Suicide and mortality following self-harm in Culturally and Linguistically Diverse communities in Victoria, Australia: insights from a data linkage study.

Background: While cultural backgrounds are well-documented to be relevant to intentional self-harm, little is known about how cultural and linguistically diverse (CALD) backgrounds affect mortality outcomes following self-harm. Aim: This study aimed to compare the risk of all-cause mortality and suicide after intentional hospital admissions for self-harm among people from CALD (vs. non-CALD) backgrounds. Method: Linked hospital and mortality data in Victoria, Australia, was used to assess suicide and all-cause death after hospital admissions for self-harm among patients aged 15+ years. All-cause death was identified by following up on 42,122 self-harm patients (hospitalized between 01 July 2007 and 30 June 2019) until death or 15 February 2021. Suicide death was evaluated in 16,928 self-harm inpatients (01 January 2013 and 31 December 2017) until death or 28 March 2018. Cox regression models were fitted to compare mortality outcomes in self-harm patients from CALD vs. non-CALD backgrounds. Outcomes: During the follow-up periods, 3,716 of 42,122 (8.8%) participants died by any cause (by 15 February 2021), and 304 of 16,928 (1.8%) people died by suicide (by 28 March 2018). Compared to the non-CALD group, CALD intentional self-harm inpatients had a 20% lower risk of all-cause mortality (HR: 0.8, 95% CI: 0.7-0.9) and a 30% lower risk of suicide (HR: 0.7, 95% CI: 049-0.97). Specifically, being from North Africa/Middle East and Asian backgrounds lowered the all-cause mortality risk; however, the suicide risk in Asians was as high as in non-CALD people. Conclusion: Overall, people from CALD backgrounds exhibited lower risks of all-cause mortality and suicide following hospital admission for self-harm compared to the non-CALD group. However, when comparing risks based on regions of birth, significant variations were observed. These findings underscore the importance of implementing culturally tailored background-specific suicide preventive actions. The study focussed on outcomes following hospital admission for self-harm and did not capture outcomes for cases of self-harm that did not result in hospital admission. This limits generalisability, as some CALD people might avoid accessing healthcare after self-harm due to cultural factors. Future research that not limited to hospital data is suggested to build on the results.

Differential item functioning for the Tendency of Avoiding Physical Activity and Sport Scale across two subculture samples: Taiwanese and mainland Chinese university students.

Aims: The aims of the study were to examine the differential item functioning (DIF) of the Tendency of Avoiding Physical Activity and Sport Scale (TAPAS) among three subgroups (gender, weight status, and region) and to test the construct and concurrent validities of the scale. Methods: Using an online survey, university students (608 Taiwanese and 2319 mainland Chinese) completed the TAPAS. Rasch analysis examined if all the 10 TAPAS items fitted the same construct and displayed no substantial DIF across three subgroups: gender (male vs. female), weight status (overweight vs. non-overweight), and region (Taiwan vs. China). Concurrent validity was examined using the scores on the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS). Results: All TAPAS items, except for Item 10 ("Prefer to participate in physical activity in a more private setting"), fitted the same construct. None of the TAPAS items displayed DIF in any of the subgroups except for Item 10 across participants from Taiwan and China (DIF contrast = -1.41). Conclusion: The TAPAS can appropriately assess the tendency to avoid physical activity and sport among both Taiwanese and mainland Chinese university students. However, Item 10 may need to be further examined.

The tendency to avoid physical activity and sport scale (TAPAS): Rasch analysis with differential item functioning testing among a Chinese sample.

BACKGROUND: The benefits of physical activity are well-known to prevent multiple long-term health conditions. Physical appearance and weight-related stigma may influence individuals' decision to engage in physical activity and sport. Therefore, the present study examined the psychometric properties of a newly developed instrument, the Tendency to Avoid Physical Activity and Sport Scale (TAPAS), using modern test theory. METHODS: A total of 2319 university students were recruited from mainland China and they completed the TAPAS. Rasch analysis was used to examine the TAPAS' rating scaling functioning, test unidimensionality, item hierarchy, ceiling and floor effects, and differential item functioning (DIF). Moreover, the concurrent validity of the TAPAS was examined using the Weight Self-Stigma Questionnaire (WSSQ), Weight Bias Internalization Scale (WBIS), and body mass index (BMI). RESULTS: Unidimensionality was confirmed except for one item. Items corresponding to attitude toward physical activity were more easily adopted compared to items corresponding to actual behavioral aspects. No ceiling and floor effects were found. No DIF existed in the TAPAS items. The TAPAS was strongly correlated with both the WSSQ and WBIS, but not BMI. CONCLUSION: The study showed that overall, the TAPAS has robust psychometric properties. However, future research needs to address the misfit item and explore the feasibility of applying the TAPAS to other populations including wider ethnic groups, age ranges, and life stages.

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.

Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, Australia.

PURPOSE: To examine the associations between Culturally and Linguistically Diverse backgrounds (vs non-Culturally and Linguistically Diverse) and in-hospital death due to self-harm, repeat self-harm and mental health service use after self-harm. METHOD: A retrospective study of 42,127 self-harm hospital inpatients aged 15+ years in Victoria, Australia, from July 2008 to June 2019. Linked hospital and mental health service data were used to assess in-hospital death, repeat self-harm and mental health service use in the 12 months following index self-harm hospital admission. Logistic regression and zero-inflated negative binomial regression models were used to estimate associations between cultural background and outcomes. RESULTS: Culturally and Linguistically Diverse people accounted for 13.3% of self-harm hospital inpatients. In-hospital death (0.8% of all patients) was negatively associated with Culturally and Linguistically Diverse background. Within 12 months, 12.9% of patients had self-harm readmission and 20.1% presented to emergency department with self-harm. Logistic regression components of zero-inflated negative binomial regression models showed no differences in the odds of (hospital-treated) self-harm reoccurrence between Culturally and Linguistically Diverse and non- Culturally and Linguistically Diverse self-harm inpatients. However, count components of models show that among those with repeat self-harm, Culturally and Linguistically Diverse people (e.g. born in Southern and Central Asia) made fewer additional hospital revisits than non-Culturally and Linguistically Diverse people. Clinical mental health service contacts following self-harm were made in 63.6% of patients, with Culturally and Linguistically Diverse people (Asian backgrounds 43.7%) less likely to make contact than the non-Culturally and Linguistically Diverse group (65.1%). CONCLUSIONS: Culturally and Linguistically Diverse and non-Culturally and Linguistically Diverse people did not differ in the likelihood of hospital-treated repeat self-harm, but among those with self-harm repetition Culturally and Linguistically Diverse people had fewer recurrences than non-Culturally and Linguistically Diverse people and utilised mental health services less following self-harm admissions.

Associations between social media addiction, psychological distress, and food addiction among Taiwanese university students.

BACKGROUND: Worldwide, 60% of people use social media. Excessive and/or addictive use of social media termed "problematic social media use", has been reported to negatively influence psychological and physiological health. Therefore, we proposed an illustrated model to investigate the associations between social media addiction, psychological distress and food addiction among Taiwanese university students. METHODS: A total of 598 participants (mean age = 22.8 years) completed an online survey comprising the Bergen Social Media Addiction Scale (BSMAS) assessing social media addiction, the Depression Anxiety and Stress Scale (DASS-21) assessing psychological distress, and the Yale Food Addiction Scale 2.0 (YFAS 2.0) assessing food addiction. RESULTS: Structural equation modeling showed the significant associations between BSMAS and DASS-21 (standardized coefficient [ß] = 0.45; p < 0.01) and between DASS-21 and YFAS 2.0 (ß = 0.43; p < 0.01). In addition, mediation effect with 100 bootstrapping samples showed the indirect effect of DASS-21 in the association between BSMAS and YFAS 2.0 CONCLUSIONS: The present study details the relationships between social media addiction and psychological distress as well as food addiction. The results suggest the need for interventions aimed at reducing these negative outcomes. Coping strategies for improving self-control or reducing weight-related stigma, such as food consumption monitoring or mindfulness, could be adopted for at-risk individuals to address these problems.

Social media addiction has been found to have psychological and physiological impacts on individuals' health. In order to better understand the role of social media addiction, the present study constructed a model to investigate the potential mechanism of social media addiction in affecting the individuals' food addiction level. The findings showed a clear pathway between social media addiction and food addiction with the involvement of psychological distress. Accordingly, we suggested that individuals with the potential risk of social media addiction should pay attention to their psychological status and food intake. The potential effect of weight-related stigmatization would also need to be considered, strategies such as mindfulness or food consumption monitoring would be beneficial to address the issues.

The effect of time spent sitting and excessive gaming on the weight status, and perceived weight stigma among Taiwanese young adults.

Background: During the COVID-19 pandemic, physical inactivity and sedentary behaviors (i.e., longer sitting time and excessive gaming) increased because governments across the globe adopted stringent mitigation strategies such as social distancing and lockdowns to curb the spread of the virus. Excessive gaming was one of the coping mechanisms used to deal with the pressure associated with the pandemic. Moreover, perceived weight stigma (PWS) and weight status became more salient concerns among young adults during the COVID-19 pandemic. The current study sought to investigate the relationship between time spent sitting, excessive gaming, weight status, and PWS of Taiwanese Young adults. Additionally, weight status and PWS were examined as mediators between both sedentary behaviors. Methods: This cross-sectional study involved 600 participants who were recruited through Taiwan universities. All participants completed a demographic questionnaire (including weight and height) and self-report measures including the International Physical Activity Questionnaire short form (IPAQ-SF), the Perceived Weight Stigma Scale (PWSS), and the Internet Gaming Disorder Scale-short form (IGDS9-SF). PROCESS model was performed to test the potential mediation roles of weight status and PWS. Moreover, we categorized participants into two groups based on the sitting-time item in the IPAQ-SF: students whose sitting time was less than 8 h daily, and those more than 8 h daily. Results: The group that had less than 8 h had significantly higher PWS and IGDS9-SF scores than the other group. Sitting time was negatively associated with weight status, PWS, and IGDS9-SF. Additionally, we found a significantly direct effect between time spent sitting and excessive gaming. Both weight status and PWS were significant mediators in the association between time spent sitting and excessive gaming.Conclusions: The present study demonstrated important negative correlates of excessive sedentary behaviors. Prevention efforts should focus on promoting physical activity and providing information to decrease sedentary behavior among university students.

Effectiveness of an educational intervention targeting homophobic language use by young male athletes: a cluster randomised controlled trial.

OBJECTIVE: Homophobic language is common in male sport and associated with negative physical and mental health outcomes for all sport participants, but particularly for gay or bisexual youth populations. Evidence-based interventions are needed to reduce such language and mitigate harm. This study evaluated the effectiveness of a short social-cognitive educational intervention delivered by professional rugby union players in youth sport. METHODS: In a two-arm, cluster randomised controlled trial, 13 Australian youth rugby teams from 9 clubs (N=167, ages 16-20, mean 17.9) were randomised into intervention or control groups. Professional rugby players delivered the intervention in-person. Frequency of homophobic language use was measured 2 weeks before and 2 weeks after the intervention. Hypothesised factors underpinning homophobic language were also measured, including descriptive (other people use), prescriptive and proscriptive injunctive norms (approval/disapproval by others), and attitudes towards the acceptability of homophobic language. RESULTS: At baseline, 49.1% of participants self-reported using homophobic language in the past 2 weeks and 72.7% reported teammates using homophobic language. Significant relationships were found between this behaviour and the hypothesised factors targeted by the intervention. However, generalised estimating equations found the intervention did not significantly reduce homophobic language, or alter the associated norms and attitudes, relative to controls. CONCLUSION: Use of professional rugby athletes to deliver education on homophobic language was not effective. Other approaches to reduce homophobic language (and other forms of discrimination) such as peer-to-peer education, and enforcement of policies prohibiting specific language by coaches, should be explored.

Intentional self-harm in culturally and linguistically diverse communities: A study of hospital admissions in Victoria, Australia.

PURPOSE: To examine the rates and profiles of intentional self-harm hospital admissions among people from culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds. METHODS: A retrospective analysis of 29,213 hospital admissions for self-harm among people aged 15 years or older in Victoria, Australia, was conducted using data from the Victorian Admitted Episodes Dataset between 2014/2015 and 2018/2019. The Victorian Admitted Episodes Dataset records all hospital admissions in public and private hospitals in Victoria (population 6.5 million). Population-based incidence of self-harm, logistic regression and percentages (95% confidence intervals) were calculated to compare between culturally and linguistically diverse groups by birthplaces and the non-culturally and linguistically diverse groups of self-harm admissions. RESULTS: When grouped together culturally and linguistically diverse individuals had lower rates of (hospital-treated) self-harm compared with the non-culturally and linguistically diverse individuals. However, some culturally and linguistically diverse groups such as those originating from Sudan and Iran had higher rates than non-culturally and linguistically diverse groups. Among self-harm hospitalised patients, those in the culturally and linguistically diverse group (vs non-culturally and linguistically diverse group) were more likely to be older, Metropolitan Victorian residents, from the lowest socioeconomic status, and being ever or currently married. Self-harm admissions by persons born in Southern and Eastern Europe were the oldest of all groups; in all other groups number of admissions tended to decrease as age increased whereas in this group the number of admissions increased as age increased. CONCLUSION: There was considerable heterogeneity in rates of hospital-treated self-harm in culturally and linguistically diverse communities, with some countries of origin (e.g. Sudan, Iran) having significantly higher rates. Some of this variation may be due to factors relating to the mode of entry into Australia (refugee vs planned migration), and future research needs to examine this possibility and others, to better plan for support needs in the culturally and linguistically diverse communities most affected by self-harm. Combining all culturally and linguistically diverse people into one group may obscure important differences in self-harm. Different self-harm prevention strategies are likely to be needed for different culturally and linguistically diverse populations.

Weight Stigma and Avoidance of Physical Activity and Sport: Development of a Scale and Establishment of Correlates.

Participation in sport and physical activity (PA) is declining, and the psychosocial factors underpinning avoidance of these activities are not understood. This study developed and tested a new measure assessing the tendency to avoid PA and sport because of weight stigma and appearance-related concerns. University students (n = 581, mean age = 19.8 years) completed an online survey at two time points. Demographic details and measures of weight stigmatization, appearance evaluations, and enjoyment and participation in PA or sport were taken. In addition, we developed and tested a new measure of the tendency to avoid physical activity and sport (TAPAS). Psychometric testing of the scale was conducted, and correlates of TAPAS were examined. The ten-item TAPAS provided a single factor solution, and the final scale score was predictive of lower levels of enjoyment of, and participation in, physical activity and sport (p < 0.001). The scale also displayed good internal and test-retest reliability. This study provides a new measure for assessing people's tendency to avoid PA and sport because of weight stigma or appearance-related concerns. The results suggest that initiatives seeking to increase participation in PA and sport may need to address weight stigma and associated appearance related concerns.

Sequentially mediated effects of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction among Taiwanese university students: A cross-sectional study.

BACKGROUND: Weight-related stigma has negative physiological and psychological impacts on individuals' quality of life. Stigmatized individuals may experience higher psychological distress and therefore increase the potential risk to develop obesity and/or food addiction. The present study examined the associations and mediated effect between perceived weight stigma, weight-related self-stigma, and psychological distress in explaining food addiction among Taiwanese university students. METHODS: All participants (n = 968) completed an online survey which included the Perceived Weight Stigma Questionnaire, Weight Self-Stigma Questionnaire, Depression, Anxiety, Stress Scale-21, and Yale Food Addiction Scale Version 2. RESULTS: After controlling for demographic variables, significant associations were found in the paths from (1) perceived weight stigma to weight-related self-stigma ([Formula: see text] = 0.23), psychological distress ([Formula: see text] = 0.35), and food addiction ([Formula: see text] = 0.23); (2) weight-related self-stigma to psychological distress ([Formula: see text] = 0.52) and food addiction ([Formula: see text] = 0.59); and (3) psychological distress to food addiction ([Formula: see text] = 0.59) (all p-values < 0.001). The mediation model showed the sequential mediated effect of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction. CONCLUSIONS: The results provide novel insights that weight-related self-stigma and psychological distress sequentially mediated the relationship between perceived weight stigma and food addiction among Taiwanese university students. The findings of the present study could be implemented into interventions that aim to reduce food addiction derived from weight-related stigma. Future studies should consider group analysis to consider confounding factors or other populations to provide more evidence regarding the mechanism of weight-related stigma.

Weight-related stigma could cause a negative influence on both physiological and psychological status of stigmatized individuals. The possibility of developing food addiction may exacerbate obesity and further worsen weight-related stigma. The present study investigated the association between perceived weight stigma, weight-related self-stigma, and psychological distress, and food addiction among university students. The additional mediated effect was determined as well. All respondents (n = 968) completed an online survey including the Perceived Weight Stigma Questionnaire, Weight Self-Stigma Questionnaire, Depression, Anxiety, Stress Scale-21, and Yale Food Addiction Scale Version 2. Significant associations were found between all the investigated variables with the control of demographic variables. The mediation models further revealed the sequential mediated effect of weight-related self-stigma and psychological distress in the relationship of perceived weight stigma and food addiction. Accordingly, the present study provides the novel insights of the mediated role of weight-related self-stigma and psychological distress regarding the development of food addition in the mechanism of weight-related stigma. The current findings could be implemented into the development of interventions targeted on reducing the food addiction derived from weight-related stigma.

Temporal associations between physical activity and three types of problematic use of the internet: A six-month longitudinal study.

Background and aims: Internet use has become an important part of daily living. However, for a minority it may become problematic. Moreover, problematic use of the Internet/smartphone (PUIS) has been associated with low physical activity. The present study investigated the temporal associations between three types of PUIS (i.e., problematic smartphone use [PSPU], problematic social media use [PSMU] and problematic gaming [PG]) and physical activity among Taiwanese university students. Methods: A six-month longitudinal survey study comprising three time points for assessments was conducted. From the original 974 participants, a total of 452 completed all three waves of an online survey comprising the International Physical Activity Questionnaire Short Form (IPAQ-SF) assessing physical activity level, Smartphone Application-Based Addiction Scale (SABAS) assessing PSPU, Bergen Social Media Addiction Scale (BSMAS) assessing PSMU, and Internet Gaming Disorder Short Form (IGDS9-SF) assessing PG. Results: The linear mixed effects model found positive temporal associations of PSMU and PG with physical activity level (PSMU: B = 85.88, SE = 26.24; P = 0.001; PG: B = 36.81, SE = 15.17; P = 0.02). PSPU was not associated with physical activity level (B = 40.54, SE = 22.99; P = 0.08). Additionally, the prevalence rates were 44.4% for at-risk/PSPU, 24.6% for at-risk/PSMU, and 12.3% for at-risk/PG. Discussion and Conclusions: PSMU and PG unexpectedly demonstrated correlations with higher physical activity level. The nature of these relationships warrants additional investigation into the underlying mechanisms in order to promote healthy lifestyles among university students.

The mediation effect of perceived weight stigma in association between weight status and eating disturbances among university students: is there any gender difference?

BACKGROUND: The study aimed to examine the association between perceived weight stigma (PWS), weight status, and eating disturbances. We hypothesized that PWS would partially mediate the association between weight status and eating disturbances among university students. METHODS: The study involved 705 undergraduate students (379 females and 326 males) recruited from Hong Kong and Taiwan Universities (399 Hong Kong; 306 Taiwan participants). Our sample was from one Hong Kong university (located in Kowloon) and five Taiwan universities (three located in Southern Taiwan, one located in Central Taiwan, and one located in North Taiwan). Participants' mean age was 20.27 years (SD = 1.79). All participants completed a demographic information sheet, the Three-Factor Eating Questionnaire-18 (TFEQ-R18), and the PWS questionnaire. PROCESS macro models were used to analyze potential mediations. RESULTS: We found a significantly higher PWS scores in a high weight group for females and males. There was a significant difference between weight status and eating disturbances. Moreover, PWS partially mediated the association between weight status and eating disturbances for both genders. CONCLUSIONS: PWS is associated with weight status and eating disturbances, making it an important target for health improvement among young adults. Further studies are needed to corroborate such associations in participants from other societies and cultures.

Perceived weight stigma, weight status (e.g., low weight, average weight, and high weight) and eating disturbances have been found to have associations between each other. However, such research is needed among Asians, and the present study examined a mediation mechanism among the three factors (i.e., perceived weight stigma, weight status, and eating disturbances). Using data from 705 university students across two regions (Hong Kong and Taiwan), the present study revealed that weight status might be associated with perceived weight stigma, and perceived weight stigma might be associated with eating disturbances. Such findings were consistent across male and female university students. The present study's findings underscore the importance of perceived weight stigma. Reducing perceived weight stigma may be an important strategy in developing health eating behaviors among university students.

The Relationship Between Children's Problematic Internet-related Behaviors and Psychological Distress During the Onset of the COVID-19 Pandemic: A Longitudinal Study.

BACKGROUND: The outbreak of the coronavirus disease 2019 (COVID-19) pandemic has generated negative effects on psychological well-being worldwide, including in schoolchildren. Government requirements to stay at home and avoid social and school settings may impact psychological well-being by modifying various behaviors such as problematic phone and Internet use, yet there is a paucity of research on this issue. This study examined whether the COVID-19 outbreak may have impacted problematic smartphone use (PSU), problematic gaming (PG), and psychological distress, specifically the pattern of relationships between PSU, PG, and psychological distress in schoolchildren. METHODS: Longitudinal data on psychological distress, PSU, and PG were collected from 575 children in primary schools in 3 waves: Waves 1 and 2 were conducted before the COVID-19 outbreak and Wave 3 during the outbreak. Cross-lagged panel models were used to examine relationships between factors across the 3 waves. RESULTS: Cross-lagged models found that higher levels of PSU were not significantly related prospectively to greater psychological distress before the COVID-19 outbreak, but this prospective relationship became significant during the COVID-19 outbreak. Whereas PG was associated prospectively with psychological distress before the COVID-19 outbreak (ie, between Waves 1 and 2), this association became nonsignificant during the COVID-19 lockdown (ie, between Waves 2 and 3). CONCLUSIONS: The COVID-19 outbreak has seemed to change prospective relationships between PSU and psychological distress and PG and psychological distress in schoolchildren. Future research should examine whether restrictions on or information provided to schoolchildren may exacerbate PSUs effects on psychological distress.

The Relationship between Weight Stigma, Physical Appearance Concerns, and Enjoyment and Tendency to Avoid Physical Activity and Sport.

Participation in physical activity and sport is on the decline and there is a poor understanding of the psychosocial factors that contribute to people's reluctance to participate. We examined whether there were relationships between factors such as weight stigma, weight bias internalization, appearance evaluation, and fears of negative appearance evaluations, and enjoyment and avoidance of physical activity and sport. Undergraduate students (N = 579) completed a survey assessing demographics, and the variables described above. In hierarchal multivariate regression models, weight stigma (ß = -0.16, p < 0.001), appearance evaluation (ß = 0.19, p = 0.001), and weight bias internalization (ß = -0.19, p = 0.003) were associated with lower enjoyment of physical activity and sport. Weight stigma (ß = 0.46, p = 0.001), weight bias internalization (ß = 0.42, p = 0.001), and fear of negative appearance evaluations (ß = 0.16, p = 0.000) were also significantly associated with the tendency to avoid physical activity and sport. Serial mediation analysis showed the relationship between weight stigma and enjoyment of physical activity and sport was through appearance evaluation and weight bias internalization (indirect effect = -0.007, SE = 0.002, 95% CI = -0.01, -0.02). Similarly, the relationship between weight stigma and avoidance of physical activity and sport was through weight bias internalization and fear of negative appearance evaluations (indirect effect = 0.11, SE = 0.03, 95% CI = 0.05, 0.16). These results suggest that weight stigma and concerns about one's physical appearance influence people's enjoyment and reasoning for avoiding physical activity and sport. Research is needed to identify ways to reduce body-related stigma and increase enjoyment and participation in physical activity and sport.

Relationships among Physical Activity, Health-Related Quality of Life, and Weight Stigma in Children in Hong Kong.

Objectives: Our objective in this study was to establish the relationships among active and inactive physical activity, HRQoL, and weight stigma in children. Additionally, we investigated weight stigma as a mediator of the relationship between physical activity and HRQoL.Methods: This cross-sectional study was conducted in Hong Kong (June 2017-July 2018). Participants were 437 children in elementary school (2 primary schools and 2 non-governmental organizations) and their parents (dyads). Participants completed questionnaires containing items assessing demographic characteristics, physical activity level, and several HRQoL measures.Results: We found a statistically significant difference between a higher physically activity group (exercise > 2 hours/week) in all measures of HRQoL. Weight stigma had a significant mediating effect on the relationship between physical activity and child-rated HRQoL (Coefficient = -0.37; SE=0.05; t = 8.21; p < .001), parent-rated HRQoL (Coefficient = -0.16; SE = 0.04; t = 4.21; p < .001), and child-rated weight-related QoL (Coefficient = -0.56; SE = 0.04; t = 14.92; p < .001). Conclusions: Physical activity was associated with better HRQoL and lower weight stigma. Weight stigma appears to affect how physical activity is related to better HRQoL, but the association is somewhat weak.

Problematic Use of Internet-Related Activities and Perceived Weight Stigma in Schoolchildren: A Longitudinal Study Across Different Epidemic Periods of COVID-19 in China.

Background: Social distancing and school suspension due to the coronavirus pandemic (COVID-19) may have a negative impact on children's behavior and well-being. Problematic smartphone use (PSU), problematic social media use (PSMU) and perceived weight stigma (PWS) are particularly important issues for children, yet we have a poor understanding of how these may have been affected by lockdowns and physical isolation resulting from COVID-19. This research aimed to understand how these psychosocial and behavioral variables may be associated with psychological distress, and how these associations may have changed during the COVID-19 pandemic. Methods: A total of 489 children completed a three-wave longitudinal study from January 2020 to June 2020. The first wave was conducted before the COVID-19 outbreak. The second wave was conducted during the outbreak. The third wave was conducted during post-COVID-19 lockdown. Questionnaires measured psychological distress, PSU, PSMU, and PWS. Results: PSU, PSMU, PWS and psychological distress were all significantly associated with each other. PSU was significantly higher during outbreak. PWS was significantly higher before outbreak. We found an increased association between PSMU and PWS across three waves in all three models. The association between PSU and depression/anxiety decreased across three waves; however, association between PSMU and depression/anxiety increased across three waves. Conclusions: COVID-19 initiated school suspension and associated lockdowns appear to have exacerbated PSU and depression among children. However, PWS was reduced during this period. Children should use smartphones and social media safely and cautiously, and be aware of the potential exposure to weight stigmatization.

Definitions of Culturally and Linguistically Diverse (CALD): A Literature Review of Epidemiological Research in Australia.

Objective: To identify how Culturally and Linguistically Diverse (CALD) communities are defined in epidemiological research in Australia and provide a definition of CALD status that aids the consistency and interpretability of epidemiological studies. Methods: Peer-reviewed literature from January 2015 to May 2020 was searched via four databases (Ovid Medline combined with PubMed, Embase, Emcare, and CINAHL) to identify quantitative studies of CALD people in Australia. Results: A total of 108 studies met the criteria for inclusion in the review. Country of birth was the most commonly used CALD definition (n = 33, 30.6%), with combinations of two or more components also frequently used (n = 31, 28.7%). No studies used all the components suggested as core to defining CALD status. including country of birth, languages other than English spoken at home, English proficiency, and indigenous status. Conclusions: There was considerable inconsistency in how CALD status was defined. The review suggests that CALD status would best be defined as people born in non-English speaking countries, and/or who do not speak English at home. Additionally, indigenous peoples should be considered separately. This recommended definition will support the better identification of potential health disparity and needs in CALD and indigenous communities.