College students' perceptions of electronic cigarette risks and benefits: a concept mapping study.

The use of electronic cigarettes (e-cigarettes) is on the rise among young adults, with higher public acceptance than traditional tobacco. A study in Taiwan employed concept mapping to explore risk and benefit perceptions of e-cigarette use among college students. The study involved 100 college students from 11 Taiwanese universities, with 50 being e-cigarette users and 50 non-users. Data collection and analysis were done with the GroupWisdom™ platform. Participants engaged in brainstorming, rating and sorting their perceptions, which were analyzed using multidimensional scaling and hierarchical cluster analyses. The participants' mean age was 19.24 years, and 55% were male. This process resulted in the identification of 10 clusters encompassing 64 statements, with 3 clusters focused on risk perceptions, 6 on benefit perceptions, and 1 dealing with e-cigarette regulations. Notably, risk perceptions were rated higher than benefit perceptions. Non-users held significantly higher risk perceptions and lower benefit perceptions across the nine clusters related to e-cigarette use. Concept mapping proved to be an effective tool for understanding college students' perceptions. These findings can assist health educators in comprehending college students' viewpoints on e-cigarette use and in developing targeted interventions. Additionally, exploring benefit perceptions may enhance students' critical thinking skills regarding e-cigarette advertising.

College Students' E-health Literacy, Social Media Use, and Perceptions of E-cigarettes in Taiwan.

This study aimed to examine the relationship between social media use, e-health literacy, and the risk and benefit perceptions of e-cigarettes among college students in Taiwan. A cross-sectional online survey was conducted with 1,571 Taiwanese college students, which included four questionnaires to assess participants' perceptions, social media use behavior, e-health literacy, and sociodemographic factors. The data were presented in terms of means, standard deviations, and percentages. Stepwise regression was used to identify factors associated with the participants' perceptions. The study found that 75.01% of the participants were exposed to e-cigarette information on social media, with 31.26% actively searching for it and 15.95% sharing it. Participants had a high e-cigarette risk perception, indicating low benefit perception, but acceptable e-health literacy. Factors such as current e-cigarette and tobacco use, e-health literacy, academic achievement, and sex significantly predicted e-cigarette risk perception, while sharing e-cigarette related information, sex, age, academic achievement, and current e-cigarette use significantly predicted its benefit perception. Thus, implementing effective e-health literacy programs to enhance college students' e-cigarette risk perception is recommended along with a proactive approach to tackle e-cigarette advertising messages on social media, minimizing their sharing behavior to decrease their perception of associated benefits.

A Pilot Study to Explore the Improvements in Pulmonary and Cognitive Functions With a Kazoo Intervention Among Middle-Aged and Older Adults in a Rural Community.

Dementia is a leading cause of disability and dependence in older adults worldwide. The aim of this pilot study was to explore the effect of using a kazoo instrument to improve pulmonary function and cognitive reserve in middle-aged and older adults in rural areas. This quasi-experimental study was conducted at two community care stations selected using cluster sampling from a rural district in southern Taiwan. We enrolled 85 middle-aged and older adults who were randomly assigned into self-learner and in-class groups. Both groups received a 6-month kazoo program. Cognitive and pulmonary function were compared before and after the intervention between the two groups. Significantly improved pulmonary function with regards to forced vital capacity (p < .05) was found in the self-learner group, and significantly improved maximum expiratory flow 75% (p < .001) was found in both groups. Mini-Mental State Examination scores significantly improved in the self-learner group (p < .01), but there was no significant change in the in-class group. Our results suggest that community care stations could consider implementing wind instrument programs such as a kazoo to enhance pulmonary function and cognitive reserve in middle-aged and older adults residing in rural areas.

Preliminary evaluation of a scenario-based nutrition literacy online programme for college students: a pilot study.

OBJECTIVE: This study aimed to develop and evaluate a scenario-based nutrition literacy (NL) online programme for Taiwanese college students. DESIGN: A randomised pilot trial design was used in this study. SETTING: The study was conducted at a university in Taiwan. The intervention consisted of a five-unit web-based NL programme including videos of real-life scenario-based stories, situational analysis teaching and after-unit quizzes. Theme-related website information and smartphone apps (both iOS and Android systems) were offered for reference in every unit. The NL measure consisted of a self-rated scale, a scenario-based test and a healthy eating behaviour survey. Paired sample t-tests and ANCOVA were performed to test the effects on NL and healthy eating behaviour. PARTICIPANTS: Participants were ninety-eight students, with a retention rate of 98 %. The ratio of men to women was 0·2:1. Most students were freshmen (48 %). RESULTS: Compared with the control group, the experimental group showed significant post-intervention improvements in the NL and healthy eating behaviours after controlling for pretest scores. CONCLUSIONS: This pilot study offers preliminary evidence of the potential positive effects of implementing a scenario-based NL online programme for college students. It offers a possibly novel strategy to enhance health-promoting behaviours in Taiwanese universities. Further research with larger sample sizes and more rigorous designs is warranted to confirm and build upon these initial findings.

Competence and Stress of Medication Administration Practices for School Nurses in K-12 Taiwan Schools.

We investigated school nurses' experiences, perceived government support, school nurses' acceptance of responsibility for medication administration, perceived stress, and perceived competence of medication administration and analyzed factors associated with perceived competence. In this cross-sectional study, from February to April 2023, we conducted an online survey of 269 school nurses serving at K-12 schools in Taiwan. The results revealed that although 71% of the participants had prior experience with medication administration, they reported low competence and high stress in areas such as drug interactions, adverse drug effects, and referrals. The school nurses' disagreement with responsibilities for medication administration emerged as the only factor to be significantly associated with perceived medication administration competence, accounting for 22.8% of the variance. We recommend implementing continuing training programs to provide school nurses with up-to-date medication information. Additionally, the development of practice guidelines is suggested as a means of enhancing nurses' competence and reducing their stress levels for the administration of medications.

Orthokeratology compliance, digital device use, and myopia control among children with myopia during COVID-19 home confinement in Taiwan.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts lifestyle habits and myopia control in children worldwide. This study investigated the changes in eyecare habits, orthokeratology compliance, axial length, and time interval of follow-up visits during home confinement in the COVID-19 pandemic in Taiwan. Methods: This investigation was part of a prospective study undertaken to evaluate the effectiveness of a mobile application. A semi-structured telephone interview was conducted with parents retrospectively to document eyecare habits and myopia control during the COVID-19 home confinement. Results: Thirty-three children with myopia participated in the follow-up of orthokeratology lenses for 2 years. The children's time viewing digital devices such as tablets and televisions significantly increased during the COVID-19 pandemic (P < 0.05). An analysis using McNemar's test found that the proportional growth of axial length <0.2 mm in 2021 was significantly higher than that in 2020 (77.42% vs. 58.06%, P < 0.05). In the multivariate logistic regression analysis, onset <10 years of age (P = 0.001) and parents with high myopia (P < 0.001) were independent risk factors for the growth of axial length ≥0.2 mm in 2021. Conclusion: The suspension of face-to-face classes and after-school tutorials benefited myopic axial elongation in children during COVID-19 home confinement. The use of digital devices and staying indoors may not be the exclusive reasons for myopia progression. Educating parents about the influence of extra learning classes after school on myopia progression would be prudent.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey.

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (ß = -.29) and indirect negative effects (ß = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Factors Associated With Follow-Up Visits in Parents With Myopic Children Wearing Orthokeratology Lens.

BACKGROUND: Orthokeratology (Ortho-k) is an effective method for slowing the progression of myopia and correcting refractive error in school children. Although parents of children aged < 10 years play a major role in Ortho-k lens care, they have a generally low level of compliance in performing regular follow-up visits. PURPOSE: This study was developed to analyze the associations between follow-up visits by parents of Ortho-k lens wearers aged < 10 years and, respectively, the Ortho-k-related knowledge of these parents and information resources promoting Ortho-k use. METHODS: A cross-sectional study design was used. Parents of children who wear Ortho-k lenses were recruited through a private Facebook group with 3,500 members in 2020 that was created in 2018 for information sharing and exchange among parents of these children. The following data were collected: demographics of the parents and their children, four-item Ortho-k-related knowledge, information resources that prompted the decision to use Ortho-k, and the regularity of follow-up visits. These data were presented in terms of means, standard deviations, and percentages. Logistic regression was performed to compute the odds ratios ( OR s) and 95% confidence intervals (CIs). RESULTS: The study showed that 83.11% had regular follow-up visits. The correct response rate on Ortho-k-related knowledge was > 80%. However, 15.51% of the participants did not recognize axial length as an indicator for monitoring myopia progress, and 10.76% did not know that at least 6 hours of nighttime sleep is required for myopia control with Ortho-k. The most common information resource leading to Ortho-k use was self-acquisition from Internet sources. The spherical equivalent refraction of < -2.0 D was 2.58 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 2.58, 95% CI [0.22, 5.63]). In addition, acknowledgment of "There is no need to change the Ortho-k lenses regularly as long as there is no discomfort" was 7.19 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 7.19, 95% CI [1.26, 13.93]). However, participants with regular follow-up visits did not receive Internet ophthalmology advertisements prompting their decision to use Ortho-k 2.62 times higher than their peers with irregular follow-up visits ( OR = 2.62, 95% CI [0.04, 4.29]). CONCLUSIONS: The results support that both information sources and knowledge of Ortho-k use influence the frequency of follow-up visits among parents of Ortho-k lens wearers aged < 10 years. Related support from health professionals in terms of providing appropriate information and guidance is recommended to promote higher rates of regular follow-up visit attendance.

Delay discounting, time perspective, and self-schemas in adolescent alcohol drinking and disordered eating behaviors.

Delay discounting, time perspective, and self-schemas are well-known predictors of health risk behaviors among adolescents. However, the associations between these constructs and their influence on such behaviors are yet to be examined. This study aimed to determine the relationships among three cognitive constructs, namely, delay discounting, time perspective, and self-schemas, and determine the associations of these constructs with alcohol drinking (alcohol use and alcohol problems) and disordered eating behaviors in adolescents. Participants were 436 eighth-graders from three public junior high schools in southern Taiwan, who answered an anonymous questionnaire assessing self-schema, delay discounting, time perspective, and health risk behaviors. Generalized linear models with robust estimation were performed to estimate the effects; gender was the covariate. Delay discounting was associated with alcohol use (OR = 1.15), but not alcohol problems and disordered eating behaviors. Present-Hedonistic time perspective was associated with alcohol use (OR = 2.01), alcohol problems (IRR = 2.23), and disordered eating behaviors (Exp(b) = 1.38); while Future time perspective was associated with alcohol problems (IRR = 2.18). Drinker self-schema was associated with alcohol use (OR = 1.62) and alcohol problems (IRR = 1.71). Fat/overweight self-schema was associated with overall disordered eating (Exp(b) = 1.03). Thus, the findings suggest that each of the three constructs is independently associated with drinking and disordered eating behaviors, and these associations vary according to the specific type of behavior. Future research identifying the underlying mechanisms linking these constructs to the abovementioned behaviors can be useful for developing targeted intervention strategies.

Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity.

OBJECTIVE: The objective of this study was to examine the relationships between students' perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity. DESIGN: Cross-sectional study. SETTING: Primary, middle and high schools in Taiwan. PARTICIPANTS: A nationally representative sample of 2433 primary school (5th-6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018. RESULTS: Multivariate analysis results showed that after controlling for school level, gender and age, the students' perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools' campaigns promoting the eating of vegetables and fruit were positively associated with students' consumption of vegetables. In addition, schools' initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students' engagement in outdoor physical activities and daily moderate-to-vigorous physical activity. CONCLUSIONS: Students' perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

Feasibility of Intervention Program to Prevent Adolescent Health-Compromising Behaviors.

Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12-14 years. Feedback from teachers and students supported the proposed program's feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings.

A Cooperative Management App for Parents with Myopic Children Wearing Orthokeratology Lenses: Mixed Methods Pilot Study.

Orthokeratology (OK) lens wear is an effective modality to inhibit axial elongation in myopic children. Willingness for commitment from both parents and children contributes to the success of OK treatment. We aimed to develop and assess the usability of a mobile application on OK lens wear by quantitatively and qualitatively evaluating parents with myopic children and eye care professionals (ECPs). Moreover, the preliminary outcome was also evaluated in this study. The app was developed and tested using a co-design approach involving key stakeholders. Two prototype tests were conducted during the feasibility and utility assessment. The app features include self-reported compliance documentation, analytics, and personalized and generalized messages for compliance behaviors of OK lenses. After the trial period, the full usage of app functions ranged from 40% to 60% among the enrolled parents. After app implementation, the compliance with follow-up visits substantially improved. Qualitative data show that the high-satisfaction app functions reported by parents were the app's reminder and axial length recording, although it was recommended that the number of compliance questions should be reduced to minimize the survey completion time. Additionally, who should complete the recording of the axial length data as well as the management and reminder for the follow-up visit remained controversial. This is the first app developed to improve parents of myopic children's compliance with OK lens wear and to assist ECPs and parents in collaboratively monitoring and managing the use and care of OK lenses among myopic children. This study highlights the importance of interdisciplinary collaboration in the design, development, and validation of such an app.

Nutrition Literacy Mediates the Relationships between Multi-Level Factors and College Students' Healthy Eating Behavior: Evidence from a Cross-Sectional Study.

College students experience new pressures and choices as they transition to independent living and can easily develop unhealthy eating habits, resulting in obesity and obesity-related chronic diseases in later life. This study aimed to test the hypothesis that nutrition literacy (NL) mediated the relationship between multi-level factors influencing healthy eating behavior identified from the social-ecological model and healthy eating behavior of college students. A four-part questionnaire was completed by 412 participants recruited from six different four-year universities in Taiwan (effective response rate = 85.8%). Data were analyzed using descriptive statistics, an independent samples t-test, hierarchical multiple regression, and mediation analysis. The results indicated that the students' mean nutrition literacy score was 4.32 (SD = 0.78, range = 1-6). In the social-ecological framework, nutrition literacy significantly predicted healthy eating behavior (ß = 0.28, p < 0.001; ΔF = 32.54, p < 0.001; ΔR2 = 0.05) with control variables of background, intrapersonal, interpersonal, environmental, and macrosystem factors. Nutrition literacy mediated the effects of seven factors on healthy eating behavior across four levels. These findings suggested that strengthening influential multi-level factors associated with healthy eating behavior not only enhanced NL, but also improved individuals' healthy eating behavior.

Compliance with orthokeratology care among parents of young children in Taiwan.

OBJECTIVES: To evaluate compliance with orthokeratology (Ortho-K) care and its influencing factors among parents of 6-13-year-old myopic children in Taiwan. METHODS: Parents who are responsible for the care of the Ortho-K lenses of their myopic children were recruited through a closed Facebook peer support group to answer an online compliance questionnaire, including the wear and care behaviours and follow-up visits of Ortho-K. RESULTS: A total of 253 online questionnaires were analysed after excluding those with wrong information. Most participants (89.7%) were mothers and had university-level or higher education (72.3%); 67.6% of them could achieve a score equal or higher than 60% correct rate on knowledge items. In addition, 39.3% of participants had high myopia (spherical equivalent ≦ 6.0 diopters). The mean age at onset of myopia was 7.75 years for children, and 57.4% wore Ortho-K lenses for less than a year. Full compliance rate was 22.8%, as reported by fathers or mothers. The compliance rate for follow-up visits significantly increased with provision of axial length information in follow-up visits, knowledge of axial length changes as an effect of myopia control, and Ortho-K use for less than 6 months. The compliance rate for wear and care was significantly associated with high myopia in one of parents, high education level, early onset of myopia in children, knowledge of Ortho-K and myopia control, and Ortho-K use for less than 6 months. CONCLUSION: These results indicate the need for a comprehensive education programme for parents with young myopic children to ensure strict adherence to fitting and wear protocols and good follow-up of Ortho-K lenses.

Cultural competence among pre-graduate nursing students, new graduate nurses, nurse mentors, and registered nurses: A comparative descriptive study.

BACKGROUND: Achieving and improving cultural competence in nursing is an ongoing process, beginning in the student period and continuing through the professional career. OBJECTIVES: The present study aims to compare pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors in Taiwan in terms of their respective levels of cultural competence, and to determine associated influencing factors. DESIGN: A comparative cross-sectional study. SETTINGS: Three universities and three hospitals (one regional hospital and two teaching hospitals) in Taiwan. PARTICIPANTS: A total of 756 nurses/students (103 pre-graduate nurses, 321 newly graduated nurses, 101 registered nurses, and 231 nurse mentors). METHODS: The Cultural Competence Scale for Pre-Graduated Students to Licensed Professionals was used to measure the cultural competence level. One-way analysis of variance and hierarchical regression analysis were used for statistical analysis. RESULTS: For overall cultural competence and the subscales of knowledge, awareness, and skills, the pre-graduate students scored lower than the other three groups. Experience of caring for patients from diverse cultures and countries significantly influenced the cultural competence of all four groups. Ability to speak fluent English and receiving cultural competence education during nursing education only significantly influenced the cultural competence of the pre-graduate and new graduate nurses. Current job position and primary practice setting significantly influenced the cultural competence of the registered nurses and nurse mentors. CONCLUSION: Pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors have differing levels of cultural competence and differing influencing factors. Cultural competence education that accords with the influencing factors for each nursing position would continuously cultivate nursing staff's cultural competence.

Trajectories of myopia control and orthokeratology compliance among parents with myopic children.

SIGNIFICANCE: This study set out to illustrate the trajectories of myopia control in time sequence and explore orthokeratology compliance for parents with myopic children in the first fitting within one year. Profiling these results is crucial to improving myopia control and orthokeratology care. PURPOSE: To obtain a better understanding of myopia control and orthokeratology care that could promote compliance with orthokeratology (ortho-K) lenses for parents with myopic children. METHODS: We conducted semi-structured qualitative interviews and pre-interview questionnaire surveys of the parent who is mainly responsible for complying to ortho-K lens care for their myopic children aged 7-12 years, including 16 mothers and 4 fathers. A framework analytical approach that involved gaining familiarity with the data to identify a thematic framework was used for data analysis. It was written in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. RESULTS: Five themes and twelve subthemes depicted the parents' trajectory during myopia diagnosis, treatment, and compliance with ortho- K for their children in the first fitting within one year. Myopia control and the convenience of outdoor activities were important reasons for parents to actively ask for ortho-K lenses for their children. Parents have non-compliance behaviors after the children wore the lenses for three months, including not scheduling follow-up visits, simplifying cleaning procedures, not replacing accessories. The degree of parents' non-compliance differed based on the uncomfortable feelings of their child's eyes. In general, clear, unaided vision (visual acuity > 0.9) during the day was an indicator of ortho-K's effectiveness, according to parents. CONCLUSIONS: Although parents play a passive role when a child is diagnosed with myopia, they take on a proactive role when deciding on ortho-K treatment. Myopia treatment for children is a long-term process. Understanding the course of treatment and non-compliance helps eye care professionals provide parents with the necessary assistance and resources, and enables myopia treatment to yield maximum effects.

Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students.

PURPOSE: To investigate the change in the prevalence of reduced visual acuity (VA) in Taiwanese school children after a policy intervention promoting increased time outdoors. DESIGN: Prospective cohort study based on the Taiwan School Student Visual Acuity Screen (TSVAS) by the Ministry of Education in Taiwan. PARTICIPANTS: All school children from grades 1 through 6 were enrolled in the TSVAS from 2001 through 2015. METHODS: The TSVAS requires each school in Taiwan to perform measurements of uncorrected VA (UCVA) on all students in grades 1 through 6 every half year using a Tumbling E chart. Reduced VA was defined as UCVA of 20/25 or less. Data from 1.2 to 1.9 million primary school children each year were collected from 2001 through 2015. A policy program named Tian-Tian 120 encouraged schools to take students outdoors for 120 minutes every day for myopia prevention. It was instituted in September 2010. To investigate the impact of the intervention, a segmented regression analysis of interrupted time series was performed. MAIN OUTCOME MEASURES: Prevalence of reduced VA. RESULTS: From 2001 to 2011, the prevalence of reduced VA of school children from grades 1 through 6 increased from 34.8% (95% confidence interval [CI], 34.7%-34.9%) to 50.0% (95% CI, 49.9%-50.1%). After the implementation of the Tian-Tian 120 outdoor program, the prevalence decreased continuously from 49.4% (95% CI, 49.3%-49.5%) in 2012 to 46.1% (95% CI, 46.0%-46.2%) in 2015, reversing the previous long-term trend. For the segmented regression analysis controlling for gender and grade, a significant constant upward trend before the intervention in the mean annual change of prevalence was found (+1.58%; standard error [SE], 0.08; P < 0.001). After the intervention, the trend changed significantly, with a constant decrease by -2.34% annually (SE, 0.23; P < 0.001). CONCLUSIONS: Policy intervention to promote increased time outdoors in schools was followed by a reversal of the long-term trend toward increased low VA in school children in Taiwan. Because randomized trials have demonstrated outdoor exposure slowing myopia onset, interventions to promote increased time outdoors may be useful in other areas affected by an epidemic of myopia.

Alcohol-related cognitive mechanisms underlying adolescent alcohol use and alcohol problems: Outcome expectancy, self-schema, and self-efficacy.

PURPOSE: The objective of this study was to empirically test a theoretical model to determine the cognitive mechanisms that are associated with adolescent alcohol use and alcohol problems. We posited that alcohol outcome expectancies would affect alcohol-refusal self-efficacy through the drinker self-schema. We also posited that alcohol outcome expectancies and the drinker self-schema would affect alcohol use and problems through alcohol-refusal self-efficacy. METHODS: A survey was administered to 225 adolescents in a public junior high school in Taiwan at two-time points, six months apart. Path analysis was used to determine the mechanisms underlying the alcohol-related cognitive constructs on the alcohol use and alcohol problems separately, controlling for appropriate alcohol-related personal and environmental factors. Indirect effects were estimated using the bootstrapping method. RESULTS: Higher positive alcohol outcome expectancies and lower negative alcohol outcome expectancies predicted higher drinker self-schema scores. Higher positive alcohol outcome expectancies and drinker self-schema scores predicted lower alcohol-refusal self-efficacy. Lower alcohol-refusal self-efficacy was associated with a history of drinking and alcohol problems in the past six months. Effects of alcohol outcome expectancies on alcohol use and alcohol problems were partially mediated through the drinker self-schema and alcohol-refusal self-efficacy. CONCLUSIONS: Findings support the proposed theoretical cognitive mechanisms underlying alcohol use and alcohol problems in a sample of Taiwanese adolescents. Given that alcohol-related cognitive constructs are modifiable, the findings also provide a foundation to suggest that interventions to reduce positive alcohol outcome expectations and prevent the formation of a drinker self-schema may facilitate alcohol-refusal self-efficacy and mitigate drinking behaviors in this adolescent population.

Factors Influencing Technology Integration in the Curriculum for Taiwanese Health Profession Educators: A Mixed-Methods Study.

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator-student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.