The health of rural Black communities during COVID: Some affirmations, some surprises.

Background and objective: There are overwhelming health disparities in the Deep South. It is important to include the voice of communities affected by these disparities when developing interventions. The goal of the current study was to develop an academic community engaged partnership to strengthen the ability to address priority health concerns of rural African American communities with a focus on health literacy and health advocacy. Methods: A community-based participatory research approach was used to administer a 15-item community health survey in five rural communities led by African American mayors in Alabama (N = 752). The survey assessed the health concerns and the potential behaviors that may be associated with those health concerns. Results: The five communities demonstrated similarities as well as differences in both the health concerns endorsed and the potential health behaviors that may contribute to those concerns. All five communities identified cardiovascular disease as a health concern with three endorsing mental health issues and 2 dental health. With respect to behaviors, all five communities identified either unhealthy eating/exercise and substance use as concerns with one community identifying racism as a risky behavior affecting health. Conclusion: The results presented replicate CBPR studies demonstrating that communities are important sources of information about local health priorities and concerns.

Research on the psychologically restorative effects of campus common spaces from the perspective of health.

Contemporary college students are suffering from increasingly serious psychological health problems, such as attention fatigue, psychological stress and negative emotions. A growing body of evidence has revealed that restorative environment design is conducive to psychological health. As the main choice of venue for students' daily activities, campus common spaces are supposed to be restorative to some extent. Given the above, the author studied 22 common spaces in the South China University of Technology (SCUT) Wushan Campus from the perspective of college students' behavioral patterns based on theories pertaining to restorative environments, then constructed a structural equation model (SEM) analyzing the psychologically restorative effects exerted by the characteristics of campus common spaces upon college students through a scale design and questionnaire survey. With the analysis of 478 valid questionnaires, the research found that the characteristics of campus common spaces with psychologically restorative effects mainly comprise the architectural environment, landscape environment, rest facilities and activity facilities. Among them, the characteristics of activity facilities and the landscape environment have the greatest impact on psychologically restorative effects, accounting for 33 and 30% of the total effects, respectively; they are followed by those of the architectural environment, which accounts for 21% of the total effects; those of the rest facilities have the least impact, accounting for 16% of the total effects. The research also found that the characteristics of campus common spaces can both directly influence college students' psychological recovery and produce psychologically restorative effects mediated by college students' behavioral patterns. The mediation effect of college students' behavioral patterns accounts for approximately 41% of the total effect of psychological restoration, in which the psychologically restorative effect of dynamic exercise behaviors is 2.5 times that of static leisure behaviors. The research reveals how the characteristics of campus common spaces promote the psychological restoration of college students, and it provides inspiration for healthy environment design in campus common spaces.

Health service behaviors of migrants: A conceptual framework.

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

[The population health and attitude to it in conditions of instability].

The article considers issues of attitude of modern man to one's own health, both physical and mental in conditions of instability. The results of sociological studies implemented in 2021-2022 among the population of the Kursk Oblast are presented. The results reflect personal characteristics and attitudes to health, in particular in conditions of complex epidemiological situation and changes in population behavior in area of health saving in conditions of complicated geopolitical situation.

CBT treatment delivery formats for panic disorder: a systematic review and network meta-analysis of randomised controlled trials.

Several in-person and remote delivery formats of cognitive-behavioural therapy (CBT) for panic disorder are available, but up-to-date and comprehensive evidence on their comparative efficacy and acceptability is lacking. Our aim was to evaluate the comparative efficacy and acceptability of all CBT delivery formats to treat panic disorder. To answer our question we performed a systematic review and network meta-analysis of randomised controlled trials. We searched MEDLINE, Embase, PsycINFO, and CENTRAL, from inception to 1st January 2022. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO. We found a total of 74 trials with 6699 participants. Evidence suggests that face-to-face group [standardised mean differences (s.m.d.) -0.47, 95% confidence interval (CI) -0.87 to -0.07; CINeMA = moderate], face-to-face individual (s.m.d. -0.43, 95% CI -0.70 to -0.15; CINeMA = Moderate), and guided self-help (SMD -0.42, 95% CI -0.77 to -0.07; CINeMA = low), are superior to treatment as usual in terms of efficacy, whilst unguided self-help is not (SMD -0.21, 95% CI -0.58 to -0.16; CINeMA = low). In terms of acceptability (i.e. all-cause discontinuation from the trial) CBT delivery formats did not differ significantly from each other. Our findings are clear in that there are no efficacy differences between CBT delivered as guided self-help, or in the face-to-face individual or group format in the treatment of panic disorder. No CBT delivery format provided high confidence in the evidence at the CINeMA evaluation.

Healthy orthorexia vs. orthorexia nervosa: Italian validation of the Teruel Orthorexia Scale (TOS).

PURPOSE: Orthorexia nervosa (OrNe) is a potentially pathological condition characterized by a fixation on healthy diet. An increasing number of studies have been conducted on this mental preoccupation, but the validity and reliability of some of the psychometric instruments employed in its assessment are still under debate. Among these measures, the Teruel Orthorexia Scale (TOS) seems to be promising, given that it allows to differentiate between OrNe and other non-problematic forms of interest with healthy eating, named as healthy orthorexia (HeOr). The aim of this study was to examine the psychometric properties of an Italian version of the TOS, by testing its factorial structure, internal consistency, test-retest reliability, and validity. METHOD: Through an online survey, we recruited 782 participants from different regions of Italy, asking them to complete the following self-report instruments: TOS, EHQ, EDI-3, OCI-R, and BSI-18. From the initial sample, 144 participants agreed to complete a second TOS administration 2 weeks later. RESULTS: Data confirmed the validity of the 2-correlated factors structure of the TOS. The questionnaire also showed good reliability, both in terms of internal consistency and temporal stability. With regard to the TOS validity, results showed that OrNe was significantly and positively associated with measures of psychopathology and psychological distress, while HeOr showed no correlations or negative associations with the above-mentioned measures. CONCLUSION: Based on these results, the TOS can be considered a promising measure for the assessment of both pathological and non-problematic forms of orthorexic eating behavior also in Italian population. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

A strategic analysis of health behaviour change initiatives in Africa.

BACKGROUND: Changed health behaviours can contribute significantly to improved health. Consequently, significant investments have been channelled towards health behaviour change initiatives in Africa. Health behaviour change initiatives that address social, economic and environmental levers for behaviour change can create more sustained impact. OBJECTIVES: Through a scoping study of the literature, we explored the literature on behaviour change initiatives in Africa, to assess their typologies. We explored whether the availability of initiatives reflected country demographic characteristics, namely life expectancy, gross domestic product (GDP), and population sizes. Finally, we assessed topical themes of interventions relative to frequent causes of mortality. METHODS: We used the Behaviour Change Wheel intervention categories to categorise each paper into a typology of initiatives. Using Pearson's correlation coefficient, we explored whether there was a correlation between the number of initiatives implemented in a country in the specified period, and socio-demographic indicators, namely, GDP per capita, total GDP, population size, and life expectancy. RESULTS: Almost 64% of African countries were represented in the identified initiatives. One in five initiatives was implemented in South Africa, while there was a dearth of literature from Central Africa and western parts of North Africa. There was a positive correlation between the number of initiatives and GDP per capita. Most initiatives focused on addressing sexually transmitted infections and were short-term trials and/or pilots. Most initiatives were downstream focused e.g. with education and training components, while upstream intervention types such as the use of incentives were under-explored. CONCLUSION: We call for more emphasis on initiatives that address contextual facilitators and barriers, integrate considerations for sustainable development, and consider intra-regional deprivation.

[Learning motivational interviewing to better support patient medication adherence]. / Se former à l'entretien motivationnel pour mieux soutenir l'adhésion thérapeutique des patients.

Motivational interviewing (MI), developed in the 1980s, demonstrated efficacy in helping patients to change their health behavior, and more recently in supporting patient therapeutic adherence. However, the training in patient therapeutic adherence support is poor and unequally distributed within the initial and continuing training of health professionals. To cope, an interprofessional continuing training was designed by health professionals and researchers, aiming at acquiring fundamental knowledge in therapeutic adherence and MI skills. The results of the first training session should encourage health professionals to train, and decision-makers to promote wider dissemination of this training.

Depuis son développement dans les années 1980, l'entretien motivationnel (EM) s'est avéré efficace pour accompagner les patients à modifier leur comportement en santé, et plus récemment dans le soutien de leur adhésion thérapeutique. Cependant, la formation au soutien de l'adhésion thérapeutique est pauvre et inégalement répartie au sein de la formation initiale et continue des professionnels de santé. Face à ce constat, une formation continue interprofessionnelle a été conçue par des professionnels de santé et chercheur-e-s, visant à l'acquisition des connaissances fondamentales en adhésion thérapeutique et des compétences en EM. Les résultats objectivés par la première session de formation devraient inciter les professionnels de santé à se former et les décideurs à favoriser une diffusion plus large de ce type de formation.

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017-2021: focusing on the comparisons before and during the COVID-19 pandemic.

Objectives: We investigated recent trends in health behaviors and mental health conditions among Korean adolescents from 2017 to 2021 and compared the changes before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Data analysis was conducted on 289,415 adolescents participating in the Korea Youth Risk Behavior Web-Based Survey, an annual cross-sectional study from 2017 to 2021. All analysis was conducted using sex stratification, and the annual percentage change (APC) was calculated. Results: Alcohol consumption and smoking decreased in the first year of the COVID-19 pandemic compared with before, except for girls from the low-income level. The prevalence of inadequate physical activity for both boys and girls increased in 2020 compared with the pre-COVID-19 period and decreased again by 2021. The prevalence of obesity in both sexes increased regardless of the period (boys, APC = 8.2%, 95% confidence intervals (CI), 6.4-10.1; girls, APC = 3.3%, 95% CI, 1.8-4.8). The prevalence of stress, depression, and suicidal ideation, plans, and attempts for both sexes decreased in 2020 compared to the pre-COVID-19 period. By 2021, this prevalence had returned to a level similar to before the pandemic. No significant APC changes were observed in the prevalence of mental health. Conclusions: These findings demonstrate the trends and APCs in health behaviors and mental health conditions among Korean adolescents over the last 5 years. We must pay attention to the heterogeneous and multifaceted features of the COVID-19 pandemic.

Sustaining youth physical activity in times of challenge and change: lessons from COVID-19.

Physical activity (PA) is recognized as essential for positive physical and mental well-being in young people. However, participation in PA is known to decline as adolescents emerge into adulthood under the influence of complex social and structural factors. Globally, COVID-19 restrictions resulted in changes to PA and PA participation levels in youth populations, providing a unique opportunity for gaining insight into PA barriers and enablers in circumstances of challenge, limitation and change. This article details young people's self-reported PA behaviours during the 4-week 2020 COVID-19 lockdown in New Zealand. Taking a strengths-based view and drawing on the COM-B (capabilities, opportunity and motivation behaviour) model for behaviour change, the study explores factors enabling young people to sustain or increase PA during lockdown. Findings are drawn from qualitative-dominant mixed-methods analyses of responses to an online questionnaire: New Zealand Youth Voices Matter (16-24 years; N = 2014). Key insights included the importance of habit and routine, time and flexibility, social connections, incidental exercise and awareness of links between PA and well-being. Of note were the positive attitudes, creativity and resiliency demonstrated as young people substituted or invented alternatives to their usual PA. PA needs to change to adapt to new circumstances over the life course, and youth understanding and knowledge of modifiable factors may provide support for this. Thus these findings have implications for sustaining PA during late adolescence and emerging adulthood, a life phase that can be associated with significant challenge and change.

Retirement planning and types of healthy lifestyle after retirement: a Nationwide Survey in Taiwan.

Limited research has examined the components of retirement planning and the effects on retirees' health behaviors. This study aims to explore whether retirement planning is associated with different types of healthy lifestyles after retirement. We conducted a nationwide Health and Retirement Survey in Taiwan and analyzed the data from 2015 to 2016. A total of 3128 retirees aged 50-74 years were included in the analysis. Twenty items on retirement planning from five categories were administered, and 20 health-related behaviors were used for measuring healthy lifestyles. Results showed that five types of healthy lifestyles were found from the 20 health behaviors by factor analysis. After controlling for all covariates, various components of retirement planning were associated with different types of lifestyles. Retirees having any item of retirement planning would significantly increase the score of 'healthy living'. Those with 1-2 items were also associated with the total score and the type of 'no unhealthy food'. However, those with ≥ 6 items were the only group positively related to the type of 'regular health checkups' but negatively to the type of 'good medication'. In conclusion, retirement planning offers a 'window of opportunity' for promoting healthy lifestyles after retirement. Pre-retirement planning should be advocated in the workplace to improve health-related behaviors, especially for those upcoming retired workers. In addition, a friendly environment and continuous programs should also be incorporated for better retirement life.

Weight Changes and Unhealthy Weight Control Behaviors Are Associated With Dysmenorrhea in Young Women.

BACKGROUND: This study aimed to evaluate the prevalence of dysmenorrhea and to investigate the effect of weight changes or unhealthy weight control behaviors on dysmenorrhea in young Korean women. METHODS: We used large-scale data of women, aged 14 to 44 years, who participated in the Korean Study of Women's Health-Related Issues. Dysmenorrhea was measured using a visual analog scale and was categorized as none, mild, moderate, and severe according to the severity. Weight changes and unhealthy weight control behaviors (any of the behaviors, fasting/meal skipping, drugs, the use of unapproved dietary supplements, and one-food diets) over the past year were self-reported. We used multinomial logistic regression to investigate the association between weight changes or unhealthy weight control behaviors and dysmenorrhea. RESULTS: Of the 5,829 young women participating in the study, 5,245 (90.0%) participants experienced dysmenorrhea [2,184 (37.5%) had moderate and 1,358 (23.3%) had severe]. After adjusting for confounders, the odds ratios for moderate and severe dysmenorrhea in participants with weight changes ≥ 3 kg (vs. < 3 kg) were 1.19 (95% confidence interval: 1.05-1.35) and 1.25 (95% confidence interval: 1.08-1.45), respectively. The odds ratios in participants with any unhealthy weight control behaviors were 1.22 (95% confidence interval: 1.04-1.42) and 1.41 (95% confidence interval: 1.19-1.67) for those with moderate and severe dysmenorrhea, respectively. CONCLUSION: Weight changes (≥ 3 kg) or unhealthy weight control behaviors are common among young women, which may adversely affect dysmenorrhea. Therefore, attention needs to be paid to excessive weight changes and unhealthy weight control behaviors to improve dysmenorrhea in young women.

Development of a Supported Self-management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence-Based Co-design Approach.

BACKGROUND: Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services. OBJECTIVE: We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI. METHODS: The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence. RESULTS: Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes. CONCLUSIONS: The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial.

False Beliefs and Attitude Are Barriers to COVID-19 Vaccination.

As of October 2021, Medical Reserve Corps (MRC) volunteers donated over 2 million h to coronavirus disease 2019 (COVID-19). The Health Belief Model (HBM) is used to understand the value a person places on preventative behavior against the risk of disease. A mixed method, unmatched, prospective case-control study was conducted regarding volunteers' experience during the pandemic, reasons why these highly trained persons volunteer, what barriers to vaccination they observed, and how they helped others overcome those barriers. The HBM can elucidate the cognitive process to vaccinate. Regression analysis found a person's attitude (which includes beliefs, peer pressure, preconceptions, unwillingness, and other indicators) is a barrier to vaccination. Service hours increased from 20 to 56 h among volunteers who saw attitude as a barrier to vaccination. Superstition and fear accounted for 99.8% of unvaccinated persons (P < 0.001). Fear was a barrier to protective health behavior. The public health system must do better to build trust as an ongoing endeavor, as even the increased service volunteers provided in response to the observed attitudes, was not enough to stem exponential transmission once the pandemic had begun. Policy-makers and the public health authority should take all necessary steps early in the pandemic to ensure the effectiveness of the vaccination program.

Health-promoting lifestyle and its predictors among health-related and non-health-related university students in Taiwan: a cross-sectional quantitative study.

BACKGROUND: University students majoring in different disciplines are believed to have different personality traits, courses exposure, and future roles, which may further affect their health behaviors and health status. The purpose of this study was to investigate the differences in health-promoting lifestyle (HPL) and its predictors among health-related and non-health-related students. METHODS: The research participants were university students in the main island of Taiwan, and a two-stage sampling approach was adopted to obtain the samples from November 2020 to March 2021. First, 37 universities were randomly selected based on the ratio of public and private universities in each region of Taiwan. Then, based on the ratio of health-related and non-health-related majors of selected university, 25-30 students were randomly drawn from each university according to the student ID number to complete self-administered questionnaires, which included items for personal factors, perceived health status (PHS), health conception (HC), and health-promoting lifestyle profile (HPLP). A total of 1062 valid questionnaires were recovered, including 458 from health-related students and 604 from non-health-related students. Chi-squared test, independent samples t-test, one-way ANOVA, Pearson product-moment correlation analysis, and multiple regression analysis were performed. RESULTS: The results showed that gender (p < 0.001), residential status (p = 0.023), body mass index (p = 0.016), and daily sleep duration (p = 0.034) of the students majoring in different disciplines were different. Health-related students having better HC (p = 0.002) and HPLP (p = 0.040) than non-health-related students. In addition, for both majors, females, low PHS scores, and low scores for functional/role, clinical, and eudaimonistic dimensions of HC were important indicators of a relatively negative HPLP, while health-related students who exercised 75 min or less per week and non-health-related students with a monthly disposable income of 15,000 TWD or less or who dined out 15 times or more per week also required attention in the promotion of HPL (health-related majors: adjusted R2 = 0.481, p < 0.001; non-health-related majors: adjusted R2 = 0.443, p < 0.001). CONCLUSIONS: Students majoring in each discipline who had poor HPLP which is mentioned above should be prioritized in the provision of appropriate exercise or nutritional support programs on campus to promote their awareness and ability to pay attention to their health.

Effects of online social media on improving mothers' behaviors towards preventing their children's otitis media based on the PRECED model: a randomized educational intervention trial.

BACKGROUND: Otitis media is one of the most common diseases in children, especially those under 2 years of age. This study aimed to investigate the effect of educational intervention based on the PRECEDE model on mothers' preventive behaviors of middle ear infections in infants. METHODS: This study was conducted as an educational randomized controlled trial on 88 mothers with infants referred to health centers in Arak, Iran. Sampling from September 2021 to February 2022 selected trough stratified random sampling who were assigned to two groups of experimental = 44 and control = 44. The data collection tool was a reliable and valid questionnaire that included demographic information, constructs of PRECEDE model regarding otitis media, and preventive behaviors. The experimental group received 4 training sessions (each session 60 min) through WhatsApp social network. Information was collected through an online questionnaire before and 3 months after the educational intervention from both groups. Data analysis was also performed with SPSS version 23. RESULTS: Before the educational intervention there was no significant difference between the experimental and control groups in the otitis media preventive behaviors and structures of PRECEDE model (p > 0.05). After the educational intervention, in the experimental group the average score of knowledge from 0.49 to 0.81, attitude from 4.01 to 4.58, enabling factors from 0.72 to 0.85, reinforcing factors from 3.31 to 3.91 and behavior from 3.25 to 3.66 increased significantly (p < 0.001). CONCLUSIONS: PRECEDE-based education with controlling, monitoring and follow-up during the program was effective in promoting the preventive behaviors of otitis media. Therefore, due to the side effects of otitis media, especially in vulnerable periods such as childhood, it is recommended that trainings based on this model be carried out in other health care centers and clinics in order to maintain children health. TRIAL REGISTRATION: This trial has been registered at the Iranian Registry of Clinical Trials, IRCT20210202050228N1. Prospectively registered at 2021-May-21, (2021/05/21) available at: URL: https://en.irct.ir/trial/54073 .

[Potential short-term effects of tobacco control scheme under various application scenarios of tobacco control measures across the globe: a Meta-analysis].

Objective: based on summarizing the simulation and prediction of tobacco control measures across the globe and sorting out the various scenarios of tobacco control measures, the potential short-term effects of seven tobacco control measures in different scenarios were systematically analyzed. Methods: Until April 2022, PubMed, Embase, EconLit, PsychINFO, and CINAHL databases were used to retrieve literature about tobacco control measures simulation and prediction models across the globe. Inclusion and exclusion criteria were strictly followed. Meta-analysis for the potential short-term effects of seven tobacco control measures in different scenarios was performed using the R software. Results: A total of 22 papers covering 16 countries were selected. Five studies were conducted in the United States, three in Mexico, and two in Italy. There were all papers with the measures to tax increases, smoke-free air laws, and mass media campaigns, 21 papers with youth access restrictions, 20 with marketing restrictions, and 19 with cessation treatment programs and health warnings. The tax increases had diverse influences on the price elasticity of different age groups. The price elasticity in the age group 15-17 years was the highest, which was 0.044 (95%CI: 0.038-0.051). The potential short-term effects of smoke-free air laws in workplaces were higher than in restaurants and other indoor public places. The effects of youth access restrictions were greater in the age group <16 years than in the age group 16-17. The stronger the implementation of other measures, the greater the potential short-term effects. A comparison of seven tobacco control measures showed that the cessation treatment programs increase in cessation rate was the highest, 0.404 (95%CI: 0.357-0.456). The reduction in smoking rate and reduction in initiation rate of youth access restrictions strongly enforced and publicized was the highest in the age group <16 years, 0.292 (95%CI: 0.269-0.315), and 0.292 (95%CI: 0.270-0.316). Conclusions: The potential short-term effects of seven tobacco control measures in different scenarios were evaluated more accurately and objectively through Meta-analysis. In the short term, cessation treatment programs will substantially increase smoking cessation rates, and strong youth access enforcement will sharply reduce smoking and initiation rates among adolescents under 16. These results also offer strong data-related support for the simulation and prediction of tobacco control measures in China and other countries.

Reach Out Emergency Department: A Randomized Factorial Trial to Determine the Optimal Mobile Health Components to Reduce Blood Pressure.

BACKGROUND: Mobile health (mHealth) strategies initiated in safety-net Emergency Departments may be one approach to address the US hypertension epidemic, but the optimal mHealth components or dose are unknown. METHODS: Reach Out is an mHealth, health theory-based, 2×2×2 factorial trial among hypertensive patients evaluated in a safety-net Emergency Department in Flint, Michigan. Reach Out consisted of 3 mHealth components, each with 2 doses: (1) healthy behavior text messaging (yes versus no), (2) prompted self-measured blood pressure (BP) monitoring and feedback (weekly versus daily), and (3) facilitated primary care provider appointment scheduling and transportation (yes versus no). The primary outcome was a change in systolic BP from baseline to 12 months. In a complete case analysis, we fit a linear regression model and accounted for age, sex, race, and prior BP medications to explore the association between systolic BP and each mHealth component. RESULTS: Among 488 randomized participants, 211 (43%) completed follow-up. Mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a primary care doctor, 21% lacked transportation, and 51% were not taking antihypertensive medications. Overall, systolic BP declined after 6 months (-9.2 mm Hg [95% CI, -12.2 to -6.3]) and 12 months (-6.6 mm Hg, -9.3 to -3.8), without a difference across the 8 treatment arms. The higher dose of mHealth components were not associated with a greater change in systolic BP; healthy behavior text messages (point estimate, mmHG=-0.5 [95% CI, -6.0 to 5]; P=0.86), daily self-measured BP monitoring (point estimate, mmHG=1.9 [95% CI, -3.7 to 7.5]; P=0.50), and facilitated primary care provider scheduling and transportation (point estimate, mmHG=0 [95% CI, -5.5 to 5.6]; P=0.99). CONCLUSIONS: Among participants with elevated BP recruited from an urban safety-net Emergency Department, BP declined over the 12-month intervention period. There was no difference in change in systolic BP among the 3 mHealth components. Reach Out demonstrated the feasibility of reaching medically underserved people with high BP cared for at a safety-net Emergency Departments, yet the efficacy of the Reach Out mHealth intervention components requires further study. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03422718.

A Comparison of Women's and Men's Web-Based Information-Seeking Behaviors About Gender-Related Health Information: Web-Based Survey Study of a Stratified German Sample.

BACKGROUND: Gender-sensitive approaches to health communication aim to integrate gender perspectives at all levels of communication, as an individual's biological sex and socially assigned gender identity have an impact on whether and how one acquires what type of health information. Due to the fast and low-cost opportunity to search for a wide range of information, the internet seems to be a particularly suitable place for gender-related health information about diseases of sex-specific organs and diseases where biological differences are associated with different health risks. OBJECTIVE: This study aims to inform gender-related information provision and acquisition in 2 ways. The first objective was to provide a theory-driven analysis of web-based health information-seeking behavior (HISB) regarding gender-related issues. Therefore, the Planned Risk Information Seeking Model (PRISM), which is one of the most integrative models of HISB, was adapted and applied. Second, we asked for gender-specific motivational determinants of gender-related web-based HISB comparing the predictors in the groups of women and men. METHODS: Data from a stratified web-based survey of the German population (N=3000) explained gender-related web-based HISB and influencing patterns comparing women and men. The applicability of PRISM to gender-related web-based HISB was tested using structural equation modeling and a multigroup comparison. RESULTS: The results revealed PRISM as an effective framework for explaining gender-related web-based HISB. The model accounted for 28.8% of the variance in gender-related web-based HISB. Gender-related subjective norms provided the most crucial explanatory power, followed by perceived seeking control. The multigroup comparison revealed differences in the model's explanatory power and the relevance of predictors of gender-related web-based HISB. The share of explained variances of web-based HISB is higher in men than in women. For men, norms were a more relevant promoting factor, whereas web-based HISB of women was more strongly associated with perceived seeking control. CONCLUSIONS: The results are crucial for gender-sensitive targeting strategies and suggest gender-related health information interventions that address gender-related subjective norms. Furthermore, programs (eg, web-based learning units) should be developed and offered to improve individuals' (perceived) abilities to perform web-based searches for health information, as those with higher control beliefs are more likely to access web-based information.