FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers.

OBJECTIVE: To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers. METHODS: A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme. RESULTS: A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity. CONCLUSIONS: Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

Baseline higher hair cortisol moderated some effects in a healthy lifestyle intervention.

Children and families from socioeconomically marginalized background experience high levels of stress, especially persistent chronic stress, due to unstable housing, employment, and food insecurity. Although consistent evidence supports a stress-obesity connection, little research has examined the potential moderation role of stress in childhood obesity interventions. Therefore, this study aimed to explore how chronic stress (hair cortisol) moderated the effects of a healthy lifestyle intervention on improving behavioral and anthropometric outcomes among 95 socioeconomically marginalized parent-child dyads. Data were collected in a cluster randomized controlled trial with 10 Head Start childcare centers being randomized into intervention and control. The child sample (3-5 years old) included 57.9 % female, 12.6 % Hispanic, and 40.0 % Black. For the parents, 91.6 % were female, 8.4 % were Hispanic, 36.8 % were Black, and 56.8 % were single. Parent baseline hair cortisol significantly moderated the intervention effects on child fruit intake (B = -1.56, p = .030) and parent nutrition self-efficacy (B = 1.49, p = .027). Specifically, higher parent hair cortisol lowered the increases in child fruit intake but improved the increases in parent nutrition self-efficacy in the intervention group compared to control group. Child higher baseline hair cortisol was significantly associated with the decreases in child fruit intake (B = -0.60, p = .025). Child baseline hair cortisol significantly moderated the intervention effects on parent physical activity (PA) self-efficacy (B = -1.04, p = .033) and PA parental support (B = -0.50, p = .016), with higher child hair cortisol decreasing the improvement on these two outcomes in the intervention group compared to control group. Results from this study shed lights on the moderation role of chronic stress on impacting healthy lifestyle intervention effects. Although needing further investigation, the adverse effects of chronic stress on intervention outcomes should be considered when developing healthy lifestyle interventions for preschoolers and their families.

Mental health and lifestyle behavior changes during COVID-19 among families living in poverty: A descriptive phenomenological study.

PROBLEM: Families living in poverty may be particularly vulnerable to the deleterious effects of the coronavirus disease (COVID-19). The current study focuses on caregivers of preschoolers aged 3-5 years old who lived in poverty to explore how COVID-19 affected mental health and lifestyle behaviors and what coping strategies were helpful for dealing with challenges induced by COVID-19. METHODS: A qualitative study was conducted using individual semi-structured interviews with 17 caregivers. FINDINGS: Both caregivers and preschoolers experienced high levels of stress, anxiety, and depression and reported unhealthy eating habits and excessive screen time. Physical activity increased in preschoolers, but declined among caregivers during COVID-19. Caregivers' coping strategies included taking short walks, seeking professional and social support, and praying; avoidant caregiver coping strategies including eating when stressed and increased screen time. CONCLUSIONS: Future interventions are warranted to empower caregivers who live in poverty with the skills needed to maintain optimal physical and mental health, as well as assisting them to cope with challenges that may continue post-COVID-19.

Using the Theory of Planned Behavior to determine COVID-19 vaccination intentions and behavior among international and domestic college students in the United States.

Vaccination is the most effective strategy for preventing infectious diseases such as COVID-19. College students are important targets for COVID-19 vaccines given this population's lower intentions to be vaccinated; however, limited research has focused on international college students' vaccination status. This study explored how psychosocial factors from the Theory of Planned Behavior (TPB; attitudes, perceived behavioral control, subjective norms, and behavioral intentions) related to students' receipt of the full course of COVID-19 vaccines and their plans to receive a booster. Students were recruited via Amazon mTurk and the Office of the Registrar at a U.S. state university. We used binary logistic regression to examine associations between students' psychosocial factors and full COVID-19 vaccination status. Hierarchical multiple regression was employed to evaluate relationships between these factors and students' intentions to receive a booster. The majority of students in our sample (81% of international students and 55% of domestic students) received the complete vaccination series. Attitudes were significantly associated with all students' full vaccination status, while perceived behavioral control was significantly associated with domestic students' status. Students' intentions to receive COVID-19 vaccines were significantly correlated with their intentions to receive a booster, with international students scoring higher on booster intentions. Among the combined college student population, attitudes, intentions to receive COVID-19 vaccines, and subjective norms were significantly related to students' intentions to receive a booster. Findings support the TPB's potential utility in evidence-based interventions to enhance college students' COVID-19 vaccination rates. Implications for stakeholders and future research directions are discussed.

Intervention to increase physical activity and healthy eating among under-represented adolescents: GOAL trial protocol.

INTRODUCTION: To reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition recommendations is important. To address the problem, a 16-week intervention called Guys/Girls Opt for Activities for Life (GOAL) was designed. The purpose of this randomised controlled trial is to evaluate any effect of the intervention, compared with a control condition, on improving: (1) adolescents' % body fat (primary outcome), moderate-to-vigorous PA (MVPA), diet quality and cardiorespiratory fitness from 0 to 4 months; (2) body mass index (BMI), overweight/obesity percentage and quality of life from 0 to 4 months and to 13 months; and (3) perceived social support, self-efficacy and motivation from 0 to 4 months with evaluation of any mediating effect on adolescent PA and diet quality. An exploratory aim is to evaluate any effect of the intervention, compared with the control, on improving parents'/guardians' home environment, MVPA and diet quality from 0 to 4 months; and BMI from 0 to 4 months and to 13 months. METHODS AND ANALYSIS: Adolescents (fifth to eighth grade) in 14 schools located in underserved urban communities are randomly assigned to the intervention or usual school offerings. One parent per adolescent is enrolled (882 dyads total). Cohort 1 includes four schools (2022-2023). Cohorts 2 and 3 include 5 schools in 2023-2024 and 2024-2025, respectively. The 16-week intervention has three components: (1) after-school GOAL club for adolescents to engage in PA and healthy eating/cooking activities; (2) three parent-adolescent meetings to empower parents to assist adolescents; and (3) GOAL social networking website for parents to share how they helped their adolescent. ETHICS AND DISSEMINATION: The Michigan State University Biomedical Institutional Review Board provided ethical approval for the study. Findings will be shared via the trial registration database, peer-reviewed publications, conferences and community-oriented strategies. TRIAL REGISTRATION NUMBER: NCT04213014.

Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis.

BACKGROUND: Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed. AIMS: The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents. METHODS: Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators. RESULTS: The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17). CONCLUSIONS: These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

The role of psychosocial factors and biological sex on rural Thai adolescents' drinking intention and behaviours: A structural equation model.

AIMS: To examine the contributions of psychosocial factors (attitude towards drinking, perceived drinking norms [PDNs], perceived behavioural control [PBC]), and biological sex on drinking intention and behaviours among rural Thai adolescents. DESIGN: A cross-sectional study design. METHODS: In 2022, stratified by sex and grade, we randomly selected 474 rural Thai adolescents (Mage = 14.5 years; SD = 0.92; 50.6% male) from eight public district schools in Chiang Mai Province, Thailand, to complete a self-administered questionnaire. Structural equation modelling with the weighted least square mean and variance adjusted was used for data analysis. RESULTS: All adolescents' psychosocial factors contributed significantly to the prediction of drinking intention, which subsequently influenced their drinking onset, current drinking and binge drinking pattern in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention, followed by PBC. Rural adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviours either fully or partially. The path coefficient between drinking attitude and drinking intention was significantly different between males and females. CONCLUSION: Different from previous studies focus on adolescents' drinking attitude, rural Thai adolescents' PDNs play a significant role on their drinking intention and subsequently their drinking onset and patterns. This nuanced understanding supports a paradigm shift to target adolescents' perceived drinking norms as a means to delay their drinking onset and problematic drinking behaviours. IMPACT: Higher levels of perceived drinking norms significantly led to the increase in drinking intention among adolescents. Minimizing adolescents' perceptions of favourable drinking norms and promoting their capacity to resist drinking, especially due to peer pressure, are recommended for nursing roles as essential components of health education campaigns and future efforts to prevent underage drinking. PATIENT OR PUBLIC CONTRIBUTION: In this study, there was no public or patient involvement.

Happy Family, Healthy Kids: A Healthy Eating and Stress Management Program in Low-Income Parent-Preschooler Dyads.

BACKGROUND: Substantial effort has been invested to combat childhood obesity, but overall effects are disappointing, especially in low-income racial minority children. One possible reason is a lack of focus on the important stress-eating connection. Stress can negatively influence eating behaviors, leading to an increased appetite for high-fat and energy-dense foods. OBJECTIVE: This study aimed to evaluate the preliminary effects of a healthy eating and stress management program targeting multiple theoretical variables on improving eating behavior (dyads' fruit/vegetable intake, emotional eating), food insecurity, anthropometric characteristics (dyads' body mass index, % body fat), cardiovascular health (dyads' blood pressure), and mental well-being (parental stress). METHODS: A one-group, quasi-experimental pilot study was conducted among 107 low-income parent-preschooler dyads. The 14-week program included a parent component, a parent-preschooler learning component, and a day care-based preschooler component. RESULTS: The program had positive effects on improving dyads' fruit/vegetable intake, food insecurity, body mass index, and blood pressure and parents' nutrition knowledge, self-efficacy, support, food resource management behavior, problem-focused coping, and home eating environment. The overall satisfaction rate was 95.2%, and 88.1% stated that the program assisted their families with having a healthy lifestyle. DISCUSSION: Results support the preliminary effects of the program on improving health outcomes in rural and urban low-income families. Although warranting further investigation with a more rigorous randomized controlled trial, the healthy eating and stress management program provides a potential solution to the current coexistence of an obesity epidemic and mental health crisis.

Anaesthesia-related cognitive dysfunction following cardiothoracic surgery in late middle-age and younger adults: A scoping review.

AIM: This review aimed to evaluate factors associated with anaesthesia-related postoperative cognitive dysfunction (POCD) among adults younger than 65 years who underwent cardiothoracic surgeries. STUDY DESIGN: A systematic keyword search, following the scoping review framework, was performed in the PubMed and CINAHL databases. Original English-language studies that included adults younger than 65 years and addressed cognitive function after surgery along with anaesthesia management were included. Retrospective studies, animal research and in vitro and in vivo studies were excluded. RESULTS: Twenty-three articles were included (65.2% interventional studies). All studies lacked theoretical or conceptual frameworks. Ketamine's neuroprotective potential is questionable, and intravenous lidocaine may be considered a possible early agent for preventing POCD, but long-term effectiveness is uncertain. Compared to inhalational anaesthesia, total intravenous anaesthesia (TIVA) may be related to a decreased incidence of POCD. Variation in POCD assessment impacted the lack of homogeneity in obtained data. Moreover, the shorter-term timing of POCD evaluation such as in early days after surgery could be greatly influenced by medication and delirium. CONCLUSION: Although strategies such as TIVA, the use of neuroprotective anaesthetics and comprehensive preoperative assessments are suggested to prevent POCD, this multifactorial phenomenon cannot be explicitly attributed solely to anaesthetics or anaesthesia-related techniques. Use of standardized, reliable and valid tools for POCD assessment is encouraged for cross-study comparison. RELEVANCE TO CLINICAL PRACTICE: Nurses and certified nurse anaesthetists must be aware of risk factors for postoperative delirium and POCD so they can assess patients before and after surgery. Patients and caregivers need to be educated about cognitive changes after surgery and advised to report them to their health care provider if they occur.

Teaching Social Determinants of Health in Nursing Programs: An Integrative Review of Strategies and Effectiveness.

BACKGROUND: Incorporating social determinants of health (SDoH) into clinical decision-making can clarify disease causes, enhance care planning, and improve health outcomes. Nurse educators should know which strategies are most effective for teaching SDoH in bachelor of science in nursing (BSN) programs. OBJECTIVE: This integrative review synthesizes the literature on familiarizing BSN students with SDoH and identifies effective teaching interventions for SDoH in these programs. METHODS: The researchers searched CINAHL, PubMed, Web of Science, and ERIC databases, and 21 articles met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines were followed for reporting. RESULTS: The curriculum method, service learning, and international outreach experiences were frequently used teaching strategies. Qualitative evaluation was used to evaluate student outcomes. CONCLUSIONS: Nurse educators should be mindful of these strategies. Interdisciplinary teamwork can bolster students' understanding of disadvantaged populations while integrating SDoH in nursing curricula. Quantitative evaluations of learning outcomes are needed to determine teaching effectiveness.

Elevated parent and child hair cortisol moderated the efficacy of a mindful eating intervention.

To explore whether elevated baseline hair cortisol moderated effects of a mindful eating intervention on anthropometrics, blood pressure (BP), household food insecurity, eating behaviour, and various psychosocial outcomes. The 14-week intervention included a parent Facebook-based programme, 3 parent meetings, preschooler letters connecting school learning to home practices, and a preschool-based mindful eating programme. Among 107 parent-preschooler dyads, mean age was 47.32 months for preschoolers and 30.12 years for parents. Among preschoolers, 54.2% were female, 8.4% were Hispanic, and 19.6% were Black. Among parents, 95.3% were female, 6.5% were Hispanic, 15.0% were Black, 39.4% were single, and 43.4% were unemployed. Preschoolers' elevated hair cortisol was related to a smaller reduction in preschoolers' % body fat (r =.31) and smaller increases in parents' perceived responsibility for child feeding (r = -.37). Parents' elevated hair cortisol was associated with smaller decreases in preschoolers' emotional eating (r = .39) and household food insecurity (r = .44). Relationships between baseline hair cortisol and post-intervention outcomes (BP, emotional eating, fruit/vegetable intake, food insecurity, and coping) varied by baseline values of outcome variables. Given that stress may attenuate intervention effects, a stress management component may be necessary to foster positive behavioural changes. Moreover, interventions should be tailored according to participants' characteristics to achieve optimal effects.

Embracing parenting role in childhood obesity.

Active parental engagement is crucial in controlling childhood obesity. However, optimal strategies to engage parents and mechanisms linking parents' involvement to childhood obesity prevention need further investigation. In this editorial, we provide a background to invite contributions to the BMC Public Health collection titled 'Parenting role in childhood obesity'.

Effects of mindfulness-based interventions on anthropometric outcomes: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: The effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF). METHODS: Seven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge's g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics. RESULTS: The pooled effect size was -0.36 (p < .001) on BMI, -0.52 (p < .001) on WC, -1.20 (p < .004) on weight loss, and -0.43 (p = .389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (-0.37, p = .027; -.24, p = .065) and weight loss (-1.91, p = .027; -0.74, p = .011) respectively. For weight loss, adding mindful movement had greater effects than those without (-2.65 vs -0.39, p < .001). CONCLUSION: Our findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF.

Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioral Outcomes.

BACKGROUND: Currently, the effects of motivational interviewing (MI) on children's behavioral changes remain obscure. PURPOSE: This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes (fruits and vegetables [F/V], dairy, sugary beverages, calories, snacks, fat intake, moderate vigorous physical activity [MVPA], and screen time). METHODS: Six databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2022 were searched. Thirty-one intervention studies with a comparison group met the criteria. Random-effects models were performed to estimate the pooled effects; exploratory moderation analyses with mixed-effects models were used to explore potential intervention moderators. RESULTS: The pooled effect size was 0.10 (p = .334) on ↑F/V, 0.02 (p = .724) on ↑dairy, -0.29 (p < .001) on ↓calories, -0.16 (p = .054) on ↓sugary beverages, -0.22 (p = .002) on ↓snacks, -0.20 (p = .044) on ↓fat, 0.22 (p = .001) on ↑MVPA, and -0.06 (p = .176) on ↓screen time. The effects of MIs were moderated by ↑MI sessions regarding ↓snacks (B = -0.04, p = .010). Multicomponent and clinical programs had greater effects on dairy intake than their counterparts (0.09 vs. -0.21, p = .034; 0.12 vs. -0.14, p = .027, respectively). Similarly, interventions with a fidelity check resulted in greater dairy intake than those without a check (0.29 vs. -0.15, p = .014). A few long-term follow-up assessments revealed effects on ↓F/V (-0.18; p = .143, k = 2), ↓dairy (-0.13, p = .399, k = 4), ↓MVPA (-0.04; p = .611, k = 6), and ↑screen time (0.12; p = .242, k = 4). CONCLUSIONS: Our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Although motivational interviewing (MI) techniques are often recommended and used by clinicians to promote healthy behaviors, their effects on children's behavioral changes are not clear. This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes particularly in children's intakes in fruits and vegetables, dairy, sugary drinks, calories, snacks, and high-fat diet, as well as children's physical activity and screen time. A total of 957 articles from six databases were screened for eligibility. Among them, 31 eligible articles were retrieved for knowledge synthesis. This review found that MI techniques were effective in lowering children's intakes in calories, sugary drinks, snacks, high-fat diets. In addition, MI techniques were also effective in promoting children's moderate to vigorous physical activities. It seemed that more MI sessions were more likely to decrease children's snacks intakes. Taken together, our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Associations between hair cortisol and blood pressure: a systematic review and meta-analysis.

OBJECTIVE: Stress is widely considered to be a risk factor for high blood pressure (BP), but evidence on the associations between biomarkers of chronic stress and BP is inconsistent. This systematic review and meta-analysis assessed the current state of the science on relationships between measures of cortisol concentration reflecting chronic stress exposure [hair cortisol concentration (HCC), nail cortisol concentration)] and BP. METHODS: PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, and Embase were searched. Random effects models were used to assess the pooled effect size. Exploratory moderation analysis was performed. RESULTS: Out of 34 014 identified, 16 articles met eligibility criteria and were included in the review, while 14 were included in the meta-analysis. No articles were reported on the association between nail cortisol concentration and BP. Small, positive associations were observed between HCC and SBP [ r  = 0.19 (95% confidence interval (CI): 0.08-0.29)] and HCC and DBP [ r  = 0.13 (95% CI: 0.04-0.22)]. Cortisol analysis method was identified as a significant moderator of the association between HCC and DBP. HCC was largely, positively associated with hypertension status [odds ratio = 3.23 (95% CI: 2.55-4.09), P  < 0.001]. CONCLUSIONS: Current evidence suggests that higher HCC may be associated with elevated BP and a potential risk factor for hypertension. However, results should be interpreted with caution because HCC can be affected by hair color, hair care products, and analytic methods. Given the limitations of studies included in this review, further research is needed.

Vaccination rates among international students: Insights from a university health vaccination initiative.

Objective: To examine the effects of a university's health vaccination initiative in increasing vaccination rates among international students/scholars in the United States. Methods: The vaccination initiative included: increasing vaccination opportunities by holding a pre-registration event, providing vaccine recommendations from healthcare professionals including a bilingual health interpreter, implementing campus-based marketing strategies, sending reminders using social media, and offering free and affordable vaccines. Results: Total 575 international students/scholars attended from 2016 to 2019 (N = 118, 163, 193, and 101, respectively), showing an increase compared to 2015. The most common vaccines administered were for influenza, human papillomavirus (HPV), tetanus, diphtheria, and acellular pertussis (Tdap), and Hepatitis A. Slightly less than one-quarter of participants received three or more vaccines. More women than men received HPV vaccine. Participants shared they would not have been vaccinated without this initiative and wished for more vaccination events. Conclusions: Future efforts are needed to implement this initiative across universities to further evaluate its effectiveness.

Organized Physical Activity Program Participation, Physical Activity, and Related Psychosocial Factors Among Urban Adolescents.

The study purpose was to examine whether adolescents who participated in organized physical activity (PA) programs differed from nonparticipants in motivation, social support, and self-efficacy related to PA; PA (min/hr); and sedentary screen time behavior. Thirty-nine 5th-7th grade adolescents participated in organized PA programs; 41 did not. Approximately 56.3% were Black, and 52.5% had annual family incomes <$20,000. Compared to nonparticipants, those who participated reported significantly higher social support (M = 2.32 vs. 3.13, p < .001) and fewer hours watching television or movies on a usual weekend day (M = 2.49 vs. 1.59, p = .016); and had higher accelerometer-measured vigorous PA (M = 0.58 vs. 1.04, p = .009) and moderate-to-vigorous PA (M = 2.48 vs. 3.45, p = .035). Involving adolescents in organized PA programs may be important for improving their moderate-to-vigorous PA, vigorous PA, and related psychosocial factors, as well as reducing sedentary screen time behavior.

Psychosocial Determinants of Recommended Lifestyle Behaviors among Hypertensive Patients: An Integrative Literature Review.

Healthy lifestyle levels are low among adults with hypertension (HTN). Unfortunately, psychosocial factors contributing to patients' inability to meet healthy lifestyle recommendations are not well-understood. This integrative review examined the relationships of three psychosocial factors (self-efficacy, outcome expectancy, and social support) with dietary adherence (DA) and physical activity (PA) among adults with HTN. In total, 24 peer-reviewed studies were assessed. Results showed self-efficacy had small-to-large relationships with PA (r = 0.02-0.46) and DA (r = 0.06-0.79), with the strength of the associations varying by the assessed domain and country of origin. However, few studies reported a small relationship between the remaining factors (outcome expectancy and social support) and PA and DA. Thus, more efforts are needed to delineate the contributions of social support and outcome expectancies on DA or PA. When designing an intervention that focuses on improving PA or DA among adults with HTN, these psychosocial factors should be targeted.

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis.

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.

Physical activity and body mass index were interactively related to health-related quality of life among older adults.

PURPOSE: The purpose of this study was to examine how meeting physical activity (PA) guidelines (i.e., moderate-to-vigorous aerobic activity, muscle strengthening activity) and weight status were interactively related to health-related quality of life (HRQoL) among older adults. METHODS: A cross-sectional analysis was conducted using data from 87,495 older adults aged 65+ years who participated in the U.S. 2019 Behavioral Risk Factor Surveillance System. PA, weight status, and HRQoL were assessed by validated questionnaires via phone interviews. Binomial logistic regression models were used to examine the interactive effects of meeting PA guidelines and weight status on the odds of having poor HRQoL after controlling for key confounders. RESULTS: Compared to participants meeting both PA guidelines and with normal weight, both underweight and obese older adults had significantly higher odds of having poor general health (OR= 1.55-6.16) regardless of meeting PA guideline status, and those meeting muscle strengthening activities only or meeting neither PA guideline reported higher odds of poor physical health (OR= 1.83-6.22) regardless of weight status. Similarly, those meeting neither PA guideline had significantly higher odds of having poor mental health (OR= 1.69-2.78) regardless of weight status, and those meeting muscle strengthening activities only or meeting neither PA guideline reported higher odds of having frequent activity limitation days (OR= 2.18-7.05). CONCLUSIONS: The positive associations between moderate-to-vigorous aerobic PA and HRQoL indicate the need to promote aerobic PA in older adults. Both sex and weight status should be considered when designing PA interventions to improve HRQoL among older adults.