COVID-19-related stress response among adult females: Relevance of sociodemographics, health-related behaviors and COVID-19 contact.

Women were more affected than men during the COVID-19 pandemic. This study aimed to investigate COVID-19-related stress response in adult women and its association with the relevant socioeconomic, lifestyle and COVID-19-related factors. This research was carried out in eight randomly chosen cities from September 2020 to October 2021. To examine stress, we distributed the COVID Stress Scales (CSS) and the Perceived Stress Scale (PSS). Women also fulfilled a general socio-epidemiologic questionnaire. The study included 1,264 women. Most women were healthy, highly educated, employed, married, nonsmokers who consumed alcohol. The average total CSS score suggested a relatively low COVID-19 related stress), while 1.7% of women had CSS ≥ 100. The mean PSS was around the mid-point value of the scale. Older women, who were not in a relationship, didn't smoke, didn't drink alcohol, but used immune boosters, had chronic illnesses and reported losing money during the pandemic had higher CSS scores. A higher level of stress was also experienced by women exposed to the intense reporting about COVID-19, had contact with COVID-19 positive people or took care of COVID-19 positive family members. In this sample of predominantly highly educated women few women experienced very high stress level, probably due to the study timing (after the initial wave) when the pandemic saw attenuated stress levels. To relieve women from stress, structural organization and planning in terms of health care delivery, offsetting economic losses, controlled information dissemination and psychological support for women are needed.

CYBERBULLYING AMONG ADOLESCENTS AND ONLINE INFORMATION SEEKING ABOUT MENTAL HEALTH.

BACKGROUND: Cyberbullying is a serious problem among adolescents and has an impact on mental health. The purpose of this study was to: 1) translate and validate the Cyberbullying and Online Aggression Survey in the Serbian language; 2) explore factors associated with more intense cyber victimization and cyber offending and 3) examine whether more intense cyber victimization and cyber offending are associated with a higher likelihood of online search for topics on mental health in a sample of high school students. SUBJECTS AND METHODS: A total of 702 students from 4 public high schools participated in this cross-sectional study. Data were collected using a general questionnaire and the Cyberbullying and Online Aggression Survey. Internal consistency of the questionnaire was examined and confirmatory factor analysis was conducted to assess construct validity. The multiple linear regression model examined factors associated with higher levels of cyber offending and cyber victimization. The multiple logistic regression models examined whether cyber offending and cyber victimizations were associated with searching for mental health topics on the Internet. RESULTS: Cronbach's alpha for the Cyberbullying Victimization Scale was 0.813 and for the Cyberbullying Offending Scale was 0.789. Both scales had a one-factorial structure and parameters on the confirmatory factor analysis were appropriate. More than one-half of students (56.2%) reported ever being cyber victimized and 39.9% of students reported ever being cyber offenders. Having lower grades, being younger at first Internet use and more frequent use of the internet were associated with both higher Cyberbullying Victimization and Offending scores. Having higher scores on both Cyberbullying Victimization and Offending scales was associated with higher odds of searching for mental health topics online. CONCLUSION: It is necessary to address cyberbullying in schools to help recognize and modify the behavior of cyber offenders and provide means of support and empowerment to cyber victims.

Familiarity with the internet and health apps, and specific topic needs are amongst the factors that influence how online health information is used for health decisions amongst adolescents.

BACKGROUND: Many adolescents believe that online health information is reliable, particularly when they are familiar with the source of information. OBJECTIVE: To analyse the degree of influence of online health information on high school students' health decisions and examine whether socio-demographic characteristics, digital literacy, use of different websites and interest in specific health topics are associated with a stronger influence of online health information on adolescents' health-related decisions. METHODS: Participants were students from four public high schools in Belgrade, Serbia. Socio-demographic and behavioural questionnaire as well as the e-health literacy scale (eHEALS) were used to collect data. RESULTS: The study sample comprised 702 students. A total of 79.6% of students reported that online health information influenced their health decisions to a certain extent (from 'a little' to 'a lot'). Being a boy, using the internet since younger age, better self-perceived e-health literacy, using health apps, Google, health forums, websites of health institutions, social media and YouTube, being interested in diet/nutrition, sexually transmitted infections and cigarettes were the characteristics associated with a stronger influence of online health information on students' health decisions. CONCLUSION: This study provides clues about how online health-related information can be used to adjust and enhance health promotion amongst adolescents.

Patterns of online health information seeking after visiting a physician: perceptions of adolescents from high schools in central Belgrade, Serbia.

BACKGROUND: Browsing webpages that offer health information allows visitors to remain anonymous, particularly when researching sensitive topics. Uncertainty about confidentiality may be a barrier for adolescents to discuss their health in-person with a physician and seek further health information on the Internet after seeing a physician. OBJECTIVE: To explore factors contributing to perceived online health information seeking after visiting a physician in a sample of high school students. METHODS: A cross-sectional study was conducted from December 2016 to January 2017. The study included 702 high school students. Socio-demographic and behavioral questionnaire as well as the electronic health (e-health) literacy scale (eHEALS) were used to collect data. Students described their perceptions of what they commonly do after visiting a physician, which was not connected to a particular clinic at any point in time. RESULTS: A total of 347 students (49.4%) perceived that they search for online health information after visiting a physician. Attending humanities-languages school program, lower education level of parents, being older at first Internet use, stronger influence of online health information on students' behaviour, better e-health literacy, use of smartphones, YouTube, social networks and heath forums were associated with perceived online health information seeking after visiting a physician. CONCLUSION: One-half of high school students in this study perceived that they search for online health information after having visited a physician. Our results suggest that many adolescents might seek additional information about health.

eHealth and adolescents in Serbia: psychometric properties of eHeals questionnaire and contributing factors to better online health literacy.

Internet is important resource of health-related information and health services. Factors associated with higher level of online health (eHealth) literacy among adolescence have been understudied. The aim of this study was to assess psychometric properties of the eHealth Literacy Scale (eHEALS) in Serbian language and to evaluate eHealth literacy among adolescents in Serbia. The study was carried out in four high schools in Belgrade, Serbia in the period December 2016 to January 2017. A total of 702 students comprised the study sample. The eHEALS was translated according to internationally accepted methodology and its psychometric properties were analyzed. The Cronbach's alpha coefficient for the entire eHEALS was 0.849. On exploratory factor analysis we obtained two-factorial structure. Our adolescents reported low confidence in knowing what health resources are available online. High confidence was observed for knowing how to use and how to find health information online. There was no difference in eHEALS score between genders or between school years. After adjustment for gender, type of school program, parental marital status, fathers' education level and household income, being female was associated with higher eHealth literacy (B = 1.12, 95% confidence interval 0.07-2.18; p = 0.036). Serbian version of the eHEALS is a valid instrument in assessment of online health literacy and can be further used in evaluation of eHealth literacy in other population groups in Serbian language. It is advised that some classes in school are dedicated to appraisal and use of online health websites. This could be achieved through peer-education.

Sociodemographic Characteristics and Digital Behaviors Associated with the Use of Fitness and Diet Apps Among Adolescents.

BACKGROUND: Numerous health apps focusing on fitness, nutrition, and physical activity are available, yet many adolescents have never used them. The purpose of this study was to assess the prevalence of the use of fitness and diet apps and related socio-demographic factors and digital behaviors among high school students. Study Design: A cross-sectional study. METHODS: High school students were recruited from 4 out of 21 public high schools in Belgrade, Serbia. Participants filled out an anonymous questionnaire about socio-demographic characteristics and digital behaviors, along with the e-health literacy scale (eHEALS). Adjusted logistic regression was applied for data analysis using SPSS 20. RESULTS: Of the 702 students who completed the questionnaire, 670 used smartphones (95.4%; average age 16.5±1.2 years). The prevalence of fitness and diet app use among girls was 29.7% and 9.6%, as well as 17.3% and 3.6% among boys, respectively. Having higher family income, having better e-health literacy, browsing websites about fitness and diet, and using diet apps but not watching YouTube were associated with the use of fitness apps among girls. Being younger and browsing fitness websites and YouTube were associated with the use of fitness apps among boys. Being younger, browsing websites about diet, and using fitness apps were associated with the use of diet apps among girls. CONCLUSION: Based on the findings, girls used fitness and diet apps more often than boys. Practical demonstrations on how to utilize certain health apps could be an additional opportunity to support positive health behaviors among adolescents.

Validity and reliability of the Serbian COVID Stress Scales.

This study aimed to generate a linguistic equivalent of the COVID Stress Scales (CSS) in the Serbian language and examine its psychometric characteristics. Data were collected from September to December 2020 among the general population of three cities in Republic of Serbia and Republic of Srpska, countries where the Serbian language is spoken. Participants completed a socio-demographic questionnaire, followed by the CSS and Perceived Stress Scale (PSS). The CSS was validated using the standard methodology (i.e., forward and backward translations, pilot testing). The reliability of the Serbian CSS was assessed using Cronbach's alpha and McDonald's omega coefficients and convergent validity was evaluated by correlating the CSS with PSS. Confirmatory factor analysis was performed to examine the construct validity of the Serbian CSS. This study included 961 persons (52.8% males and 47.2% females). The Cronbach's alpha coefficient of the Serbian CSS was 0.964 and McDonald's omega was 0.964. The Serbian CSS with 36 items and a six-factorial structure showed a measurement model with a satisfactory fit for our population (CMIN/DF = 4.391; GFI = 0.991; RMSEA = 0.025). The CSS total and all domain scores significantly positively correlated with PSS total score. The Serbian version of the CSS is a valid and reliable questionnaire that can be used in assessing COVID-19-related distress experienced by Serbian speaking people during the COVID-19 pandemic as well as future epidemics and pandemics.

Searching for online health information instead of seeing a physician: a cross-sectional study among high school students in Belgrade, Serbia.

OBJECTIVES: Fear of being judged and stigmatized has been reported as barriers for adolescents to timely use healthcare services. The objective of this study was to examine the prevalence and factors associated with online health information seeking instead of seeing a physician among high school students. METHODS: A cross-sectional questionnaire-based study was carried out in four out of 21 public high schools in Belgrade, from December 2016 to January 2017 (n = 702, 41.9% males, 15-19 years old). The association of socio-demographic characteristics, digital literacy, interest in health topics and the use of online platforms with health information seeking was analysed using multinomial regression models. RESULTS: More than half of high school students (56.6%) search for online health information instead of seeking a physician. Being male, having lower-grade point average, attending humanities-languages program, older age at first Internet use, better e-health literacy, use of smartphones, interest in sexually transmitted diseases and mental health, use of websites run by physicians and Youtube was associated with online health information seeking instead of in-person visit to a physician. CONCLUSIONS: Setting up safe and supportive online platform could help adolescents improve health education. Physicians who see adolescent patients should encourage discussions about sensitive health topics.