Peer Victimization Trajectory and Psychosocial Maladjustment in Early Taiwanese Adolescents: A Longitudinal Study.

This study examined the peer victimization trajectory and maladjustment outcomes among early Taiwanese adolescents. Data were extracted from a large-scale longitudinal study with a national representative sample. A total of 1691 school students in 4th, 6th, and 8th grade were analyzed. Using latent profile analysis, students were classified into four trajectories, chronic victims, late onset victims, desisters, and non-victims, based on their self-reported physical and verbal victimization at three time points. Maladjustment, including psychological distress, reduced school attachment, internet addiction, and suicidal ideation in 8th grade, were assessed. The results showed significant differences in adjustment among students in the four trajectories. Chronic victims had the poorest outcomes on most variables, followed by late onset victims and desisters, while non-victims had the least maladjustment. The findings highlight the need for future interventions that would consider students' victim status over time and pay particular attention to those who suffer constant bullying and abuse.

Weight stigma is associated with body mass index among college students in Taiwan: the mediated role of internalized weight stigma.

BACKGROUND: Weight stigma is an issue often studied in Western countries; however, such information is scarce in Asian studies. METHODS: This study aimed to examine the role of internalized weight stigma as a mediator in the relationship between perceived weight stigma and changes in body mass index (BMI). The data were collected through a longitudinal online survey with two phases (n = 974; Phase 1: August and September 2021; Phase 2: November and December 2021). The Perceived Weight Stigma Scale (PWSS), Weight Self-Stigma Questionnaire (WSSQ), and Depression, Anxiety, Stress Scale - 21 (DASS-21) were administered to assess perceived weight stigma, internalized weight stigma, and psychological distress. Hierarchical regressions were used to examine the proposed model, and Hayes' Process Macro was used to test a mediation model. RESULTS: The changes in perceived weight stigma and internalized weight stigma were significantly and positively associated with changes in BMI. There were significant and positive associations between perceived weight stigma, internalized weight stigma and psychological distress over time. Change in internalized weight stigma was found to be a significant mediator in the association of change in perceived weight stigma with change in BMI for the entire sample (unstandardized coefficient = 0.04; 95% CI = 0.02, 0.06), female subgroup (unstandardized coefficient = 0.05; 95% CI = 0.02, 0.08), and male subgroup (unstandardized coefficient = 0.03; 95% CI = 0.01, 0.06). Change in perceived weight stigma also had significant effects on change in BMI for the entire sample and the female subgroup, but not for the male subgroup. CONCLUSION: Because perceived weight stigma may significantly impact changes in BMI through internalized weight stigma, treatment strategies to ameliorate self-stigma may enhance the results of weight-reduction programs. Such treatment strategies should be considered for inclusion in weight-loss interventions.

Weight stigma is commonly studied in Western countries rather than in Asian ones. To further explore how internalized weight stigma mediates the relationship between perceived weight stigma and the changes in body mass index (BMI), the study collected data through a longitudinal online survey with two phases by applying the Perceived Weight Stigma Scale (PWSS), Weight Self-Stigma Questionnaire (WSSQ) and Depression, Anxiety, Stress Scale − 21 (DASS-21) to assess perceived weight stigma, internalized weight stigma, and psychological distress. The changes in perceived and internalized weight stigma were significantly and positively associated with changes in BMI. There were significantly positive associations between perceived weight stigma, internalized weight stigma, and psychological distress over time. Based on the findings, treatment strategies to alleviate self-stigma may enhance the results of weight-reduction programs and should be considered for inclusion in weight-loss interventions.

The Impact of Contact Experience on the Attitudes and Beliefs Toward Same-Sex Parents and Their Children Among Kindergarten Teachers.

Intergroup contact is important to reduce prejudice toward sexual minorities. Yet little is known regarding how kindergarten teachers' contact experiences with sexual minority affect their attitudes toward sexual minorities and their beliefs regarding same-sex family parents' parenting skills and same-sex family children's adjustment. This cross-sectional study recruited kindergarten teachers (n = 261; mean age = 38.8 years) in Taiwan in 2021-2022. A self-reported online questionnaire was administered which included questions about quantity and quality of contact experiences with lesbians, gay men (LG) and same-sex families, attitudes toward same-sex families, beliefs regarding same-sex parenting skills, and children's adjustment. Hierarchical multiple regression was used for analysis. The results showed that higher quality of contact with LG was associated with lower prejudice toward LG and with a more positive belief regarding same-sex parents' parenting skills and children's adjustment in same-sex families. The contact experience with same-sex families has an association with positive beliefs regarding same-sex family parents and children. After adjustment of quality of contact, quantity of contact did not show association with attitude toward LG or beliefs regarding same-sex family parents and children. The findings suggest that the quality of contact experience with LG is an important factor to reduce the stereotype against same-sex families.

Understanding the Dynamics of Unwanted Online Sexual Solicitation Among Youth in Taiwan: Vulnerability and Resilience Factors.

The rise in online sexual exposure and solicitation among youth has heightened concerns. Youth, due to their limited socio-cognitive capacity, face greater risks of online sexual victimization compared to adults. Unwanted online sexual solicitation (UOSS) is a concerning aspect of sexual victimization, encompassing requests for unwanted sexual talks, activities, and sharing personal sexual information or images online. This study, based on target congruence theory, examined UOSS risk and protective factors using a national-representative youth sample in Taiwan. In 2020, 19,556 students (Grades 5-12, average age 15, 50% male) participated in the school-based online survey. Hierarchical linear regression was used to determine the significance of UOSS predictors. Findings revealed a 15.4% prevalence of UOSS. Accounting for age and gender, target-vulnerability variables (self-esteem, bullying victimization, psychological distress) and target-gratifiability variables (online self-disclosure, time spent online) significantly linked to UOSS. Youth who were bullied, had greater psychological distress and online self-disclosure, and increased Internet use were prone to UOSS, while self-esteem mitigated risks. Bullying victimization and online self-disclosure were the strongest correlates of UOSS in Taiwan's youth, followed by psychological distress, Internet usage, and self-esteem. In sum, this study enriches the understanding of UOSS among Taiwanese youth and suggests strategies to prevent online sexual victimization. Enhancing self-esteem, promoting social media education including online privacy and self-disclose, tackling bullying, addressing psychological distress, and furnishing relevant services are crucial preventive measures. These findings offer guidance to parents, educators, and health professionals for supervising and steering adolescents' online conduct, presenting an evidence-based framework to avert online sexual victimization.

Measurement Invariance and Psychometric Evaluation of the Tendency to Avoid Physical Activity and Sport Scale (TAPAS) Among Mainland Chinese University Students.

Introduction: Preventative factors in young people's physical inactivity require further understanding, including related psychosocial factors (eg, body image and weight stigma). The Tendency to Avoid Physical Activity and Sport Scale (TAPAS) is a recently developed instrument to address this issue and the present study examined its psychometric properties among Chinese university students particularly in relation to patterns across sex, physical activity (PA) level, and weight status. Methods: Using a convenience sample of 3142 students (mean age = 19.8 years; 56% female) in mainland China, data were collected using an online survey between August and October 2022. Psychometric instruments including the Weight Bias Internalization Scale, 21-item Depression, Anxiety and Stress Scale, and International Physical Activity Questionnaire Short Form were administered along with the TAPAS to assess convergent and discriminant validity. Multi-group confirmatory factor analysis (CFA) assessed the measurement invariance across specific groups. Results: The unidimensional structure of the scale was confirmed through CFA (CFI=0.995; RMSEA=0.046). All configural, metric and scalar models of invariance indicated that the scale was invariant across sex, PA level, and weight status. Acceptable convergent and discriminant validity for the scale were found. Conclusion: The TAPAS is a suitable instrument to assess body image and weight stigma concerns for avoiding physical activity and sport among Chinese university students.

Psychometric properties and development of the Chinese versions of Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A).

Currently, six instruments have been developed using the 11th revision of the International Classification of Diseases (ICD-11) criteria for Gaming Disorder (GD). Two of these are the Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A). The present study validated both the GDT and GADIS-A among a large sample of Chinese emerging adults. Via an online survey, 3381 participants (56.6% females; mean age = 19.56 years) completed the Chinese versions of the GDT, GADIS-A, Internet Gaming Disorder-Short Form (IGDS9-SF), and Bergen Social Media Addiction Scale (BSMAS). Confirmatory factor analysis was used to examine the factor structure of the Chinese GDT and GADIS-A. Pearson correlations were computed to examine the convergent validity (with IGDS9-SF) and divergent validity (with BSMAS) of the Chinese GDT and Chinese GADIS-A. The GDT had a unidimensional structure, which was invariant across sex and disordered gaming severity subgroups. The GADIS-A had a two-factor structure, which was also invariant across gender and gaming severity subgroups. Both the GDT and GADIS-A had significant associations with both IGDS9-SF and with BSMAS. Both the Chinese GDT and GADIS-A are valid instruments to assess GD among emerging adults in mainland China, enabling healthcare providers to adopt these tools in their efforts to prevent and examine GD severity among Chinese youth.

Determinants of Life Satisfaction and Quality of Life Among American Indian Women Cancer Survivors: The Role of Psychosocial Resources.

PURPOSE: This study assessed the relationship of spirituality, social support, and sense of mastery to life satisfaction and quality of life to identify viable psychosocial coping resources among American Indian (AI) women cancer survivors. METHOD: We conducted a cross-sectional survey of 73 AI women cancer survivors residing in South Dakota. A series of multivariate hierarchical regression analyses was conducted. RESULTS: Findings indicated that lower self-rated physical health was consistently associated with lower levels of life satisfaction and quality of life. Spirituality was found to be the most influential predictor for life satisfaction, while social support and sense of mastery were two significant predictors for quality of life. DISCUSSION: Our data underscored the importance of spirituality, social support, and sense of mastery to the well-being of AI women cancer survivors and as effective coping strategies to mitigate life stressors. Implications of this evidence for the design of cancer preventions and interventions are discussed.

Patterns and trajectories of children's maltreatment experiences in Taiwan: Latent transition analysis of a nationally representative longitudinal study.

BACKGROUND: Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan. OBJECTIVE: To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan. PARTICIPANTS AND SETTING: A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed. METHODS: Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference. RESULTS: Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time. CONCLUSIONS: This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed.

Understanding Children's Online Victimization through the Psychosocial Lens: The Roles of Loneliness, Online Social Currency, and Digital Citizenship.

This study employed a risk and resilience framework to investigate the influence of multidimensional factors, considering psychosocial and behavioral aspects, on online victimization among fifth-grade children (ages 10-11). Loneliness, online social currency disturbance, and digital citizenship were examined as predictors of online victimization. Data were collected from 196 students through a self-reported online survey conducted on electronic devices provided by the schools. The findings indicated that 78.6% of fifth-graders owned a smartphone, 70.9% had a gaming console, and the most common online activities were playing online gaming (73%), talking with friends (62.8%), and seeking entertainment (62.2%). Online victimization was prevalent, with 30.8% of children reporting they had been called bad names, 24.7% receiving rude comments, 15.9% expressing feelings of worry or threat due to online harassment, and 3.1% experiencing cyberbullying lasting for days. Furthermore, the results revealed a negative association between digital citizenship and online victimization, while loneliness and online social currency disturbance were positively associated with online victimization after accounting for children's gender and time spent online. In conclusion, this study suggests that efforts to prevent and address online victimization should prioritize promoting digital citizenship and increasing awareness of the roles of loneliness and social currency disturbances in online social dynamics.

Dynamic weight status changes and peer lifestyles in early adolescence: A social network analysis on a longitudinal cohort of Taiwanese youth.

BACKGROUND: Friendship networks are relevant to adolescent weight status and lifestyle, but little is known about their relationship in an East Asian setting. Using a longitudinal cohort of Taiwanese adolescents, we studied how weight status and lifestyles might influence friendship. Simultaneously considering the influence of friendship networks, we further examined the effects of peers' lifestyles on the body weight status of adolescents. METHODS: Data were retrieved from the first three waves of the Taiwan Youth Project (N = 2409; 51 % boys). Participants were asked to nominate their friends at school and to report their lifestyle factors (e.g. sleep habits, internet use, and athletic performance). Weight status was proxied by body mass index calculated from self-reported weight and height. Stochastic actor-based modeling was used for the friendship network analyses. RESULTS: Considering network structure, adolescents selected friends based on similarities in weight status (ß = 0.147 [standard error = 0.044], p < 0.001) and lifestyle factors, such as athletic performance (ß = 0.181 [0.034], p < 0.001), internet use (ß = 0.156 [0.039], p < 0.001), and social jetlag (ß = 0.055 [ ± 0.022], p < 0.05). In the behavior dynamics model, we did not observe any peer influence on changes in adolescents' weight status. CONCLUSION: These findings suggest a pervasive homophilic friendship selection explained by weight and lifestyle-based similarities, despite no evidence of peer influence on weight status. Stakeholders and care providers of adolescent health should be aware of the social network processes that underlie weight problems.

Relationship Between Weight Status and Self-Image Mediated by Pubertal Timing and Athletic Competence: A Cohort Study With Taiwanese Adolescents.

Background: Self-image reflects overall self-acceptance in developing adolescents. Using a representative cohort of Taiwanese youth, this study aims to explore the relationship between weight status, pubertal timing, athletic competence, and adolescent self-image. Methods: Data come from the Taiwan Youth Project that comprised a longitudinal cohort of adolescents (N = 2690, 51% males, Mage = 13.3 ± 0.5 years) surveyed annually from seventh grade. Self-image was measured by perceived satisfaction with appearance and physique. Weight status was proxied by self-reported body mass index (BMI; kg/m2). Pubertal timing was defined using the Pubertal Developmental Scale, which mainly measured physical changes in puberty. Athletic competence was assessed by experiences with participation in competitive sports and self-perceived talent for sports. Linear regression analysis was applied to test for an association between BMI and self-image. In order to test for mediating roles of pubertal timing and athletic competence, Hayes' PROCESS macro on SPSS was conducted applying 5,000 bootstrap resamples with 95% confidence intervals of the indirect effect. Results: BMI was inversely associated with self-image in both males (ß = -0.074, [-0.095, -0.053]) and females (ß = -0.095, [-0.122, -0.069]). The boot-strapped 95% confidence intervals indicated statistically significant mediating effects of pubertal timing (ß = -0.008, [-0.015, -0.001]) and athletic competence (ß = -0.006, [-0.011, -0.002]) in the link between BMI and self-image in females, whilst only athletic competence mediated this association (ß = -0.006, [-0.009, -0.002]) in males. Moreover, BMI at baseline were also associated with long-term self-image in males (ß = -0.037, [-0.057, -0.017]) and females (ß = 0.132, [0.073, 0.190]). Conclusions: Understanding the mediating factors may help enhance adolescents' self-image by providing guidance on healthy weight and physical activity behaviors according to different stages of pubertal progression.

Mifepristone (RU-486®) as a Schedule IV Controlled Drug-Implications for a Misleading Drug Policy on Women's Health Care.

BACKGROUND: Mifepristone (RU-486) has been approved for abortion in Taiwan since 2000. Mifepristone was the first non-addictive medicine to be classified as a schedule IV controlled drug. As a case of the "misuse" of "misuse of drugs laws," the policy and consequences of mifepristone-assisted abortion for pregnant women could be compared with those of illicit drug use for drug addicts. METHODS: The rule-making process of mifepristone regulation was analyzed from various aspects of legitimacy, social stigma, women's human rights, and access to health care. RESULTS AND DISCUSSION: The restriction policy on mifepristone regulation in Taiwan has raised concerns over the legitimacy of listing a non-addictive substance as a controlled drug, which may produce stigma and negatively affect women's reproductive and privacy rights. Such a restriction policy and social stigma may lead to the unwillingness of pregnant women to utilize safe abortion services. Under the threat of the COVID-19 pandemic, the US FDA's action on mifepristone prescription and dispensing reminds us it is time to consider a change of policy. CONCLUSIONS: Listing mifepristone as a controlled drug could impede the acceptability and accessibility of safe mifepristone use and violates women's right to health care.

Epigenetic Deregulation of Protein Tyrosine Kinase 6 Promotes Carcinogenesis of Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma (OSCC) accounts for over 90% of oral cancers and causes considerable morbidity and mortality. Epigenetic deregulation is a common mechanism underlying carcinogenesis. DNA methylation deregulation is the epigenetic change observed during the transformation of normal cells to precancerous and eventually cancer cells. This study investigated the DNA methylation patterns of PTK6 during the development of OSCC. Bisulfite genomic DNA sequencing was performed to determine the PTK6 methylation level. OSCC animal models were established to examine changes in PTK6 expression in the different stages of OSCC development. The DNA methylation of PTK6 was decreased during the development of OSCC. The mRNA and protein expression of PTK6 was increased in OSCC cell lines compared with human normal oral keratinocytes. In mice, the methylation level of PTK6 decreased after treatment with 4-nitroquinoline 1-oxide and arecoline, and the mRNA and protein expression of PTK6 was increased. PTK6 hypomethylation can be a diagnostic marker of OSCC. Upregulation of PTK6 promoted the proliferation, migration, and invasion of OSCC cells. PTK6 promoted carcinogenesis and metastasis by increasing STAT3 phosphorylation and ZEB1 expression. The epigenetic deregulation of PTK6 can serve as a biomarker for the early detection of OSCC and as a treatment target.

Single-Cell RNA Sequencing Analysis for Oncogenic Mechanisms Underlying Oral Squamous Cell Carcinoma Carcinogenesis with Candida albicans Infection.

Oral squamous cell carcinoma (OSCC) carcinogenesis involves heterogeneous tumor cells, and the tumor microenvironment (TME) is highly complex with many different cell types. Cancer cell-TME interactions are crucial in OSCC progression. Candida albicans (C. albicans)-frequently pre-sent in the oral potentially malignant disorder (OPMD) lesions and OSCC tissues-promotes malignant transformation. The aim of the study is to verify the mechanisms underlying OSCC car-cinogenesis with C. albicans infection and identify the biomarker for the early detection of OSCC and as the treatment target. The single-cell RNA sequencing analysis (scRNA-seq) was performed to explore the cell subtypes in normal oral mucosa, OPMD, and OSCC tissues. The cell composi-tion changes and oncogenic mechanisms underlying OSCC carcinogenesis with C. albicans infec-tion were investigated. Gene Set Variation Analysis (GSVA) was used to survey the mechanisms underlying OSCC carcinogenesis with and without C. albicans infection. The results revealed spe-cific cell clusters contributing to OSCC carcinogenesis with and without C. albicans infection. The major mechanisms involved in OSCC carcinogenesis without C. albicans infection are the IL2/STAT5, TNFα/NFκB, and TGFß signaling pathways, whereas those involved in OSCC carcinogenesis with C. albicans infection are the KRAS signaling pathway and E2F target down-stream genes. Finally, stratifin (SFN) was validated to be a specific biomarker of OSCC with C. albicans infection. Thus, the detailed mechanism underlying OSCC carcinogenesis with C. albicans infection was determined and identified the treatment biomarker with potential precision medicine applications.

Exploring the Interaction Effects of Gender Contentedness and Pubertal Timing on Adolescent Longitudinal Psychological and Behavioral Health Outcomes.

Background: Off-time pubertal timing (PT) and non-conforming gender identity have been reported to predict adverse health and well-being in adolescents. However, the joint effects of these two factors are less addressed. We aimed to investigate the main and interaction effects of gender identity, proxied by perceived gender contentedness (GC), and PT on longitudinal adolescent psychological and behavioral outcomes. Methods: Data (N = 1806, Mage = 13.3 ± 0.5 years) come from the Taiwan Youth Project, which prospectively followed a longitudinal cohort of Taiwanese junior high school students from 2000 (wave 1) to 2009 (wave 9). GC was self-reported at waves 1 and 9 in a binary response, and thus 4 GC trajectories were created. PT was defined using the Pubertal Developmental Scale, which mainly measured physical changes in puberty. Multiple linear regression analyses with gender stratification were applied to examine the effects of the GC trajectory and its interaction with PT on the outcomes. Results: A total of 1,562 subjects (86.5%) remained consistently satisfied with their gender, while the GC of 226 subjects (12.6%) changed at some point. Regression analyses found that males with gender dissatisfaction at wave 9 were likely to engage in delinquent behavior, and females in this group were more likely to have lower self-esteem, as compared to those with consistent GC. The interaction effect between the GC trajectory and PT appeared to be associated with smoking and drinking only at wave 1. Conclusions: These findings indicate that healthcare professionals should concentrate on gender non-conforming individuals at early adolescence, navigating them toward a healthy adulthood.

Protective Factors against Depressive Symptoms in Female American Indian Cancer Survivors: The Role of Physical and Spiritual Well-being and Social Support.

BACKGROUND: This exploratory study examined how perceived physical well-being, spiritual well-being and social support relate to depressive symptoms among American Indian (AI) female cancer survivors. METHODS: Cross-sectional data were obtained from 73 AI female cancer survivors between 32 to 77 years of age in the Midwest of the United States. Standardized measures were used to assess for depression (Center for Epidemiologic Studies Depressive Symptoms Scale Short Form), spiritual well-being (Functional Assessment of Chronic Illness Therapy, Spiritual Well-being Scale), and social support (Medical Outcomes Study of Social Support Questionnaire). A single item measured physical well-being. After univariate and bivariate analyses, hierarchical multiple regression (HMR) was used for modeling. RESULTS: Approximately 47% of the sample scored higher than 10 on the depressive symptoms scale. HMR results indicated that perceived physical well-being, spiritual well-being, and social support were negatively associated with depressive symptoms, accounting for 47% of the variance in the final model (adjust R2 = 0.47). CONCLUSIONS: A high percentage of the sample exceeded the cut point for probable depression, highlighting the importance of addressing mental health in the aftermath of cancer treatments for AI women. Results suggest that perceived physical well-being, spiritual well-being, and social support serve as protective factors and possible levers to reduce depression in this population. Interventions designed to bolster existing social support and spirituality could improve the mental health of AI women in the aftermath of cancer treatment. Community-based, culturally appropriate health education programs should be developed to enhance AI women's physical health. 
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Ecological Predictors and Trajectory of Internet Addiction from Childhood through Adolescence: A Nationally Representative Longitudinal Study.

We examined multidimensional factors within four systems (individual, family, school, and community) that influence internet addiction across time among children through adolescence in Taiwan. We hypothesize that internet addiction increases from childhood to adolescence and that resilience, child neglect, positive school experiences, and community violence are significant predictors at baseline and of the rate of change across time. Based on stratified random sampling, a valid sample size of 6233 Taiwanese children participated in our study, which we began in 2014 and then followed this sample in 2016 and 2018 using repeated measures. We used hierarchical linear modeling to model changes in internet addiction across time (with equal two-year intervals between assessments) and the associations between the predictors and internet addiction over time. The results show that internet addiction increases from childhood to adolescence. After controlling for gender, we found that resilience and positive school experiences predict less internet addiction, whereas neglect and community violence predict greater internet addiction. Over time, greater resilience predicts a decreasing trajectory of internet addiction, whereas greater neglect and community violence predict a slower increasing trajectory and positive school experiences predict a faster-increasing trajectory. A holistic approach can help children cope with internet addiction.

Adolescent developmental assets and longitudinal weight status and psychosocial health outcomes: Exploratory analysis from a youth cohort study in Taiwan.

BACKGROUNDS: Asset-based youth development has been proposed to be associated with health behaviors and psychological well-being in adolescents. This study aims to extend the current knowledge regarding the effects of positive youth development on weight status and psychosocial health outcomes in young adulthood using a large representative longitudinal sample. METHODS: Data were retrieved from the Taiwan Youth Project that comprised a longitudinal cohort of adolescents (N = 2688) surveyed at grades 7, 8, 9, and 12, and at age 22. Principal component analysis was used to construct developmental asset scores based on 35 items selected from the relevant questions at wave 1. Outcomes were standardized scores of body mass index, self-rated healthiness and happiness, depressive symptomology and deviant behaviors in the subsequent waves. Generalized estimating equation analysis was applied to assess the impact of developmental assets on these repeatedly measured outcome variables. RESULTS: As compared to those with the highest quintile level of developmental assets, individuals with the lowest quintile level were more likely to rate themselves unhealthy (ß = 0.33 [95% confidence interval 0.26, 0.40]) and unhappy (ß = 0.47 [0.41, 0.54]) and report more depressive symptomatology (ß = 4.18 [3.35, 5.01]) and deviant behaviors (ß = 0.63 [0.44, 0.81]). No association was found between body mass index and developmental asset scores. CONCLUSION: The results concluded a longitudinal association between adolescent developmental assets and psychological and behavioral health outcomes. Further research may be required to investigate whether positive youth development could be translated into long-term benefits in adult physical conditions, such as obesity.

Nonattendance at Scheduled Appointments in Outpatient Clinics Due to COVID-19 and Related Factors in Taiwan: A Health Belief Model Approach.

During the COVID-19 pandemic, the number of hospital visits and attendance at scheduled appointments have dropped significantly. We used the health belief model (in three dimensions) to examine the determinants of non-attendance of scheduled appointments in outpatient clinics due to the COVID-19 pandemic. Participants in Taiwan (n = 1954) completed an online survey from 10 April 10 to 23 April 2020, which assessed how people perceived and responded to the outbreak of a fast-spreading infectious disease. We performed both univariate and multivariate logistic regression to examine the roles of cognitive, affective, and behavioral health belief constructs in nonattendance at scheduled appointments. The results indicated that individuals who perceived high confidence in coping with COVID-19 were less likely to miss or cancel their doctor's appointments, whereas individuals who reported high anxiety and practiced more preventive health behaviors, including avoiding crowded places, washing hands more often, and wearing a mask more often, were more likely to miss or cancel their appointments due to the COVID-19 pandemic. Non-heterosexual participants had a lower rate of nonattendance at scheduled appointments compared with heterosexual ones. The study results increase our understanding of the patients' cognitive health beliefs, psychological distress, and health behaviors when assessing adherence to medical appointments during a pandemic.