The Longitudinal Relationships among Casual Sex and Psychological Well-Being in Chinese College Student.

This study integrates the important psychological well-being indicators (i.e., life satisfaction, psychological distress, and self-esteem) into a model framework. We used a cross-lagged panel design (CLPD) to examine the bidirectional relationship between casual sex and psychological well-being among Chinese college students. Chinese college students (N = 833) completed self-report measures (i.e., hookup behavior, life satisfaction, psychological distress, and self-esteem) at six-month intervals. The results show that the ratio of college students who reported engaging in at least one hookup experience in the past year or half a year was lower than that of Western college students. We find that college students with hookup behavior had poorer psychological well-being in later six months than those who did not engage in hookup behavior. However, previous psychological well-being did not predict subsequent hookup behavior. We discuss these findings in terms of China's unique sexual culture to provide useful information for preventing and interfering with risky sexual behaviors and their negative consequences among Chinese college students. Specifically, this study could provide students with a more in-depth understanding of associated risks, assisting those engaged in or intending to engage in hookups to evaluate the advantages and drawbacks of such behavior. Furthermore, it underscores the importance of implementing targeted educational programs in China that address the psychological consequences of casual sex.

Hearing loss in juvenile rats leads to excessive play fighting and hyperactivity, mild cognitive deficits and altered neuronal activity in the prefrontal cortex.

Background: In children, hearing loss has been associated with hyperactivity, disturbed social interaction, and risk of cognitive disturbances. Mechanistic explanations of these relations sometimes involve language. To investigate the effect of hearing loss on behavioral deficits in the absence of language, we tested the impact of hearing loss in juvenile rats on motor, social, and cognitive behavior and on physiology of prefrontal cortex. Methods: Hearing loss was induced in juvenile (postnatal day 14) male Sprague-Dawley rats by intracochlear injection of neomycin under general anesthesia. Sham-operated and non-operated hearing rats served as controls. One week after surgery auditory brainstem response (ABR) measurements verified hearing loss or intact hearing in sham-operated and non-operated controls. All rats were then tested for locomotor activity (open field), coordination (Rotarod), and for social interaction during development in weeks 1, 2, 4, 8, 16, and 24 after surgery. From week 8 on, rats were trained and tested for spatial learning and memory (4-arm baited 8-arm radial maze test). In a final setting, neuronal activity was recorded in the medial prefrontal cortex (mPFC). Results: In the open field deafened rats moved faster and covered more distance than sham-operated and non-operated controls from week 8 on (both p < 0.05). Deafened rats showed significantly more play fighting during development (p < 0.05), whereas other aspects of social interaction, such as following, were not affected. Learning of the radial maze test was not impaired in deafened rats (p > 0.05), but rats used less next-arm entries than other groups indicating impaired concept learning (p < 0.05). In the mPFC neuronal firing rate was reduced and enhanced irregular firing was observed. Moreover, oscillatory activity was altered, both within the mPFC and in coherence of mPFC with the somatosensory cortex (p < 0.05). Conclusions: Hearing loss in juvenile rats leads to hyperactive behavior and pronounced play-fighting during development, suggesting a causal relationship between hearing loss and cognitive development. Altered neuronal activities in the mPFC after hearing loss support such effects on neuronal networks outside the central auditory system. This animal model provides evidence of developmental consequences of juvenile hearing loss on prefrontal cortex in absence of language as potential confounding factor.

DNA methylation differences in genes associated with human personal disorders and deviant behavior.

Epigenetic regulation of gene expression is involved in the progression of mental disorders, including deviant behavior, brain developmental, and personality disorders. The large number of genes has been studied for their activity association with stress and depression; however, the obtained results for the majority of these genes are contradictory. The aim of our study was to investigate the possible contribution of methylation level changes to the development of personality disorders and deviant behavior. A systematic study of CpG Islands in 21 target regions, including the promoter and intron regions of the 12 genes was performed in DNA samples extracted from peripheral blood cells, to obtain an overview of their methylation status. High-throughput sequencing of converted DNA samples was performed and calling of the methylation sites on the "original top strand" in CpG islands was carried out in the Bismark pipeline. The initial methylation profile of 77 patients and 48 controls samples revealed a significant difference in 7 CpG sites in 6 genes. The most significant hypermethylation was found for the target sites of the HTR2A (p-value = 1.2 × 10-13) and OXTR (p-value = 2.3 × 10-7) genes. These data support the previous reports that alterations in DNA methylation may play an important role in the dysregulation of gene expression associated with personality disorders and deviant behavior, and confirm their potential use as biomarkers to improve thediagnosis, prognosis, and assessment of response to treatment.

The modulatory role of gut microbiota on host behavior: exploring the interaction between the brain-gut axis and the neuroendocrine system.

The brain-gut axis refers to the communication between the central nervous system and the gastrointestinal tract, with the gut microbiome playing a crucial role. While our understanding of the interaction between the gut microbiome and the host's physiology is still in its nascent stage, evidence suggests that the gut microbiota can indeed modulate host behavior. Understanding the specific mechanisms by which the gut microbiota community modulates the host's behavior remains the focus of present and future neuro-gastroenterology studies. This paper reviews several pieces of evidence from the literature on the impact of gut microbiota on host behavior across animal taxa. We explore the different pathways through which this modulation occurs, with the aim of deepening our understanding of the fascinating relationship between the gut microbiome and the central nervous system.

Effect of Fluid and Caffeine Management on Quality of Life in Older Women with Overactive Bladder in Rural Korea: A Pilot Study.

Purpose: This study aimed to investigate the effectiveness of the simplified intervention, consisting of fluid and caffeine management alone in older women with overactive bladder symptoms. Patients and Methods: A quasi-experimental pretest-posttest design was used. Rural, community-dwelling older women were recruited at four senior centers in South Korea. Of the 63 participants initially enrolled, 34 met the inclusion criteria. One group (n = 15) used fluid and caffeine management alone (FM), and the other group (n = 12) used a combination of fluid and caffeine management and pelvic floor muscle training (FM+PFMT). Urinary symptom-specific health-related quality of life was measured using the Korean version of KHQ. Sleep quality was measured using the Pittsburgh Sleep Quality Index. After the intervention, participants were assessed 4 and 8 weeks. A linear mixed model was used for the analysis. Results: The mean age of the participants was 74.44 ± 5.67 years. Among the nine domains of KHQ, impact on life and physical limitations decreased significantly in both groups, without significant between-group differences. Sleep/energy increased in both groups, and the scores in the FM+PFMT group were significantly improved. The number of micturition episodes per day and the quality of sleep did not differ significantly between the two groups. Conclusion: A simplified intervention, consisting of fluid and caffeine management alone can be considered as the first-line intervention to improve health-related quality of life in rural, community-dwelling, older women with overactive bladder symptoms. Healthcare providers should consider providing a relatively simple, but equally effective intervention to maximize the adherence and effectiveness.

Thermal escape box: A cost-benefit evaluation paradigm for investigating thermosensation and thermal pain.

Thermosensation, the ability to detect and estimate temperature, is an evolutionarily conserved process that is essential for survival. Thermosensing is impaired in various pain syndromes, resulting in thermal allodynia, the perception of an innocuous temperature as painful, or thermal hyperalgesia, an exacerbated perception of a painful thermal stimulus. Several behavioral assays exist to study thermosensation and thermal pain in rodents, however, most rely on reflexive withdrawal responses or the subjective quantification of spontaneous nocifensive behaviors. Here, we created a new apparatus, the thermal escape box, which can be attached to temperature-controlled plates and used to assess temperature-dependent effort-based decision-making. The apparatus consists of a light chamber with an opening that fits around temperature-controlled plates, and a small entryway into a dark chamber. A mouse must choose to stay in a brightly lit aversive area or traverse the plates to escape to the enclosed dark chamber. We quantified escape latencies of adult C57Bl/6 mice at different plate temperatures from video recordings and found they were significantly longer at 5 °C, 18 °C, and 52 °C, compared to 30 °C, a mouse's preferred ambient temperature. Differences in escape latencies were abolished in male Trpm8-/- mice and in male Trpv1-/- animals. Finally, we show that chronic constriction injury procedures or oxaliplatin treatement significantly increased escape latencies at cold temperatures compared to controls, the later of which was prevented by the analgesic meloxicam. This demonstrates the utility of this assay in detecting cold pain. Collectively, our study has identified a new and effective tool that uses cost-benefit valuations to study thermosensation and thermal pain.

Path of Physical Exercise's Impact on Deviant Behavior Among Chinese Adolescents.

Purpose: Physical exercise is an important predictor of deviant behavior in adolescents; however, the paths and mechanisms underlying this relationship remain understudied. Patients and Methods: This cross-sectional study used education tracking data of 8725 Chinese adolescents (4453 males, 4240 females, average age 14 ± 0.73) to construct a chain mediation model to explore whether sleep quality and mental health mediated the relationship between physical exercise and adolescent deviant behavior. Results: The results show that physical exercise cannot directly predict adolescent deviant behavior; however, it can indirectly affect deviant behavior through the mediating effect of sleep quality and mental health as well as the chain mediating benefit of "sleep quality-mental health". Conclusion: Sleep quality and mental health are important internal factors of physical exercise that inhibit deviant adolescent behavior. The lack of physical activity and poor sleep quality should be prioritized in interventions regarding deviant behavior among Chinese adolescents.

Effect of feeding frequency on reproductive performances and stress responses in gestating sows.

The objective of this study was to investigate the influence of feeding frequency on a sow's reproductive performance and stress response during gestation. A total of twenty multiparous sows (Yorkshire × Landrace) were used in a completely randomized design based on their parity, body weight (BW), and backfat thickness (BFT), and the sows were allotted to two different feeding systems: 1) once daily feeding (OF) and 2) twice daily feeding (TF) in corn-soybean meal based diets. The gestation diet was formulated to contain 3,265 kcal of metabolizable energy (ME) / kg, 12.90% of crude protein (CP), and 0.75 % of total lysine. The lactation diet was formulated to contain 3,265 kcal of ME / kg, 16.80% of CP, and 1.08% of total lysine and provided ad libitum during lactation. In gestation, sow BFT and BF changes were not affected by feeding frequency, but higher BW and BW gain from day 35 to 90 and day 35 to 110 were observed in OF sow (p < 0.10). In lactation, feeding frequency did not influence on BW, BW gain, BFT, BF changes, average daily feed intake, and wean-to-estrus interval. Also, there were no differences in litter size, litter weight and piglet weight in lactating sows. OF sows had higher (p < 0.05; p < 0.10) protein, solid-not-fat, and total solid concentrations in colostrum compared to TF sows, while OF sows had a lower (p < 0.05) lactose concentration in colostrum compared to TF sows. Sows in OF showed significantly lower average daily water consumption (ADWC) from day 35 to 110 of gestation (p < 0.05). While there were no significant differences in stereotypic behaviors and salivary cortisol levels during gestation between treatments, the OF sows showed less time spending on the activity at day 105 (p < 0.05). In conclusion, reduced feeding frequency increased BW gain during gestation, decreased activation time, and changed the colostrum composition. This information may contribute to the understanding of the physiological and behavioral change of gestating sows by manipulating feeding frequency.

Anti-psychotic Nature of Antibiotics: Vancomycin and Omadacycline Combination Ameliorating Stress in a Zebrafish Model.

Background Stress affects mental health significantly and is a ubiquitous feature of contemporary living. Among the possible antibiotics are omadacycline and vancomycin, whose anti-inflammatory properties have also been thoroughly documented in recent research. The goal of the current study was to examine their complex involvement in the brain's stress response circuits and how they modulate stress. An established model organism that provides a useful platform for examining stress-induced behaviors and possible therapeutic approaches is the zebrafish. To investigate how dopamine affects the stress response, we used a zebrafish model that was exposed to stress. Methodology For three minutes, zebrafish were continually subjected to chasing stress. They were then given antibiotic combinations of 50 µg/mL each of vancomycin and omadacycline at various ratios of 1:1, 3:1, and 3:1. Behavior alterations, including freezing bouts, top-bottom ratios, and latency periods, were analyzed and contrasted with control groups. ImageJ software was utilized to analyze the video footage of the fish. Results The study showed that the combination of omadacycline and vancomycin greatly reduced the behaviors in zebrafish caused by stress. They chose their concentration (50 µg/mL) according to the lethal concentration 50% result. By shortening the latency time and increasing the intensity of breezing sessions, these chemicals restored almost normal activity. There was statistical significance in the outcomes. The results show that the combination of vancomycin and omadacycline may have an anti-psychotic impact on zebrafish behaviors brought on by stress. Their control of stress reactions is consistent with their known roles in the reward and stress circuits of the brain. These results emphasize the complex interactions between neurotransmitter systems and the control of stress, highlighting the therapeutic potential of dopamine in the treatment of stress-related mental illnesses. Conclusions The combination of vancomycin and omadacycline has been shown to have anti-psychotic effects, which presents potential opportunities for the development of new treatment strategies for mental diseases associated with stress. To fully understand the specific processes underpinning their involvement in stress management and how they relate to mental illnesses in humans, more investigation is necessary.

Understanding Risk Factors for Suicide Among Older People in Rural China: A Systematic Review.

Background and Objectives: In China, rural older adults face a significantly heightened risk of suicide. However, there has been no comprehensive review of the literature examining the risk factors associated with suicide among older people in rural China. Therefore, a comprehensive understanding of risk factors for this phenomenon among rural older people must be gained. We conducted a systematic literature review on risk factors for suicide among older people in rural China. Research Design and Methods: Seven English electronic databases (PubMed, EMBASE, PsycINFO, Cochrane, CINAHL, ScienceDirect, and Web of Science) and 3 Chinese electronic databases (CNKI, CQVIP, and Wanfang) were searched for peer-reviewed articles published in English or Chinese, from inception to July 25, 2022. For data collection, scientific strategies were used for searching and selecting literature within the electronic databases. The collected data were then synthesized using the thematic analysis method. The study was conducted under PRISMA 2020 guidelines. Results: The final analysis included 16 studies. The identified risk factors were categorized under 6 themes: navigating the challenges of illness, unmet basic needs, experiencing abuse from children, feelings of loneliness, negative life events, and altruistic motivation to benefit children. Discussion and Implications: Multiple factors affect suicide among older people in rural China. This invaluable information can be used to develop targeted prevention strategies particularly relevant to this age group.

A mixed-method evaluation of implementation determinants for chaplain intervention in a hospital setting.

Healthcare chaplains address broad social and emotional dimensions of care within a pluralistic religious landscape. Although the development and evaluation of chaplaincy interventions has advanced the field, little research has investigated factors influencing the implementation of new chaplain interventions. In this mixed-method study, we examined attitudes about evidence-based interventions held by chaplain residents (n = 39) at the outset of an ACPE-accredited residency program in the southeast United States. We also used semi-structured interviews (n = 9) to examine residents' attitudes, beliefs, and decision-making processes after they trained in the delivery of a novel manualized intervention, Compassion-Centered Spiritual Health (CCSH). Most residents reported favorable attitudes toward manualized approaches prior to training. Interviews revealed complex decision-making processes and highlighted personal motivations and challenges to learning and implementing CCSH. Implementation science can reveal factors related to motivation, intention, and training that may be optimized to improve the implementation of healthcare chaplaincy interventions.

An LSTM-based adversarial variational autoencoder framework for self-supervised neural decoding of behavioral choices.

Objective. This paper presents data-driven solutions to address two challenges in the problem of linking neural data and behavior: 1) unsupervised analysis of behavioral data and automatic label generation from behavioral observations, and 2) extraction of subject-invariant features for the development of generalized neural decoding models. Approach. For behavioral analysis and label generation, an unsupervised method, which employs an autoencoder to transform behavior data into a cluster-friendly feature space is presented. The model iteratively refines the assigned clusters with soft clustering assignment loss, and gradually improves the learned feature representations. To address subject variability in decoding neural activity, adversarial learning in combination with a long short-term memory-based adversarial variational autoencoder (LSTM-AVAE) model is employed. By using an adversary network to constrain the latent representations, the model captures shared information among subjects' neural activity, making it proper for cross-subject transfer learning. Main results. The proposed approach is evaluated using cortical recordings of Thy1-GCaMP6s transgenic mice obtained via widefield calcium imaging during a motivational licking behavioral experiment. The results show that the proposed model achieves an accuracy of 89.7% in cross-subject neural decoding, outperforming other well-known autoencoder-based feature learning models. These findings suggest that incorporating an adversary network eliminates subject dependency in representations, leading to improved cross-subject transfer learning performance, while also demonstrating the effectiveness of LSTM-based models in capturing the temporal dependencies within neural data. Significance. Results demonstrate the feasibility of the proposed framework in unsupervised clustering and label generation of behavioral data, as well as achieving high accuracy in cross-subject neural decoding, indicating its potentials for relating neural activity to behavior.

Understanding the foam stability mechanisms of complex formed by soy protein isolate and different charged polysaccharides: Air/water interfacial behavior and rheological characteristics.

This study evaluated the foaming properties, the dynamic adsorption behavior at the air/water (A/W) interface and the foam rheological characteristics of complexes formed by soy protein isolate (SPI) and different charged polysaccharides, including chitosan (CS), guar gum (GUG) and gellan gum (GEG). The results showed that the SPI/CS10 had the highest initial foam volume (26.67 mL), which were 3.89 %, 100.08 % and 70.19 % higher than that of single SPI, SPI/GUG and SPI/GEG complexes, respectively. Moreover, three charged polysaccharides could all significantly improve the foam stability of complexes. Among them, foams stabilized by SPI/GEG10 were the most stable that the foam volume slightly changed (approximately 1 mL) and no drainage occurred throughout the whole recording process. The interfacial behavior analysis showed that SPI/CS10 had higher diffusion (Kdiff) and rearrangement rate (KR) but lower penetration rate (KP) at the A/W interface compared with single SPI, while SPI/GUG10 and all SPI/GEG complexes showed higher KR and KP but lower Kdiff. In addition, SPI/CS10 was beneficial to concurrently enhance the elastic strength and solid-like behavior of foam system, while all SPI/GEG complexes could improve the elastic strength of foam system but was not conducive to the solid-like behavior.

Disruption of Zfh3 abolishes mulberry-specific monophagy in silkworm larvae.

Feeding behavior is critical for insect survival and fitness. Most researchers have explored the molecular basis of feeding behaviors by identifying and elucidating the function of olfactory receptors (ORs) and gustatory receptors (GRs). Other types of genes, such as transcription factors, have rarely been investigated, and little is known about their potential roles. The silkworm (Bombyx mori) is a well-studied monophagic insect which primarily feeds on mulberry leaves, but the genetic basis of its monophagy is still not understood. In this report, we focused on a transcription factor encoded by the Zfh3 gene, which is highly expressed in the silkworm central and peripheral nervous systems, including brain, antenna, and maxilla. To investigate its function, Zfh3 was abrogated using clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein 9 (Cas9) mutagenesis. Since Zfh3 knockout homozygotes are not viable, we studied feeding behavior in heterozygotes, and found that disruption of Zfh3 affects both gustation and olfaction. Mutant larvae lose preference for mulberry leaves, acquire the ability to consume an expanded range of diets, and exhibit improved adaptation to the M0 artificial diet, which contains no mulberry leaves. These results provide the first demonstration that a transcription factor modulates feeding behaviors in an insect.

Behavioral indicators of heterogeneous subjective experience in animals across the phylogenetic spectrum: Implications for comparative animal phenomenology.

This behavioral study was undertaken to provide empirical evidence in favor of or opposed to the notion that animals across a wide breadth of the animal kingdom have subjective (personal) experience that varies with their lifestyles, ecological constraints, or phylogeny. Twelve species representing two invertebrate phyla and six vertebrate classes were observed unobtrusively in 15-min episodes, during which three modes of behavior (volitional, interactive, and egocentric) were quantified according to the frequency, variety, and dynamism of each mode. Volitional behavior was the most prevalent and dynamic mode for nearly all species, largely without regard to phylogenetic position. Interactive behavior likewise varied inconsistently across the entire evolutionary spectrum. Egocentric behavior was concentrated among the avian and mammalian species, but evidence of it were observed in the invertebrate species as well. Diagrams of the matrix constructed from the three qualitative modes and three quantitative attributes for each mode provide a metaphorical representation of the unique experiential profile of each species. To the extent that these behavioral measures correlate with the nature of the animal's subjective experience, they support the growing view that phenomenology is heterogeneous, multimodal, and non-linear in extent across the animal kingdom.

Observing heroic behavior and its influencing factors in immersive virtual environments.

Studying heroism in controlled settings presents challenges and ethical controversies due to its association with physical risk. Leveraging virtual reality (VR) technology, we conducted a three-study series with 397 participants from China to investigate heroic actions. Participants unexpectedly witnessed a criminal event in a simulated scenario, allowing observation of their tendency to physically intercept a thief. We examined situational factors (voluntariness, authority, and risk) and personal variables [gender, impulsivity, empathy, and social value orientation (SVO)] that may influence heroism. Also, the potential association between heroism and social conformity was explored. In terms of situational variables, voluntariness modulated participants' tendency to intercept the escaping thief, while perceived risk demonstrated its impact by interacting with gender. That is, in study 3 where the perceived risk was expected to be higher (as supported by an online study 5), males exhibited a greater inclination toward heroic behavior compared to females. Regarding other personal variables, the tendency to engage in heroic behavior decreased as empathy levels rose among males, whereas the opposite trend was observed for females. SVO influenced heroic behavior but without a gender interaction. Finally, an inverse relationship between heroism and social conformity was observed. The robustness of these findings was partly supported by the Chinese sample (but not the international sample) of an online study 4 that provided written descriptions of VR scenarios, indicating cultural variations. These results advance insights into motivational factors influencing heroism in the context of restoring order and highlight the power of VR technology in examining social psychological hypotheses beyond ethical constraints.

The combined effect of family environment and parents' characteristics on the use of food to soothe children.

Parental feeding practices, such as the use of food to soothe, can be shaped by various factors, including the family environment and parents' psychological characteristics and capacities. To our knowledge, the combined effect of these factors has not been studied. Furthermore, parental feeding practices have mainly been studied in women, resulting in a gender gap in the research. This study aims to investigate the combined effect of family environment and parental characteristics on the likelihood of using food to soothe children, taking the gender of both parents into account. This cross-sectional study included a sample of 846 parents (36.3% men) of 1-year-old children from different regions of Spain. Participants completed an online survey that included questionnaires to measure whether parents used food to soothe children, the family environment, parents' characteristics, and their psychological capacities. Binary logistic regression analyses were performed to identify associations between the variables. The final model showed that, within the family environment, higher levels of dyadic adjustment between couples (OR = 0.965; p = .026) were associated with a reduced likelihood of using food to soothe children, whereas the psychological characteristic of parental fatigue (OR = 1.053; p = .007) appeared to be associated with an increased likelihood. Also associated with an increased likelihood of this practice were higher parental sense of competence (OR = 1.028; p = .029) and the attention dimension of emotional intelligence (OR = 1.043; p = .007). Our study suggests that using food to soothe children may be influenced by factors at different levels, from the quality and adjustment of the couple's relationship to parental fatigue, self-competence, and emotional intelligence. For future research, it may be worthwhile contextualizing parental practices to gain a better understanding of children's behavior.

Influence of waning immunity on vaccination decision-making: A multi-strain epidemic model with an evolutionary approach analyzing cost and efficacy.

In this research, we introduce a comprehensive epidemiological model that accounts for multiple strains of an infectious disease and two distinct vaccination options. Vaccination stands out as the most effective means to prevent and manage infectious diseases. However, when there are various vaccines available, each with its costs and effectiveness, the decision-making process for individuals becomes paramount. Furthermore, the factor of waning immunity following vaccination also plays a significant role in influencing these choices. To understand how individuals make decisions in the context of multiple strains and waning immunity, we employ a behavioral model, allowing an epidemiological model to be coupled with the dynamics of a decision-making process. Individuals base their choice of vaccination on factors such as the total number of infected individuals and the cost-effectiveness of the vaccine. Our findings indicate that as waning immunity increases, people tend to prioritize vaccines with higher costs and greater efficacy. Moreover, when more contagious strains are present, the equilibrium in vaccine adoption is reached more rapidly. Finally, we delve into the social dilemma inherent in our model by quantifying the social efficiency deficit (SED) under various parameter combinations.

Online health information seeking behavior, healthcare access, and health status during exceptional times.

Online health information seeking behavior (e-HISB) is becoming increasingly common and the trend has accelerated as a result of the COVID-19 pandemic when individuals strongly relied upon the Internet to stay informed by becoming exposed to a wider array of health information. Despite e-HISB having become a global trend, very few empirical investigations have analyzed its potential influence on healthcare access and individuals' health status. In this paper, we try to fill this gap. We use data from the second SHARE Corona Survey, supplemented with data from the previous 8th wave of SHARE, and estimate a recursive model of e-HISB, healthcare access, and individuals' health status that accounts for individuals' unobserved heterogeneity. Our findings suggest that e-HISB can empower individuals to better understand health concerns, facilitating improved health condition management. However, e-HISB can also trigger a chain reaction, as navigating vast amonts of online health information can heighten fear and anxiety. This increased anxiety may lead to higher utilization of medical services, adversely affecting individuals' perceptions of their health.