Factors influencing the continuance intention of the women's health WeChat public account: an integrated model of UTAUT2 and HBM.

Background: Women's health WeChat public accounts play a crucial role in enhancing health literacy and fostering the development of healthy behaviors among women by disseminating women's health knowledge. Improving users' continuous usage behavior and retention rates for the women's health WeChat public account is vital for influencing the overall effectiveness of health communication on WeChat. Objective: This study aimed to construct a comprehensive model, delving into the key factors influencing women's continuance intention of the women's health public accounts from the perspectives of perceived health threats, individual abilities, and technological perceptions. The goal is to provide valuable insights for enhancing user stickiness and the effectiveness of health communication on WeChat public accounts. Method: An online survey was conducted among women receiving gynecological care at a certain hospital to gage their willingness for sustained use of the women's health WeChat public accounts. Through structural equation modeling, the study investigated the influencing factors on women's sustained intention to use the women's health WeChat public accounts. Results: The study included a total of 853 adult women. Among them, 241 (28.3%) women had followed women's health official accounts in the past but do not currently follow them, 240 (28.1%) women had followed women's health official accounts in the past and are still following them, and 372 (43.6%) women had never followed women's health official accounts. Currently, 240 women are still browsing women's health public accounts, 52 of whom read women's health public accounts every day, and most of them read women's health public accounts for 10-20 min at a time (100, 11.7%). The results of the structural equation model revealed that performance expectancy, social influence, hedonic motivation, habit, and e-health literacy had significantly positive effects on women's sustained intention to use public accounts (performance expectancy: ß = 0.341, p < 0.001; social influence: ß = 0.087, p = 0.047; hedonic motivation: ß = 0.119, p = 0.048; habit: ß = 0.102, p < 0.001; e-health literacy: ß = 0.158, p < 0.001). E-health literacy and self-efficacy indirectly influence sustained intention by affecting performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, and habit. The effect sizes of e-health literacy on performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, and habit were 0.244 (p < 0.001), 0.316 (p < 0.001), 0.188 (p < 0.001), 0.226(p < 0.001), 0.154 (p < 0.001), and 0.073 (p = 0.046). The effect sizes of self-efficacy on performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, and habit were 0.502 (p < 0.001), 0.559 (p < 0.001), 0.454 (p < 0.001), 0.662 (p < 0.001), 0.707 (p < 0.001), and 0.682 (p < 0.001). Additionally, perceived severity and perceived susceptibility indirectly affected sustained intention by influencing performance expectancy and social influence. The effect sizes of perceived severity on performance expectancy and social influence were 0.223 (p < 0.001) and 0.146 (p < 0.001). The effect size of perceived susceptibility to social influence was 0.069 (p = 0.042). Conclusion: Users' e-health literacy, self-efficacy, perception of disease threat, and users' technological perceptions of the WeChat public accounts are critical factors influencing women's continuance intention of using the WeChat public accounts. Therefore, for female users, attention should be given to improving user experience and enhancing the professionalism and credibility of health information in public account design and promotion. Simultaneously, efforts should be made to strengthen users' health awareness and cultivate e-health literacy, ultimately promoting sustained attention and usage behavior among women toward health-focused public accounts.

Nonlinear relationships between sleep duration, mental health, and quality of life: The dangers of less sleep versus more sleep.

BACKGROUND: Recent research has found a non-linear relationship between sleep duration and mental health/quality of life. However, it is currently unclear which age group is more affected by sleep duration and what the optimal sleep duration is for each age group. Additionally, the underlying mechanisms of the non-linear relationship between sleep duration and quality of life are not well understood. METHODS: Therefore, this study utilized questionnaire data from 20,962 participants in the Chinese PBICR-2022 database(Cross-sectional study) and constructed models to analyze the relationship between sleep duration and quality of life. RESULTS: The results showed that the optimal sleep duration varied among different age groups: approximately 9 h for adolescents, 8 h for early/middle-aged adults, and 7 h for older adults. Compared to other age groups, less or more sleep duration had a greater impact on mental health and quality of life in adolescents. Furthermore, mental health was found to play a significant mediating role between sleep duration and quality of life in both the less sleep group and the more sleep group, but this mediating effect was not significant among the older adults in the less sleep group, whereas the mediating effect of mental health was not significant among the middle-aged adults in the more sleep group. CONCLUSIONS: This suggests that different age groups have different optimal sleep duration, and age may be an important factor influencing the relationship between sleep duration and mental health/quality of life, with mental health playing a mediating role in the relationship between sleep duration and quality of life.

[Factors associated with the care needs of the older adults based on different disability levels].

OBJECTIVE: To identify the factors associated with the care needs of the older adults aged 65-105 by age groups, and to compare these factors across different age groups. METHODS: A total of 12 244 older adults from the Chinese longitudinal healthy longevity survey (CLHLS) conducted in 2018 were included in the analyses. The participants were categorized into three age groups: young-old (aged 65-79), middle-old (aged 80-89), and oldest-old (aged 90-105). The level of disability was measured by the disability index (DI) in four dimensions, reflecting their care needs. Potential factors associated with care needs were selected based on the health ecological model (HEM), including perspectives of personal characteristics, behavioral characteristics, interpersonal network, living and working conditions, and policy environment. Multifactor analysis was performed using multinomial Logistic regression. RESULTS: Among China ' s 12 244 older adults, 43.4% had medium or high care needs. Factors for higher care needs of older adults included higher age, higher number of chronic diseases, no exercise habit, excessive sleep duration (≥9 h/d), depressive tendency, living with children or spouse, and uneducated (all P < 0.05). In addition, the young-old group who were past smokers (OR=2.009, 95% CI: 1.019-3.959), were past drinkers (OR=2.213, 95% CI: 1.141-4.291), and reported self-perceived poverty (OR=2.051, 95% CI: 1.189-3.540), had higher level of care needs. The middle-old group who were female (OR=1.373, 95% CI: 1.038-1.817), never drank alcohol (OR=1.551, 95% CI: 1.059-2.269), and were lack of medical insurance (OR=1.598, 95% CI: 1.053-2.426), and had higher level of care needs. The oldest-old group who were female (medium care needs vs. low care needs: OR=1.412, 95% CI: 1.062-1.878; high care needs vs. low care needs: OR=1.506, 95% CI: 1.137-1.993), reported self-perceived poverty (OR=2.064, 95% CI: 1.282-3.323), and were lack of medical insurance (OR=1.621, 95% CI: 1.148-2.291), and had higher level of care needs. CONCLUSION: The identical factors associated with care needs across different age groups include age, chronic disease, exercise, sleep, depression, living arrangement, and education. Smoking, alcohol consumption, and economic status are specific factors among the young-old group of the older adults, while gender and medical insurance are specific factors among the middle-old and the oldest-old group of the older adults. We recommend conducting prospective cohort studies and intervention studies among specific age groups on the above factors to provide reliable evidence for policy formulation.

Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12-18 in China: a cross-sectional study.

The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.

How is family health related to health-related quality of life among middle-aged and older adults in rural China? A cross-sectional study.

BACKGROUND: Health-related quality of life (HRQOL) is unequal between countries and regions, and the emphasis on HRQOL of populations of low-income countries and regions is unprecedented. OBJECTIVES: To examine the association between family health and HRQOL among middle-aged and older adults in rural China, and determine whether this association differs by age, gender and chronic disease subgroup. METHODS: Cross-sectional survey carried out from July to September 2021. The participants were 1059 people aged 46 and over living in rural China. We used the European Quality of Life Five Dimension Five Level (EQ-5D-5L) and Family Health Scale-Short Form (FHS-SF) to assess health-related quality of life (HRQOL) and family health, respectively. RESULTS: The mean EQ-VAS was 75.66, the mean EQ index score was 0.92, and the mean FHS was 37.90 in rural middle-aged and older adults. After Bonferroni correction, generalised linear regression models showed that FHS was significantly associated with the EQ-VAS (ß = 0.829; 95% confidence interval [CI]: 0.660 to 0.997; p < .001) and the EQ index score (ß = 0.003; 95%CI: 0.001 to 0.004; p < .001). Binary logistic regression models showed that FHS was associated with three dimensions of HRQOL (mobility, self-care and usual activities) (p < .01). Based on subgroup analyses, the effect of FHS on EQ-VAS and the EQ index score was significant in three subgroups after Bonferroni correction (p < .01), but the association between FHS and the dimensions of HRQOL differed by age, gender and chronic disease group (p > .01). CONCLUSIONS: This study is the first to explore that family health and its dimensions are significant positive predictors of HRQOL among middle-aged and older adults in rural China. Family-based measures may have more potential and value because better family health significantly improves HRQOL. IMPLICATIONS FOR PRACTICE: In the health strategy, the government and primary health care workers should include family health as an indicator and assess it before and after the implementation of the strategy.

Thirdhand smoke beliefs, exposure status and associated factors among young people in China: A cross-sectional study.

INTRODUCTION: Thirdhand smoke is an emerging threat to global public health. There is no research on young people's exposure to thirdhand smoke in China. This study aims to investigate the exposure status and beliefs of thirdhand smoke among young Chinese people and provide a reference for policy regarding thirdhand smoke. METHODS: Data from the 2022 Chinese Resident Psychological and Behavioral Survey were used to select young people aged 15-24 years. A total of 11781 subjects were included in this study. Demographic information, beliefs about thirdhand smoke, and exposure status to thirdhand smoke were investigated. RESULTS: Among the participants, 47.8% reported being exposed to thirdhand smoke (males: 49.1%, females: 47.0%). Young people living in urban areas (AOR=0.84, 95% CI: 0.77-0.91, p<0.001) and those with a monthly family income >12000 RMB (AOR=0.81, 95% CI: 0.71-0.92, p=0.001) were less likely to be exposed to thirdhand smoke. Young people with junior high school education or higher, and current or former smokers, were more likely to be exposed to thirdhand smoke. There is room for improvement in the beliefs about thirdhand smoke among young people. CONCLUSIONS: Thirdhand smoke exposure is an issue that should be addressed in public health policy. Young people with low income and current or former smokers are populations that should be mainly focused on in public education and prevention work on thirdhand smoke.

The influence of media use degree on public depressive symptoms: mediating role of big five personality.

BACKGROUND: Mixed results have been found regarding the relationship between media use degree and depressive symptoms. The purpose of this study is to explore the relationship between media use degree, big five personality and depressive symptoms with a mediation model. METHOD: This was a cross-sectional study. With 9-item Patient Health Questionnaire (PHQ-9), 10-item Big Five Inventory (BFI-10) and self-designed media usage scale, 11,031 participants aged 12 and above in 120 cities in China were collected. Pearson correlation analysis and regression analysis were performed on the data. The Process plug-in was used to construct the mediation model and explore the relationship among media use degree, big five personality and depressive symptoms. The nonparametric percentile Bootstrap method was used to test the mediating effect of personality traits. RESULTS: The degree of media use was positively correlated with depressive symptoms (r = 0.20, P < 0.001), and big five personality played a mediating role between the degree of media use and depressive symptoms. Among five traits, extroversion (r=-0.12, P < 0.001), conscientiousness (r=-0.23, P < 0.001), openness (r=-0.03, P < 0.01) and agreeableness (r=-0.22, P < 0.001) were negatively correlated with depressive symptoms, and neuroticism (r = 0.25, P < 0.001) were positively correlated with depressive symptoms. In addition, extraversion (-0.004, -0.001), conscientiousness (-0.015, -0.008), agreeableness (-0.008, -0.001) and neuroticism (-0.015, -0.007) in big five personality played a mediating role between media use and depressive symptoms. CONCLUSION: The degree of media use positively predicted depressive symptoms, and excessive media use may bring risks to mental health. People with high neuroticism, low agreeableness, low conscientiousness and low extroversion are more likely to suffer from depressive symptoms.

Public's preferences for health science popularization short videos in China: a discrete choice experiment.

Background: Health science popularization short video disseminates health information to the public in an understandable way about health information. Objective: To investigate the preferences of Chinese residents for health science popularization short videos and provide suggestions for optimizing the production of short videos. Methods: An online survey of Chinese people was conducted using a self-administered questionnaire, and a discrete choice experiment (DCE) was used to explore the public's preferences for health science popularization short videos. Results: A total of 618 respondents were included, of which 306 (45.51%) were male and 312 (50.49%) were female, 271 (43.85%) were aged 18-25, 239 (38.67%) were aged 26-60, and 108 (17.48%) were aged 60 and above. Whether the video is charged or not (46.891%) and the account subject (28.806%) were both considered important. The results of the DCE revealed that the participants considered video free of charge as the most significant attribute of health science popularization short videos (OR 3.433, 95% CI 3.243-3.633). Overall, participants preferred and were more willing to pay for health science popularization short videos with a hospital account subject (OR 1.192, 95% CI 1.116-1.274), with the form of graphic narration (OR 1.062, 95% CI 1.003-1.126), free of charge (OR 3.433, 95% CI 3.243-3.633), with the content that satisfies their needs (very much needed: OR 1.253, 95% CI 95% CI 1.197-1.311; generally needed: OR 1.078, 95% CI 1.029-1.129), with platform certification (OR 1.041, 95% CI 1.011-1.073), without commercial advertisements (OR 1.048, 95% CI 1.018-1.080), with simple-to-understand content (OR 1.071, 95% CI 1.040-1.104), and with video content that evokes fear or dread of illness in the viewer (OR 1.046, 95% CI 1.015-1.078). Conclusion: Participants favor free health popularization short videos, which are hospital accounts, with content that is illustrated, understandable, meets their needs, and can serve as a warning. In the future, the production of health popularization short videos should focus on improving the diversity and relevance of video content, making it as easy to understand to achieve good science popularization effects.

Exploring factors that influence the behavioural intention of medical students to use 3D gastroscopic model to learn how to operate gastroscope using UTAUT Model.

BACKGROUND: The application of virtual reality (VR) in gastroscopic operation teaching can be safe and effective, but the advantages can be realized only when students accept and use it. This study aims to identify the factors influencing Chinese clinical medical postgraduates on their intention to use the 3D gastroscopic model constructed based on VR technology using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Students' demographic factors are also taken into consideration. METHODS: All methods were carried out in accordance with relevant guidelines. Data were collected from clinical medical postgraduates students in China using stratified sampling. A total of 292 questionnaires including valid responses were used in this study. Data were processed using Amos 24.0 and SPSS 26.0 software and the statistical analysis technique was based on structural equation modeling (SEM). RESULTS: The results showed that different from the mediator of home location and year of clinical learning, mediator of gender, university kind and graduate degree did not affect the behavioral intention. In addition, performance expectancy, facilitating condition, and social influence directly and indirectly have effect on behavioral intention. Also, the significance between social influence and performance expectancy, social influence and effort expectancy were verified. CONCLUSIONS: This study manifested that the proposed framework based on the UTAUT had explanatory power to identify the factors influencing the students' behavioral intention to use the 3D gastroscopic model constructed based on VR technology. Whereas, an important variable of effort expectancy in the frame of the SEM were not certified, thereby indicating that particular attention should be paid to this variable by universities and teachers before applying 3D gastroscopic model constructed based on VR technology in teaching. Added preparatory work is required such as explaining the basic knowledge of the operating steps of VR model and make students adequately understand its accessibility, which can probably improve the intentions of them to use it. The positive effects of social influence on performance expectancy and effort expectancy we proposed was also verified in this study, which provided a direction for future research.

Public Attitudes About the Use of Gene Therapy in Mainland China.

Importance: In addition to technical barriers, public attitudes about the use of gene therapy have an important association with the clinical implementation of gene therapy. Objective: To investigate the factors associated with public acceptance of gene therapy among individuals in China. Design, Setting, and Participants: This cross-sectional study used data from a survey conducted among 21 880 individuals in mainland China from June 20 to August 31, 2022. Main Outcomes and Measures: Stepwise linear regression was used to analyze factors associated with public acceptance of gene therapy in 5 key areas: basic personal information (gender, region, age, and educational level), family situation (marital status, children, and cousins), economic status (assets, debts, and insurance coverage), health knowledge (health literacy score and media use), and physical health status (chronic illness, cancer, European Quality of Life 5-Dimension 5-Level version [EQ-5D-5L] score, and Brief Illness Perception Questionnaire [BIPQ] score). Acceptance scores were calculated based on a visual analog scale (range, 0-100, with higher scores indicating higher acceptance of gene therapy). Further subgroup analysis was carried out in different age subgroups and populations with or without chronic diseases. Results: A total of 21 880 participants (mean [SD] age, 39.4 [18.9] years; 10 947 female participants [50.0%]; 10 933 male participants [50.0%]) were analyzed in this study. The mean (SD) acceptance score of gene therapy in the survey was 60.56 (27.60). Compared with people aged 60 years or older, those aged 12 to 18 years had higher acceptance of gene therapy (ß = 1.48 [95% CI, 0.09-2.88]), while groups aged 19 to 30 years (ß = -3.43 [95% CI, -4.80 to -2.07]), 31 to 44 years (ß = -1.44 [95% CI, -2.76 to -0.12]), and 45 to 59 years (ß = -2.05 [95% CI, -3.27 to -0.83]) had lower acceptance. Compared with people living in Eastern China, those in Central China had lower acceptance of gene therapy (ß = -1.58 [95% CI, -2.54 to -0.62]), while those in Western China had higher acceptance (ß = 0.92 [95% CI, 0.09-1.76]). Higher educational level (undergraduate or above vs junior high or below) was associated with higher acceptance of gene therapy (ß = 1.56 [95% CI, 0.49-2.63]). Number of properties owned was also associated with higher acceptance of gene therapy (2 vs 0: ß = 2.38 [95% CI, 1.04-3.72]; ≥3 vs 0: ß = 4.66 [95% CI, 2.92-6.39]). Diagnosis of chronic disease was associated with lower acceptance of gene therapy (ß = -17.86 [95% CI, -20.49 to -15.24]), while diagnosis of cancer was associated with higher acceptance (ß = 6.99 [95% CI, 1.84-12.14]). Higher BIPQ score (ß = 0.40 [95% CI, 0.34-0.45]), higher health literacy score (ß = 0.70 [95% CI, 0.62-0.78]), and media use (ß = 0.49 [95% CI, 0.41-0.57]) were all associated with high acceptance of gene therapy, while a higher EQ-5D-5L score was associated with lower acceptance (ß = -0.29 [95% CI, -0.47 to -0.11]). For older people, being in debt, not having health insurance, and the EQ-5D-5L score were uniquely relevant factors. For people with chronic disease, having an undergraduate degree or higher, a diagnosis of cancer, and the BIPQ score were uniquely relevant factors. Conclusions and Relevance: These results suggest that basic personal information, economic status, health knowledge, and physical health status were the main factors associated with the acceptance of gene therapy. Improving the health literacy of the population and promoting trust in gene therapy may be effective ways to increase the acceptance of gene therapy. Poorer economic levels and worse disease states may reduce the public's willingness to accept gene therapy.

Effect of Artificial Intelligence-based Health Education Accurately Linking System (AI-HEALS) for Type 2 diabetes self-management: protocol for a mixed-methods study.

BACKGROUND: Patients with type 2 diabetes (T2DM) have an increasing need for personalized and Precise management as medical technology advances. Artificial intelligence (AI) technologies on mobile devices are being developed gradually in a variety of healthcare fields. As an AI field, knowledge graph (KG) is being developed to extract and store structured knowledge from massive data sets. It has great prospects for T2DM medical information retrieval, clinical decision-making, and individual intelligent question and answering (QA), but has yet to be thoroughly researched in T2DM intervention. Therefore, we designed an artificial intelligence-based health education accurately linking system (AI-HEALS) to evaluate if the AI-HEALS-based intervention could help patients with T2DM improve their self-management abilities and blood glucose control in primary healthcare. METHODS: This is a nested mixed-method study that includes a community-based cluster-randomized control trial and personal in-depth interviews. Individuals with T2DM between the ages of 18 and 75 will be recruited from 40-45 community health centers in Beijing, China. Participants will either receive standard diabetes primary care (SDPC) (control, 3 months) or SDPC plus AI-HEALS online health education program (intervention, 3 months). The AI-HEALS runs in the WeChat service platform, which includes a KBQA, a system of physiological indicators and lifestyle recording and monitoring, medication and blood glucose monitoring reminders, and automated, personalized message sending. Data on sociodemography, medical examination, blood glucose, and self-management behavior will be collected at baseline, as well as 1,3,6,12, and 18 months later. The primary outcome is to reduce HbA1c levels. Secondary outcomes include changes in self-management behavior, social cognition, psychology, T2DM skills, and health literacy. Furthermore, the cost-effectiveness of the AI-HEALS-based intervention will be evaluated. DISCUSSION: KBQA system is an innovative and cost-effective technology for health education and promotion for T2DM patients, but it is not yet widely used in the T2DM interventions. This trial will provide evidence on the efficacy of AI and mHealth-based personalized interventions in primary care for improving T2DM outcomes and self-management behaviors. TRIAL REGISTRATION: Biomedical Ethics Committee of Peking University: IRB00001052-22,058, 2022/06/06; Clinical Trials: ChiCTR2300068952, 02/03/2023.

Association of smoking status and nicotine dependence with multi-morbidity in China: A nationally representative crosssectional study.

INTRODUCTION: Multi-morbidity is a public health priority as it is associated with an increased risk of mortality and a substantial healthcare burden. Smoking is considered a predisposing factor for multi-morbidity, but evidence for an association between multi-morbidity and nicotine dependence is insufficient. This study aimed to explore the association between smoking status, nicotine dependence, and multi-morbidity in China. METHODS: We recruited 11031 Chinese citizens from 31 provinces in 2021 using a multistage stratified cluster sampling strategy to ensure the study population represented national population characteristics. The association between smoking status and multi-morbidity was analyzed using binary logistic regression and multinomial logit regression models. We then analyzed the associations between four kinds of smoking status (age at smoking initiation, cigarette consumption per day, smoking when ill in bed, and inability to control smoking in public places), nicotine dependence, and multi-morbidity among participants who were current smokers. RESULTS: Compared with non-smokers, the odds of multi-morbidity were higher among ex-smokers (adjusted odd ratio, AOR=1.40, 95% CI: 1.07-1.85). The risk of multi-morbidity was greater in participants who were underweight/overweight/obese (AOR=1.90; 95% CI: 1.60-2.26) compared with those who were normal weight. and also greater for drinkers (AOR=1.34; 95% CI: 1.09-1.63) than non-drinkers. Compared with children who began smoking at the age of <15 years, participants aged >18 years had a lower likelihood of multi-morbidity (AOR=0.52; 95% CI: 0.32-0.83). People who consumed ≥31 cigarettes per day (AOR=3.77; 95% CI: 1.47-9.68) and those who smoked when ill in bed (AOR=1.70; 95% CI: 1.10-2.64) were more likely to have multi-morbidity. CONCLUSIONS: Our findings show that smoking behavior, including initiation age, frequency of daily smoking, and still smoking during illness or in public, is a critical risk factor for multi-morbidity, especially when combined with alcohol consumption, physical inactivity, and abnormal weight (underweight, overweight, or obese). This highlights the crucial effect of smoking cessation in the prevention and control of multi-morbidity, especially in patients with three or more diseases. Implementing smoking and lifestyle interventions to promote health would both benefit adults and prevent the next generation from initiating habits that increase the risk of multi-morbidity.

Convenient green synthesis of Cu/Fe nanoparticles using pomegranate peel extracts and their performance for tetrabromobisphenol A removal.

In this work, pomegranate peel extracts were used as the green reducing agent to synthesize Cu/Fe nanoparticles (P-Cu/Fe nanoparticles) and removed tetrabromobisphenol A (TBBPA) in aqueous solution. P-Cu/Fe nanoparticles were amorphous and irregularly spherical. The surfaces of nanoparticles contained Fe0, Fe3+ oxides (hydroxides), and Cu0. The bioactive molecules from pomegranate peel were extremely important for the synthesis of nanoparticles. P-Cu/Fe nanoparticles had excellent removal performance for TBBPA, and 98.6% of TBBPA (5 mg L-1) was removed within 60 min. The removal reaction of TBBPA by P-Cu/Fe nanoparticles was well-fitted with the pseudo-first-order kinetic model. The Cu loading was critical for TBBPA removal with an optimum value of 1.0 wt%. A weakly acidic condition (pH 5) was more favorable for the removal of TBBPA. The removal efficiency of TBBPA increased with the rise of temperature and decreased with increasing initial TBBPA concentration. The activation energy (Ea) was 54.09 kJ mol-1, indicating that the removal of TBBPA by P-Cu/Fe nanoparticles was mainly surface-controlled. Reductive degradation was the main mechanism of TBBPA removal by P-Cu/Fe nanoparticles. In conclusion, green synthesized P-Cu/Fe nanoparticles using pomegranate peel waste show great potential for the remediation of TBBPA in aqueous solution.

Exploration into the Influencing Factors for the Intention of the Public to Vaccinate against Infectious Diseases Based on the Theory of Planned Behavior-Example of the COVID-19 Vaccine.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) was applied as an example, and the Theory of Planned Behavior (TPB) was used as a conceptual model. This study aimed to explore the impact of subjective norms (SNs), attitude towards the behavior (ATT), and perceived behavioral control (PBC) on the intention of the public for regular vaccination during COVID-19. The outcomes can provide certain recommendations for relevant policymakers in developing targeted health education intervention programs in the event of similar events. METHODS: An online survey was performed between 17 April and 14 May 2021, via the online survey platform "WENJUANXING". The multistage stratified cluster sampling was employed, and 2098 participants (1114 males; 53.10%) with a mean age of 31.22 years (SD = 8.29) completed the survey. The survey covered the factors influencing the public's intention to receive future regular vaccinations during COVID-19 based on TPB. The effects of different variables on the public's vaccination intention were analyzed using hierarchical stepwise regression. RESULTS: The public's intention to receive the COVID-19 vaccine (i.e., behavioral intention) in the future was taken as the dependent variable. Gender, age, marital status, education level, per capita monthly household income, vaccine-related knowledge, whether the COVID-19 vaccine was received, subjective norms (SNs), attitude towards the behavior (ATT), and perceived behavioral control (PBC) were used as independent variables. In this way, a hierarchical stepwise multiple regression model was developed. It can be seen from the final model that gender, age, vaccine-related knowledge, vaccination, attitude, SNs, and PBC were all influential factors in the public's intention to get vaccinated in the future, with R2 = 0.399 and adjusted R2 = 0.397 (p < 0.001). CONCLUSION: TPB explains the intention of the public to receive future vaccinations to a large extent, and ATT and SNs are the most important influencing factors. It is suggested that vaccine intervention programs be developed to enhance public awareness and acceptance of vaccination. This can be achieved in three aspects, namely, improving the ATT of the public, SNs, and PBC. Furthermore, the influence of gender, age, vaccine knowledge, and previous vaccination behavior on vaccination intention should be taken into account.

Family functioning and nicotine dependence among smoking fathers: a cross-sectional study.

BACKGROUND: Nicotine dependence is a significant public health issue, and understanding the factors associated with nicotine dependence in this population is crucial for developing effective interventions. This study examined the association between family functioning and nicotine dependence levels of smoking fathers based on the McMaster model of family functioning (MMFF), providing evidence for future interventions. METHODS: In this study, we selected fathers of first- to fifth-grade students from 10 pilot elementary schools in Qingdao whose families smoked. We used the Fagerstrom test to assess nicotine dependence and the Family Assessment Device to evaluate family functioning. We performed univariate analysis to compare differences among those with different levels of nicotine dependence, and we used an ordinal logistic regression analysis to investigate the influences related to nicotine dependence. RESULTS: This study included 874 smokers, with 78.5% having mild nicotine dependence, 11.7% having moderate dependence, and 9.84% having severe dependence. Univariate analysis showed that smokers with severe dependence had lower education levels, higher prevalence of chronic diseases, more frequent alcohol consumption, and poorer family functioning compared to those with mild to moderate dependence. Ordinal logistic regression analysis showed that poorer general functioning scores (OR = 1.087, 95% CI: 1.008-1.173, P = 0.030), poorer behavioral control (OR = 1.124, 95% CI: 1.026-1.232, P = 0.012), more quit attempts, frequent alcohol consumption, and longer smoking duration may be associated with a higher likelihood of developing severe nicotine dependence. The older age of starting smoking and higher education level may be associated with a lower likelihood of developing severe nicotine dependence. However, it is important to note that the cross-sectional nature of this study precludes the determination of causal relationships. CONCLUSIONS: This study finds that heavy nicotine dependence in smoking fathers is associated with risky behaviors and demographics such as longer smoking duration and frequent alcohol consumption. Targeted smoking cessation interventions are crucial for this group, taking these specific factors into consideration. Family functioning, particularly general functioning and behavioral control, may also be linked to nicotine dependence, indicating the need for further research in this area.

Using the Unified Theory of Acceptance and Use of Technology (UTAUT) and e-health literacy(e-HL) to investigate the tobacco control intentions and behaviors of non-smoking college students in China: a cross-sectional investigation.

BACKGROUND: Non-smoking college students are starting to smoke in increasing numbers, which shows that their tobacco control situation seems not optimistic. The UTAUT and e-HL are commonly used models and theories to predict health behaviors, while there are few studies on tobacco control. This paper aims to study the influencing factors of tobacco control intention and behavior of non-smoking college students in China by combining the UTAUT and e-HL. METHODS: Based on the stratified sampling method, 625 college students from 12 universities were selected. Data were collected using a self-made questionnaire designed based on the UTAUT and e-health literacy scales. Data were analyzed by SPSS 22 and AMOS 26, including descriptive statistics, one-way variance analysis and structural equation model analysis. RESULTS: The results of one-way variance analysis showed that there were significant differences in the score of non-smoking college students' tobacco control intention or behavior by hometowns, monthly living expenses, and parents' smoking history. Performance expectancy, effort expectancy, social influence had direct positive effects on behavioral intention. Facilitating condition, behavioral intention had direct positive impacts on use behavior and e-HL had an indirect positive impact on use behavior. CONCLUSIONS: The combination of the UTAUT and e-HL can be used as an appropriate framework to predict the influencing factors of non-smoking college students' intention and behavior of tobacco control. Improving performance expectancy, effort expectancy, and e-HL among non-smoking college students, creating positive social environments, and providing facilitating condition are key aspects of increasing their tobacco control intention and behavior. It is also beneficial to promote the implementation of smoke-free campus and smoke-free family projects.

The mediating effect of family health on the relationship between health literacy and mental health: A national cross-sectional survey in China.

BACKGROUND: Mental health problems significantly affect people's well-being and result in a huge health burden. Health literacy and family health are critical to reducing people's mental health problems. However, limited studies have addressed their complex interaction. Thus, this study aims to elucidate the mediating effect of family health on the relationship between health literacy and mental health. METHODS: A national cross-sectional study based on multistage random sampling was conducted from July 10 to Sep 15, 2021, in China. Information about the public's health literacy, family health, and the level of three common mental health problems (depression, anxiety, and stress) was collected. A structural equation model (SEM) was applied to explore the mediating effect of family health on the relationship between health literacy and mental health. RESULTS: A total of 11,031 participants were investigated. Approximately 19.93 and 13.57% of participants experienced moderate or severe depressive and anxiety symptoms, respectively. The SEM showed that health literacy was directly associated with mental health, with higher health literacy resulting in lower levels of depression (coefficient: -0.018, p = .049), anxiety (coefficient: -0.040, p < .001), and stress (coefficient: -0.105, p < .001). In addition, family health played a significant mediating effect (p < .001) between health literacy and mental health, contributing to 47.5, 70.9, and 85.1% of the total effect of health literacy on personal stress, anxiety, and depression, respectively. CONCLUSIONS: This study revealed that the improvement of health literacy is directly and indirectly associated with less likelihood of people's mental health problems via family health. Thus, future mental health interventions should be integrated and targeted both at individual level and the family level.

Associations between media use, self-efficacy, and health literacy among Chinese rural and urban elderly: A moderated mediation model.

Objectives: The influence of media use on health literacy among urban and rural elderly has been unknown in China. This study aims to examine the association between media use and health literacy and to explore the mediating role of self-efficacy and the moderating role of urban-rural residency. Methods: Based on the cross-sectional study of the Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022, a total of 4,070 Chinese old people aged 60 years and above were included. We adopted the simplified New General Self-Efficacy Scale (NGSES) and the simplified Health Literacy Scale-Short Form (HLS-SF) to measure self-efficacy and health literacy. Media use was measured using a self-administrated questionnaire. Results: Results showed that Chinese urban elderly had a higher frequency of media use than rural ones in the aspects of social activities, self-presentation, social action, leisure and entertainment, information acquisition, and business transactions through media (P < 0.001). Among all participants, self-presentation (B = 0.217, 95% CI: 0.040, 0.394), leisure and entertainment (B = 0.345, 95% CI: 0.189, 0.502), and information acquisition (B = 0.918, 95% CI: 0.761, 1.076) were significantly associated with health literacy. Self-efficacy partially mediated the effect of media use on health literacy (Bindirect = 0.045, 95% CI: 0.032, 0.058), accounting for 18.37% of the total effect. Urban-rural residency (B = 0.049, 95% CI: 0.024, 0.075) moderated the relationship between media use and self-efficacy significantly. Conclusion: The urban-rural gap in health literacy requires more attention. The promotion of media use and self-efficacy may play a role in eliminating health disparities. Limitations: As a cross-sectional study, it could not establish cause-effect relationships.

The self-medication behaviors of residents and the factors related to the consideration of drug efficacy and safety-A cross-sectional study in China.

Background: Over-the-counter (OTC) drugs facilitates residents self-medication. However, inappropriate self-medications have become a serious problem in China and even all over the world. Objectives: To make an investigation on the current status of Chinese residents' self-medication behaviors and important considerations, and to explore the factors related to the considerations of drug efficacy and safety. Design: A quantitative, cross-sectional study. Methods: Multi-stage sampling was used to conduct a cross-sectional investigation in China 22 provinces, 5 autonomous regions and 4 municipalities directly under the Central Government. State that an interviewer-administrated questionnaire, was used for data collection. The questionnaire that was used in the investigation included demographic sociological characteristics, health literacy scale-short form (HLS-SF), the 10-item Big Five Inventory (BFI-10), the EuroQol-5D visual analogue scale (EQ-5D VAS), self-medication status and important considerations when self-medicating. Descriptive statistics were performed, and the Chi-square test was used for univariate analysis. Log-binomial regression was used for multivariate analysis on whether residents regard drug efficacy or safety as an important consideration. Results: 9256 respondents were included in the data analysis. The self-medication rate of Chinese adults was as high as 99.1%. Paracetamol and other analgesics were the most common types of OTC medication that respondents purchased, followed by vitamins/minerals. Medical staff recommendations, drug safety and efficacy were the top three important considerations. The residents in the east, central and western regions who consider safety is 63.5%, 61.5%, and 66.8% respectively. The proportion of curative effect was 60.2%, 55.7%, and 61.4% respectively. Log-binomial regression showed that western respondents, retired people, those who mainly used ways including basic medical insurance for employees, commercial medical insurance, free medical treatment to cover their medical cost, respondents with high neuroticism, high health literacy were more likely to consider drug safety as an important factor (p < 0.05). Eastern respondents, employed, main way of medical expenses borne was Out-of-pocket Payment, those with chronic disease were more likely to consider drug efficacy as an important factor (p < 0.05). Female, respondents with high levels of agreeableness, conscientiousness, openness, and self-rated health status were more likely to regard both drug safety and efficacy as important considerations (p < 0.05). Conclusion: Self-medication is practiced by most Chinese adults. Whether Chinese adults take drug efficacy or safety as an important consideration is related to their demographic and sociological characteristics, Big Five personality characteristics, health literacy and self-assessed health status. There is a need to strengthen the management of OTC drugs and public education about self-medication.

Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study.

The integration of chronic disease management (CDM) services into the essential public health services offered by primary care facilities has been a major strategy in China's healthcare reform since 2009. We aimed to measure the percentage of patients with chronic diseases in China who believed that they could easily obtain CDM services at a nearby primary care facility in mainland China and determine its association with the EQ visual analog scale (EQ-VAS) score and the utility index of the 5-level EQ-5D version (EQ-5D-5L). A cross-sectional survey was conducted nationwide between 20 June 2022 and 31 August 2022, involving 5525 patients with chronic diseases from 32 provincial-level administrative divisions, of which 48.1% (n = 2659) were female with a median age of 55.0 years. The median EQ-VAS score was 73.0 and the utility index of the EQ-5D-5L was 0.942. A majority of patients reported definite (24.3%) or mostly (45.9%) easy access to CDM services from nearby primary care facilities. Multivariable logistic regression analysis revealed that easy access to CDM services in primary care facilities was positively associated with higher HRQoL. Our findings indicate that, as of 2022, approximately 70% of patients with chronic diseases in mainland China had easy access to CDM services provided by primary care facilities, which was significantly and positively associated with their health status.