential urban food environment indicators across neighbourhoods and to determine if clustering profiles are associated with diet outcomes among adults in Brooklyn, New York. DESIGN: Cross-sectional. SETTING: Five neighbourhoods in Brooklyn, New York. PARTICIPANTS: Survey data (n 1493) were collected among adults in Brooklyn, New York between April 2019 and September 2019. Data for food environment indicators (fast-food restaurants, bodegas, supermarkets, farmer's markets, community kitchens, Supplemental Nutrition Assistance Program application centres, food pantries) were drawn from New York databases. Latent profile analysis (LPA) was used to identify individuals' food access-related profiles, based on food environments measured by the availability of each outlet within each participant's 800-m buffer. Profile memberships were associated with dietary outcomes using mixed linear regression. RESULTS: LPA identified four residential urban food environment profiles (with significant high clusters ranging from 17 to 57 across profiles): limited/low food access, (n 587), bodega-dense (n 140), food swamp (n 254) and high food access (n 512) profiles. Diet outcomes were not statistically different across identified profiles. Only participants in the limited/low food access profile were more likely to consume sugar-sweetened beverages (SSB) than those in the bodega-dense profile (b = 0·44, P < 0·05) in adjusted models. CONCLUSIONS: Individuals in limited and low food access neighbourhoods are vulnerable to consuming significant amounts of SSB compared with those in bodega-dense communities. Further research is warranted to elucidate strategies to improve fruit and vegetable consumption while reducing SSB intake within residential urban food environments.

Adolescents' proxy reports on obesity-related parenting practices: factorial validity and reliability across four behavioral domains.

BACKGROUND: Adolescents' energy balance behaviors are precursors to obesity shaped by the practices or strategies that many parents implement. Although key stakeholders to their families, adolescents are rarely considered to report on these obesity-related parenting practices. The aim of this study is to assess the factorial and predictive validity of adolescents' proxy-report of parents' obesity-related parenting across four behavioral domains. METHODS: This study used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study. This study tests whether adolescents' proxy reports about their parents' obesity-related parenting are significantly associated with parents' responses on their own obesity-related parenting, as well as whether these reports are significantly associated to parent-adolescent energy balance behaviors. Factorial validity was assessed using linear regression and Confirmatory Factor Analysis (CFA), whereas predictive validity was assessed using Actor-Partner Interdependence Modeling (APIM). RESULTS: Regression results indicated that adolescents' proxy report is significantly associated with parents' report of their own parenting in all four domains (ß = .59-.71; p < 0.05). CFA results indicated a final factor structure that loaded significantly onto hypothesized obesity-related parenting domains (ß > .30) in both adolescents and parents. APIM results indicated that both parent- (ß = .32; p < 0.05) and adolescent-(ß = .21; p < 0.05) reported obesity parenting for fruit and vegetable consumption were associated with their own fruit and vegetable intake. In addition, adolescent-reported physical activity parenting was significantly associated with adolescent physical activity (ß = 0.23; p < 0.05). Regarding partner effects, only parent-reported parenting for fruit and vegetable consumption were significantly associated with adolescent intake of fruit and vegetables (ß = 0.15, p < 0.05) and adolescent-reported physical activity parenting was significantly associated with parental physical activity (ß = 0.16, p < 0.05). Neither adolescent nor parent reported parenting were significantly associated with screen time or junk food intake outcomes. Each final obesity-related parenting scale had good internal consistency (a = .74-.85). CONCLUSIONS: We found that adolescent- and parent-reported obesity-related parenting were significantly associated, while adolescent-reported parenting were more explanatory of fruit and vegetable intake and physical activity than parent-reported parenting. These findings suggest that adolescent proxy reports may be a valid source of information on obesity-related parenting.

Antenatal dietary concordance among mothers and fathers and gestational weight gain: a longitudinal study.

BACKGROUND: Parent-child dietary concordance is associated with child diet, but the clinical implications of mother-father dietary concordance during pregnancy are unknown. This study evaluates antenatal mother-father dietary concordance and associations with gestational weight gain (GWG). METHODS: Mother-father (n = 111) dyads with low income reported their fruit/vegetable (FV), fast food (FF), and sugar-sweetened beverage (SSB) consumption frequency during the first trimester of pregnancy. From electronic health records, we collected height and self-reported pre-pregnancy weight and calculated pre-pregnancy body mass index (BMI). The primary outcome was excessive GWG for pre-pregnancy BMI. Dyads were categorized as healthy or unhealthy concordant (consuming similarly high or low amounts of FV, FF, or SSB), or mother-healthy or father-healthy discordant (consuming different amounts of FV, FF, or SSB). Multivariable and logistic regressions analyzed associations between dietary concordance and GWG. RESULTS: Mothers were Hispanic (25%), 43% White, 6% Black, and 23% Asian or Other. Most mothers were employed (62%) making <$50,000/year (64%). Average maternal GWG was 11.6 kg (SD = 6.40), and 36% had excessive GWG. Mothers in the mother-healthy discordant FV group (OR = 4.84; 95% CI = 1.29, 18.22) and the unhealthy concordant FF group (OR = 7.08; 95% CI = 2.08, 24.12) had higher odds for excessive GWG, compared to healthy concordant dyads. SSB concordance was associated with higher GWG in unadjusted, but not adjusted models. CONCLUSIONS: Mothers had higher risk for excessive GWG when both partners had unhealthy FF consumption frequency, and when fathers had unhealthy FV consumption frequency. These findings imply that fathers should be involved in educational opportunities regarding dietary intake during pregnancy.

Targeting family functioning, acculturative stress, and sugar-sweetened beverage consumption for obesity prevention: findings from the Hispanic community children's health study/study of Latino youth.

BACKGROUND: Maintaining a bond with one's family as well coping with stress while acculturating to the US may protect Hispanic/Latino youth from increased sugar-sweetened beverages (SSB) consumption, which heightens the risk for overweight and obesity. This study aims to examine associations between acculturative stress, family functioning, and SSB consumption by acculturation status among U.S. Hispanic/Latino youth. METHODS: With cross-sectional data on 1465 youth 8-16y (49.6% females) participating in the Hispanic Community Children's Health Study/Study of Latino Youth, we classified youths into four acculturation groups - assimilated, integrated, marginalized/separated, and unclassified. SSB consumption was assessed through two 24-h diet recalls and defined as intake frequency of soda, fruit juice, sweetened soft and fruit drinks. Multi-group path regression models were used to test associations of Hispanic/Latino youth' acculturative stress and family functioning with SSB consumption, as well as the moderating role of acculturation status. RESULTS: When controlling for age, sex, and study site, acculturative stress (ß = - 0.13, p = 0.01) was inversely associated with SSB, and poor family functioning (ß = 0.11, p = 0.07) was only marginally associated with SSB consumption among youth classified as assimilated but not among youth classified as integrated, marginalized/separated, or unclassified. CONCLUSIONS: A socio-ecological perspective that incorporates the role of key acculturation-related factors across multiple levels may aid efforts to identify mechanisms that influence the relationship between acculturation status and diet among Hispanic/Latino youth and their families.

Autonomous motivation, sugar-sweetened beverage consumption and healthy beverage intake in US families: differences between mother-adolescent and father-adolescent dyads.

OBJECTIVE: To assess interdependent effects of autonomous motivation to limit sugar-sweetened beverage (SSB) consumption in relation to SSB and healthy beverage (HB) intake in mother-adolescent and father-adolescent dyads. DESIGN: Adopting a dyadic cross-sectional design, the actor-partner interdependence modelling (APIM) approach was used to construct and analyse two APIM for mother-adolescent and father-adolescent dyads. The first model assessed actor effects (individual's autonomous motivation associated with his/her own beverage intake) and partner effects (individual's autonomous motivation associated with another family member's beverage consumption) of autonomous motivation on SSB consumption. The second model assessed actor and partner effects of autonomous motivation on HB intake. SETTING: Two Internet-based surveys were completed in participant households.ParticipantsData from a demographically representative US sample of parent-adolescent dyads (1225 mother-adolescent dyads, 424 father-adolescent dyads) were used. RESULTS: In the first model (autonomous motivation on SSB consumption), actor effects were significant for adolescents, but not for parents. Partner effects were significant for mother-adolescent, but not father-adolescent dyads. In the second model (autonomous motivation on HB intake), actor effects were significant for adolescents and parents in all dyadic combinations. Regarding partner effects, adolescent autonomous motivation had a significant effect on HB intake for mothers and fathers. In addition, maternal autonomous motivation had a significant effect on adolescent HB intake. No partner effects for HB were identified for fathers. CONCLUSIONS: We found significant interdependent effects of autonomous motivation in relation to SSB and HB intake in mother-adolescent and father-adolescent dyads for eleven out of sixteen pathways modelled.

Motor Skill Competence and Physical Activity in Preschoolers: A Review.

Objectives Preschoolers 3-5 years of age are in a crucial stage of motor skill competence. While preschoolers develop their motor skill competence through engagement in physical activity, a majority of them fail to meet guideline-recommended physical activity level. This study reviews scientific evidence on the relationship between motor skill competence and physical activity among preschoolers. Methods This systematic review followed the PRISMA framework. Keyword and reference search were conducted in PubMed, Cochrane Library, PsycINFO, Web of Science, and Google Scholar. Inclusion criteria included-age: 3-5 years of age; setting: preschool environment (e.g., preschool, childcare, head start); main outcomes: motor skill competence and physical activity; study design: cross-sectional study, case-control study, retrospective cohort study, prospective cohort study, or randomized controlled trial; language: English; and article type: peer-reviewed publication. Results Eleven studies met the inclusion criteria, including 6 randomized controlled trials and 5 cross-sectional studies. Studies were conducted in 5 countries: United States (5), United Kingdom (2), Australia (2), Switzerland (1), and Finland (1). Eight out of the 11 studies included in the review reported a significant relationship between motor skill competence and physical activity. The specific pattern and strength of the relationship tend to differ by gender, physical activity intensity, motor skill type, and day of the week (weekdays versus weekends). Conclusions An association has been consistently documented between motor skill competence and physical activity. Future research is warranted to elucidate the underlining causal link, examine potential heterogeneity, and determine the role of environment in the relationship between motor skill competence and physical activity among preschoolers.

Food is Medicine and implementation science: A recipe for health equity.

Diet-related chronic diseases such as Type II diabetes, cardiometabolic diseases, and cancer are among the leading causes of death in the USA. Nutrition security has emerged as a target outcome and a national priority for preventative medicine and the treatment of diet-related chronic diseases. Food is Medicine (FIM) initiatives encompass programs and interventions to meet priority population's needs across food and nutrition security continuums as a mechanism to address persistent food and nutrition inequities. In this position statement, we draw on implementation science, specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework and health equity principles to provide guidance on FIM initiatives. As the FIM evidence base continues to grow, we encourage the EPIS framework be applied as one lens through which we can improve our understanding of FIM implementation among multiple contexts to understand what works, for whom, and under what circumstances. Ultimately, this position statement aims to call to action the incorporation of implementation science and equity principles into FIM efforts.

This paper proposes that, in order to reduce the rates of Type II diabetes, cardiometabolic diseases, and cancer, among others; we prioritize Food is Medicine (FIM) as a way to prevent and address the impact of diet-related diseases. FIM is a pyramid of programs interested in promoting access to nutritious foods consistently to promote health. We use a framework from the field of implementation science and guiding ideas to propose FIM programs that can reach every community in an equitable way.

Consumer nutrition environment measurements for nutrient-dense food availability and food sustainability: a scoping review.

Consumer nutrition environments are defined as places in which consumers interact with the food they eat; these food choices can impact human and planetary health. Assessment measures for consumer nutrition environments are numerous, and vary widely on what, and how, they assess the food environment. The objective of this scoping review was to synthesize existing evidence on nutrition environment measurements and their capacity to assess nutrient-dense food access and food sustainability capacity. Eligibility criteria were developed to capture relevant peer-reviewed literature about auditing measures designed to assess nutrient-dense foods and food sustainability capacity in the consumer nutrition environment. A search strategy was conducted to collect articles published between January 1, 2002-June 4, 2022, using PubMed, Web of Science, Scopus, PsycINFO and the Cochrane library electronic databases. After screening 2457 manuscripts, 58 met inclusion criteria. Study aims, funding source(s), types of retailers assessed, assessment format and name, constructs measured, food categories measured, assessment of validity and/or reliability, and other relevant data were extracted from each manuscript. Results showed that most measures use checklists, surveys, questionnaires or similar methods to assess availability, quality, and price of select food items as assessment constructs. Most do not assess nutrient-dense food availability, and even fewer assess food sustainability. Development of comprehensive, reliable, and valid consumer nutrition environment measures that assess nutrient-dense food availability and food sustainability is important for research, planning, evaluation and advocacy aimed at improving consumer food environments for human and planetary health.

A Formative Evaluation of an Online Meal Kit and Grocery Platform for Supplemental Nutrition Assistance Program Recipients.

OBJECTIVE: To assess the barriers and facilitators to online food purchasing through a meal kit and grocery shopping website titled NY SNAP Express among Supplemental Nutrition Assistance Program (SNAP) beneficiaries. METHODS: A purposive sample of SNAP-eligible adults residing in New York State participated in interviews guided by the Capabilities, Opportunities, Motivations, and Behaviors Model. RESULTS: Barriers to online food purchasing among participants (n = 32) include physiological and health conditions, the weight of food, technology, language, the price of foods, transportation challenges, the stigma associated with SNAP, and concerns regarding the quantity and quality of meal kits. Facilitators include health and nutrition improvements, knowledge and skills, saving money, culturally relevant meals, increased efficiency in food purchases and preparation, and customization. CONCLUSIONS AND IMPLICATIONS: Online platforms such as NY SNAP Express have the potential to increase nutritious food access and resources among SNAP recipients; however, improvements are necessary to meet the needs of its audience.

Prioritize "Food is Medicine" initiatives in the 2024 Farm Bill for human and planetary health.

The Society of Behavioral Medicine (SBM) supports increased funding for policies in the 2024 Farm Bill that align with a Food is Medicine (FIM) framework and address multiple dimensions of human and planetary health.

The Society of Behavioral Medicine (SBM) supports funding for policies in 2024 Farm Bill that align with a Food is Medicine (FIM) framework and address multiple dimensions of human and planetary health. Recommendations include increasing funding for produce prescription programs, establishing systems to align federal- and state-funded initiatives, and the allocation of funding for financial incentives when sustainable agricultural practices are utilized in government-funded local and regional farm-to-institution programs.

POSITION STATEMENT: Pass the RESTORE (Re-entry Support Through Opportunities for Resources and Essentials) Act.

Under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), current federal policy mandates a lifetime ban for individuals with a past felony drug conviction from receiving Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) benefits. Denying nutritional and financial assistance to individuals with a past felony conviction will widen existing structural health inequities, set back individuals' successful re-entry into society, and contribute to recidivism and poorer health outcomes. Therefore, the Society of Behavioral Medicine supports the RESTORE ACT (Re-Entry Support Through Opportunities for Resources and Essentials Act), which would repeal the lifetime ban on receiving SNAP and TANF benefits for individuals convicted of a drug felony.

Current US law bans people who have been convicted of felony drug crime from participating in nutritional and financial assistance programs (i.e. Supplemental Nutrition Assistance Program [SNAP] and Temporary Assistance for Needy Families [TANF]). By not allowing people who have been convicted of a drug felony to access these programs, this law risks worsening health outcomes and perpetuating existing health disparities. The Society of Behavioral Medicine supports the RESTORE Act (Re-Entry Support Through Opportunities for Resources and Essentials Act), which would end the federal ban and allow all income-eligible people to access SNAP and TANF benefits.

Constituent-driven health policy informed by policy advocacy literature.

In this position paper, a theoretical framework is proposed to formulate engaged, evidence-based health policy based on the priorities of constituents. An initial literature review was conducted to gain insight on the gaps in knowledge. Three emergent domains were identified: advocacy, research, and policymaking. The inputs and intermediates to the final output (equitable, evidence-based health policy outcomes) were identified and further elaborated upon in each corresponding section of the paper. Additionally, the main objective of each domain based on the literature review and the implications of each step were noted. Researchers have been identified as crucial to the education of policymakers to ultimately produce informed, evidence-based policy. Community advocates and researchers must attempt to advocate for policy issues as the ultimate role of policymakers in this process necessitates effective engagement to promote political will in the policymaking process. To do so, community advocates must scale-up from the individual to coalitions with strong leadership. In conjunction with a policy champion, these efforts by constituents (community advocates and researchers) would result in the most effective modes of policy development and implementation. The Constituent-driven Policy Advocacy Model (CPAM) introduced in this paper creates the potential for a new precedent in policymaking, in which advocacy, community engagement, evidence synthesis and evaluation, as well as science communication are common practices, leading to more sensitive, targeted, and equitable policy outcomes.

This paper proposes a new lens to conceptualize health policymaking. The proposed model depicts the policy process in a collaborative nature, in which the voices of constituents are incorporated into the process to ensure that the resulting policy outcomes are informed by and are sensitive to constituents' needs. Three main stakeholder groups in this process were identified: policymakers, researchers/scientists, and community advocates. The article goes into further detail related to the actionable items for individuals in these groups. The role of researchers in this process is to inform policymaking using scientific evidence through individual and collaborative efforts with community advocates. The role of community advocates in this process is to build the capacity to assess needs, form collaborations and coalitions with strong leadership, as well as identify a policy champion invested in a shared health policy priority area. Through joint efforts between policymakers, researchers, and community advocates, accountability, evaluation, and political will can be promoted, which in turn influences policy outcomes in a more equitable and evidence-based fashion. The Constituent-driven Policy Advocacy Model (CPAM) creates the potential for a new precedent in health policymaking, in which advocacy, community engagement, evidence synthesis and evaluation, as well as science communication are common practices, leading to more sensitive, targeted, and equitable policy actions.

Advocacy efforts of the Society of Behavioral Medicine: a 6-year update.

Six years ago, we published a paper describing the Society of Behavioral Medicine's (SBM) health policy organizational leadership structure and policy initiatives. The purpose of the current paper is to provide an update on changes in the infrastructure and new policy initiatives that have been developed since 2017. We review each of the policy leadership arms of SBM including details of the work of each and goals for the future. The SBM engages in several health policy advocacy efforts through their Advocacy Council and Position Statements Committee. The Advocacy Council launched the Health Policy Ambassador Program in 2020. The Ambassador Program serves to train members to develop longer-term relationships with legislative staff around key policy priority areas. The Position Statements Committee is responsible for overseeing the development and dissemination of health policy position statements. Both groups work together and with partner organizations to increase the impact of our science. Over the last 6 years, developing a stronger infrastructure and implementing metrics for progress such as tracking social media engagement has helped to move SBM's policy agenda forward. The work of the policy-related leadership teams can serve as a model for other organizations who are interested in further developing their policy advocacy efforts.

The Society of Behavioral Medicine (SBM) engages in several health policy advocacy efforts through their Advocacy Council and Position Statements Committee. The Advocacy Council launch the Health Policy Ambassador Program in 2020. The Ambassador Program serves to train members to develop longer-term relationships with legislative staff around key policy priority areas. The Position Statements Committee is responsible for overseeing the development and dissemination of health policy position statements. Both groups work together and with partner organizations to increase the impact of our science. Over the last 6 years, developing a stronger infrastructure and implementing metrics for progress has helped to move SBM's policy agenda forward. The work of the policy-related leadership teams can serve as a model for other organizations who are interested in further developing their policy advocacy efforts.

Assessment of hepatitis-related knowledge, attitudes, and practices on quality of life with the moderating role of internalized stigma among hepatitis B-positive patients in Pakistan.

Aim: This study aimed to assess the Pakistani hepatitis B patients' knowledge, attitudes, and practices towards hepatitis management and the impact of self-management on the quality of life of hepatitis B patients as well as the moderating role of stigmatization. Methods: A cross-sectional study design was used, and the data was collected from a total of 432 hepatitis B positive patients through a self-designed questionnaire. The studied subjects consisted of men (n = 205, 47%), women (n = 165, 38%), and transgender (n = 62, 14%). The obtained data were statistically analyzed using SPSS software version 26.0 for Windows. Results: The mean age of the study participants was 48. Knowledge has a significant positive relationship with hepatitis self-management and quality of life, whereas knowledge has a negative relationship with stigmatization. Furthermore, multivariate analysis revealed that men were more knowledgeable about the disease than women and transgender people (6.14 ± 2.08 vs. 3.23 ± 1.61 vs. 1.03 ± 0.73, F = 8.2**, p = .000). On the scale of attitude and practice, significant gender differences were found. Women had more experience with hepatitis self-management than men or transgender (4.21 ± 13.0 vs. 2.17 ± 6.02 vs. 0.37 ± 0.31, F = 6.21**, p = .000). The regression analysis showed that self-management has a positive association with quality of life (B = 0.36, p = .001). The moderation analysis revealed that stigmatization negatively moderates the relationship between self-management and quality of life (B = -0.53, p = .001). Conclusion: Generally, patients had good knowledge about the disease and its self-management. However, a societal and community-level awareness campaign should be organized on the quality of life and stigmatization of people with chronic illness regarding their human rights, dignity, and physical, mental, and social well-being.

Psychometric Properties of the Spanish Burnout Inventory in University Teachers in Hybrid Education.

Introduction: The scientific literature argues the urgent need for adequate tools to assess burnout in human service professionals, however, little progress has been made on this in university teachers in hybrid environments, even though after the pandemic, these work scenarios are predominant. Objective: To determine the psychometric properties of invariance between male and female teachers of hybrid education in the Spanish Burnout Inventory (SBI). Method: The anonymous, self-administered SBI was administered to 1060 university teachers in Lima, Peru, from online random sampling. Of the total number of participants, 626 were women (59.1%) and 434 were men (40.9%), with an age range of 22 to 76 years, with a mean of 46.97 and a standard deviation of 10.256. It should be noted that 74.5% of the teachers worked full time. The analysis used the statistical programs AMOS v24, SPSS v26 and R-Project v4.1.2. First, a descriptive analysis of the data was performed, as well as a multivariate normality test of the data. Secondly, confirmatory factor analysis was performed; finally, a factorial invariance test was performed. Results: Cronbach's alpha of the SBI was 0.827, and for each subscale: Enthusiasm toward the job (0.742), Psychological exhaustion (0.889), Indolence (0.819), Guilt (0.816). According to the fit indicators, the confirmatory factor model is adequate. The results supported configural invariance, metric invariance, scalar invariance, and strict invariance in the male and female groups, although further investigation of some items specific to the indolence factor is needed. Conclusion: The SBI is a valid instrument to assess burnout in university teachers in hybrid environments. Studies associated with the SBI focus on its psychometric properties, burnout prevalence, related variables, and literature reviews. The validation of the SBI in various countries and service areas is discussed, as well as future implications for intervention in burnout prevention and mastery.

Food Insecurity and the Association between Perceptions and Trust of Food Advertisements and Consumption of Ultra-Processed Foods among U.S. Parents and Adolescents.

Adolescents exposed to food and beverage advertisements (FBAs) typically low in nutrient density can be influenced in their food choices, eating behaviors, and health. This study examines the association between perceptions and trust of FBAs (key predictor) and the outcome of daily consumption of ultra-processed foods (UPFs) in parent-adolescent dyads, with risk of food insecurity as a potential moderator. Cross-sectional data from the Family, Life, Activity, Sun, Health and Eating (FLASHE) study was used to test actor and partner effects using structural equation modeling. The final model was adjusted for parent sex and education level, and effects were compared between dyads at risk of food insecurity (n = 605) and dyads not at risk (n = 1008). In the unadjusted model, actor effects (parent: b = 0.23, p = 0.001; adolescent b = 0.12, p = 0.001) and parent-partner effects were found (b = 0.08, p = 0.004). The final comparative model produced similar results for dyads not at risk of food insecurity (parent actor: b = 0.27, p = 0.001; parent partner: b = 0.10, p = 0.01; adolescent actor: b = 0.11, p = 0.003). For dyads at risk of food insecurity, only actor effects were significant (parent: b = 0.22, p = 0.001; adolescent: b = 0.11, p = 0.013). These findings suggest that parents' favorability towards FBAs influence parent-adolescent unhealthy food consumption, and that this association is different when accounting for risk of food insecurity.

Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices?

INTRODUCTION: Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS: Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS: Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS: Parent empowerment may be an important target in interventions to prevent obesity in low-income children.

Motivation, Attitudes, and Diet Quality Among US Parents and Adolescents.

Objectives: In this paper, we assessed interdependent associations between food-related psychosocial traits and diet quality (ie, healthy and ultra-processed food consumption) among parent-adolescent dyads. Methods: This secondary analysis used data from the Family, Life, Activity, Sun and Health (FLASHE) study, which measured diet and other health behaviors in American parent-adolescent dyads (N = 1646). Actor-Partner Interdependence Models were used to apply a dyadic extension of the Theory of Planned Behavior and Social Determination Theory constructs (motivation, attitudes and self-efficacy) in relation to healthy and ultra-processed food (UPF) consumption. Results: Parent (b = 0.46, p < .01) and adolescent motivation (b = 0.42, p < .01) had positive actor effects on healthy food consumption. Parental attitudes had a negative actor effect (b = -0.20, p < .01) and adolescent attitudes had a positive actor effect (b = 0.34, p < .01) on healthy food consumption. Parent (b = -0.18, p < .01) and adolescent motivation (b = -0.14, p < .01) had negative actor effects on UPF consumption. No significant partner effects were found. Conclusions: Food-related psychosocial traits are associated with parent and adolescent diet quality. Interventions and guidelines that aim to strengthen an individual's ability to make healthful dietary choices, particularly those focused on reducing UPF consumption, are warranted, and may benefit from drawing on behavioral theories, especially those focused on motivational traits.