Evidence-Based Health Behavior Interventions for Cholera: Lessons from an Outbreak Investigation in India.

In rural India, since 2014, the Swachh Bharat Abhiyan (Clean India Mission) has ensured construction of more than 100 million toilets and is now focusing on reinforcement of sanitation behaviors. We report a cholera outbreak in a remote village in western India where open defecation was implicated in causation. A water pipeline was damaged in the vicinity of a stream flowing from a site of open defecation. Despite the availability of a toilet facility in the majority of households (75%), open defecation was widely practiced (62.8%). Many reported not washing hands with soap and water before eating (78.5%) and after defecation (61.1%). The study emphasizes the need for focused health behavior studies and evidence-based interventions to reduce the occurrence of cholera outbreaks. This could be the last lap in the path toward achieving the United Nations Sustainable Development Goal 6, which aims to "ensure availability and sustainable management of water and sanitation for all."

Activity-related typologies and longitudinal change in physical activity and sedentary time in children and adolescents: The UP&DOWN Study.

BACKGROUND: Children and adolescents can be distinguished by different typologies (clusters) of physical activity and sedentary behavior. How physical activity and sedentary behaviors change over time within different typologies is not known. This study examined longitudinal changes in physical activity and sedentary time among children and adolescents with different baseline typologies of activity-related behavior. METHODS: In this longitudinal study (3 annual time points) of children (n = 600, age = 9.2 ± 0.4 years (mean ± SD), 50.3% girls) and adolescents (n = 1037, age = 13.6 ± 1.7 years, 48.4% girls), participants were recruited in Spain in 2011-2012. Latent class analyses identified typologies based on self-reported screen, educational, social and relaxing sedentary behaviors, active travel, muscle strengthening activity, and sport at baseline. Within each typology, linear mixed growth models explored longitudinal changes in accelerometer-derived moderate-to-vigorous physical activity and sedentary time, as well as time by class interactions. RESULTS: Three typologies were identified among children ("social screenies", 12.8%; "exercisers", 61.5%; and "non-sporty active commuters", 25.7%) and among adolescents ("active screenies", 43.5%; "active academics", 35.0%; and "non-sporty active commuters", 21.5%) at baseline. Sedentary time increased within each typology among children and adolescents, with no significant differences between typologies. No changes in physical activity were found in any typology among children. In adolescents, physical activity declined within all typologies, with "non-sporty active commuters" declining significantly more than "active screenies" over 3 years. CONCLUSION: These results support the need for intervention to promote physical activity and prevent increases in sedentary time during childhood and adolescence. Adolescents characterized as "non-sporty active commuters" may require specific interventions to maintain their physical activity over time.

Loss of childcare and classroom teaching during the Covid-19-related lockdown in spring 2020: A longitudinal study on consequences on leisure behavior and schoolwork at home.

AIM: In spring 2020, the first Covid-19-related lockdown included the closing of kindergartens and schools. Home schooling, the lack of social contacts with peers and the care of the children at home posed an enormous challenge for many families. METHODS: The present study investigated the leisure behavior of 285 one- to 10-year-old German children at two time points (t1 and t2) during the Covid-19-related lockdown in spring 2020. In the subsample of primary school children (n = 102), we also explored children's attitudes towards schoolwork at home. Analyses focused on the change of behavior from t1 to t2, on differences in these changes depending on socio-economic status (SES), and on associations of behavior with SES, the number of children at home, and the frequency of receiving learning materials from school. RESULTS: While the frequency of playing outside increased significantly from t1 to t2, the frequency of handicrafts, playing board games, indoor sports, and motivation to do schoolwork decreased. The observed changes between t1 and t2 did not differ depending on SES. However, a lower SES was associated with higher media use, less outdoor activity, and (though only marginally significant) a reduced time doing schoolwork and a reduced ability to concentrate on schoolwork at t1. In households with more children, children played outside more often, but were read to less frequently and (though only marginally significant) watched movies and series less frequently. Children receiving learning materials from school on a regular basis spent significantly more time doing schoolwork at home than children receiving materials only irregularly. CONCLUSIONS: A continuing loss of childcare in day-care facilities and schools entails the danger of declining education in the form of (inter)active indoor activities and schoolwork.

Impacto de una intervención educacional sobre la calidad de la dieta mediterránea, la actividad física y el estado ponderal en adolescentes: ensayo clínico aleatorizado / Impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents: Randomised clinical trial

OBJETIVOS: Analizar el impacto de una intervención educacional sobre la calidad de la dieta mediterránea (DM), la actividad física y el estado ponderal en adolescentes. MÉTODO: Ensayo clínico aleatorizado y controlado con intervención educacional multimodal (grupo control [n=36] y grupo experimental [n=46]). Recogida de datos, al inicio y al final del estudio, en población adolescente de la ciudad de Cáceres. En ambos grupos se determinaron medidas antropométricas y datos sociodemográficos. Se evaluó la calidad de la DM mediante el test KIDMED, el grado de actividad física a través del cuestionario PAQ-A y el estado ponderal con las tablas de crecimiento de la Fundación Faustino Orbegozo Eizaguirre. RESULTADOS: Obtuvimos un aumento significativo en el grupo experimental en el cuestionario PAQ-A que valora la actividad física (p = 0,029). No se observaron diferencias significativas entre grupos en el estado ponderal (p = 0,916). Al comparar la calidad de la DM (calidad alta vs moderada o baja) con la actividad física (pcontrol=0,730; pexperimental=0,495) y con el estado ponderal (pcontrol=0,838; pexperimental=0,372), no se observaron diferencias significativas. CONCLUSIONES: La intervención educacional no mejoró la calidad de la DM ni la actividad física, aunque la mayoría de nuestra muestra presentaba normopeso y actividad física aceptable. Debemos continuar mejorando el patrón alimentario saludable de nuestros adolescentes para garantizar un estado de salud adecuado en el futuro

OBJECTIVE: To analyse the impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents. METHOD: Randomised clinical trial (RCT), controlled with a multimodal educational intervention (control group [n=36] and experimental group [n=46]). Data collection at the beginning and end of the study, in teenagers from Cáceres, Spain. In both groups anthropometric measurements and sociodemographic data were determined. The quality of the Mediterranean diet was assessed through the KIDMED test, the degree of physical activity through the PAQ-A questionnaire and weight status with the growth charts of the Faustino Orbegozo Eizaguirre Foundation. RESULTS: We obtained a significant increase in the experimental group in the PAQ-A questionnaire that assesses physical activity (P=.029). No significant differences were observed between groups in the weight status (P=.916). When comparing the quality of the Mediterranean diet (high vs moderate or low quality) with physical activity (Pcontrol=.730; experimental P=.495) and with weight status (Pcontrol=.838; experimental P=.372), No significant differences are observed. CONCLUSIONS: The educational intervention did not improve the quality of the Mediterranean diet or physical activity, although most of our sample had normal weight and acceptable physical activity. We must continue to improve the healthy eating pattern of our adolescents, to ensure an adequate state of health in the future

Una cosa es predicar, y otra dar trigo (cosas de la nutrición) / Actions speak louder than words (nutrition issues)

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Mental Health-Related Behaviors and Discussions Among Young Adults: Analysis and Classification.

BACKGROUND: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. OBJECTIVE: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. METHODS: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. RESULTS: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. CONCLUSIONS: Our results show that messages containing data about students' mental health-related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support.

Economía del comportamiento para mejorar estilos de vida y reducir factores de riesgo / Behavioral economics to improve lifestyle choices and to reduce risk factors

Una parte importante de la morbimortalidad se debe a hábitos de vida y factores de riesgo modificables. Una estrategia prometedora para promover el cambio de tales factores pasa por la aplicación de intervenciones de salud pública basadas en la economía del comportamiento, rama del conocimiento que combina principios psicológicos y económicos. Este artículo se centra en un tipo de intervención conocida como nudge (traducida habitualmente como «empujón» o «acicate»), que modifica la conducta sin restringir la capacidad de elección de las personas. Se analizan las diferentes propiedades que caracterizan a los nudges y diversos ámbitos en los que se han aplicado con éxito: vacunación, alimentación, actividad física, cesación tabáquica y prescripción de medicamentos. En conclusión, la economía del comportamiento y los nudges tienen un gran potencial para su aplicación en la esfera de la salud pública en España

A large part of morbimortality is caused by lifestyle habits and modifiable risk factors. A promising strategy to promote the change of such factors is the implementation of public health interventions based on behavioral economics, a discipline that combines psychological and economic principles. In the present article, we focus on a type of intervention known as "nudge" (that has been translated into Spanish as empujón or acicate), that changes behaviour without limiting the individual's choice. We analyze the properties that characterize nudges, and several areas in which they have been successfully implemented: vaccination, nutrition, physical activity, smoking cessation and drug prescription. We conclude that behavioural economics and nudges have great potential for their implementation in the public health sphere in Spain

Nível de e-literacia em saúde em alunos do ensino secundário privado / Level of e-literacy in health in private secondary school students

Introduction: e-literacy in health is related to the use of Internet or other electronic means related to the dissemination or visualization of information about health and / or health services. Objectives: To describe the level of e-literacy in health, in a group of students of a private high school, in the North of Portugal; to relate the level of e-literacy in health with sociodemographic data; to relate the level of e-literacy in health with the contextual variables of the students. Method: Descriptive, correlational and transversal quantitative study. 102 students from the science and technology course of a private high school in the north of Portugal participated. A questionnaire was applied consisting of 3 groups: group I sociodemographic variables; group II consisted of contextual variables and group III constituted by the "eHEALS - eHealth Literacy Scale" scale. Results: Students presented positive levels of e-Literacy in health. They know how to use the Internet to find health information and recognize its usefulness and importance, but did not have confidence in the information obtained when making deci-sions on health. Conclusion: Students present positive levels of e-literacy in health but need guidance to the sources of consultation in order to rely on the information accessed for health project management

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Medicina anticipatoria vs medicina preventiva. Como crear enfermos buscando la salud. (I) Las Estadísticas / Anticipatory medicine vs preventive medicine. How to create patients looking for health. (I) Statistics

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Healthy Jeart: promoción de la salud en la adolescencia a través de dispositivos móviles / Healthy Jeart: promotion of health in adolescence through mobile devices

Para que las campañas de promoción de la salud sean más efectivas se necesita la motivación de las personas a quienes van dirigidas, la cual puede incrementarse mediante la gamificación a través de dispositivos móviles. No se conocen experiencias en español que aborden la promoción de la salud desde una perspectiva lúdica generalista. Por ello se crea Healthy Jeart, una aplicación para teléfonos inteligentes y tabletas, destinada preferentemente a una población de entre 8 y 16 años, que tiene como objetivo la promoción de hábitos saludables a nivel físico, social y psicológico. Su contenido ha sido diseñado por profesores de las universidades de Huelva y Sevilla. Las áreas temáticas que la conforman son: ejercicio físico, alimentación, bienestar físico, bienestar psicológico, relaciones afectivo-sexuales, uso de nuevas tecnologías y tóxicos-adicciones. En 2018 consiguió la certificación de aplicación saludable, otorgada por la Agencia de Calidad Sanitaria de Andalucía (ACSA)

To make health promotion campaigns more effective, the motivation of the people to whom they are directed is required, what can be achieved by gamification through electronic devices. There are no known experiences in Spanish that address the promotion of health from a generalist perspective and not only focused on very specific issues. For this reason Healthy Jeart is created. It is an app for smartphones and tablets, aimed at a population between 8 and 16 years old, whose objective is the promotion of healthy habits on a physical, social and psychological level. Its content has been designed by professors from the universities of Huelva and Seville (Spain). The thematic areas that comprise it are: physical exercise, nutrition, physical well-being, psychological well-being, affective-sexual relationships, use of new technologies and toxic substances and addictions. In 2018 it achieved a certification granted by the Agency of Sanitary Quality of Andalusia as a healthy app

Impacto del estilo de vida de los estudiantes universitarios en la promoción de políticas públicas en salud. El caso de los nudges / Impact of university students lifestyle in the promotion of public health policies. The case of nudges

OBJETIVO: En la última década, los responsables de políticas públicas están aplicando nuevas herramientas para el fomento de hábitos saludables, partiendo de las ciencias de la economía conductual y la psicología social. Estas herramientas se conocen como nudges, y antes de ser aplicadas ha de analizarse el grado de aceptación que la población presenta sobre ellas. El objetivo de este estudio fue determinar si existía relación entre el estilo de vida de la población universitaria y el grado de aceptación de herramientas para el fomento de políticas públicas en salud. MÉTODOS: Se elaboró un estudio correlacional transversal de una muestra representativa de 590 estudiantes universitarios (IC 95%, alfa=5%) de universidades españolas, mediante un cuestionario en línea. Se realizaron análisis bivariados y multivariados aplicando chi-cuadrado y la prueba t de Student para muestras independientes. RESULTADOS: Los jóvenes universitarios tienen una alimentación inadecuada, con un deficiente consumo de fruta y verdura (solo el 27,8% las consumen varias veces al día, siendo la cantidad diaria recomendada de 5 piezas) y un consumo elevado de comida basura, alcohol (el 68,81% y el 63,39%, respectivamente, los consumían entre 1 y 2 veces por semana) y carne (consumida de 3 a 4 veces por semana por el 46,61%). Al correlacionar las variables sociodemográficas con la alimentación se encontraron resultados significativos, siendo los hombres y los estudiantes más jóvenes que apoyaban más a la derecha política, y los practicantes de alguna religión quienes tenían peores hábitos. Se obtuvo una correlación positiva entre la aprobación de nudges y los hábitos responsables con el menor consumo de carne (p < 0,001), siendo significativo en los nudges que abordaban medidas sobre alimentación. CONCLUSIONES: La aceptación de políticas públicas en salud está relacionada con la alimentación saludable y con las conductas socialmente más comprometidas. Además, estos factores son más frecuentes entre las mujeres, en el grupo de mayor edad, entre quienes muestran más apoyo a la izquierda política y entre quienes tienen menos creencias religiosas

OBJECTIVE: In the last decade, public policy makers are applying new tools to promote healthy habits, starting from the behavioral economics sciences and social psychology. These tools are known as nudges, and before being applied, the degree of acceptance that the population presents about them must be analyzed. The objective of this study was to determine if there is a relationship between the lifestyle of the university population and the degree of acceptance of tools for the promotion of public health policies. METHODS: Cross-sectional correlational study of a representative sample of 590 university students (95% CI, Alpha=5%) from Spanish universities using an online questionnaire. Bivariate and multivariate analyzes were performed applying Chi-squared test and Student t-test for independent samples. RESULTS: Young university students have an inadequate diet, with a deficient consumption of fruit and vegetables (only 27.8% consume them several times a day, the recommended daily amount being 5 pieces) and a high consumption of junk food, alcohol (68.81% and 63.39%, respectively, consumed between 1 and 2 times a week) and meat (consumed 3 to 4 times a week by 46.61%). By correlating the socio-demographic variables with food, significant results were found. The group of men, the youngest students, who are more supportive of the political right, and the religious practitioners, are the ones with the worst habits. In addition, those with older, more affiliated with the political left, less religious practice and better eating habits, they performed more responsible habits. There was a positive correlation between approval of nudges and responsible habits and less meat consumption (p < 0,001), being significant in the nudges on food. CONCLUSIONS: The acceptance of public policies on health is related to healthy eating and to the most socially committed behaviors. In addition, these factors are more frequent among women, the older group, who show more support for the political left and have fewer religious beliefs

Reliability and validity of a questionnaire for assessing self-perceived health-related fitness in Spanish children

There is a need for developing tools aimed at assessing fitness in children, due to its relationship with health. This study is aimed at testing the reliability and the validity of a questionnaire designed for assessing self-perceived health-related fitness in Spanish children. The questionnaire was created based on the model of physical self-concept developed by Fox and Corbin (1989) who conceived four sub-domains: Sport competence, attractive body, strength and physical condition. A total of 283 children (mean age: 10.80 ± 0.69 years; 45.6% girls) answered the questionnaire twice, in order to determine its test-retest reliability. The results obtained in the International Fitness Scale (IFIS) and on a fitness battery were used to determine its validity evidence based on relations to other variables. Exploratory and factorial analyses were performed to check its validity evidence based on internal structure. The obtained results indicated that the questionnaire showed an accurate validity evidence based on internal structure and a very good test-retest reliability, Intraclass correlation coefficient: .88; 95% CI [.84, .90]. The questionnaire established moderate correlations with the IFIS questionnaire (ρ = -.51 to -.68) and the fitness level showed by the children (ρ = -.53). These findings indicate that the questionnaire can be a useful research tool for assessing self-perceived health-related fitness in children

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Digital Health Behavior Change Technology: Bibliometric and Scoping Review of Two Decades of Research.

BACKGROUND: Research on digital technology to change health behavior has increased enormously in recent decades. Due to the interdisciplinary nature of this topic, knowledge and technologies from different research areas are required. Up to now, it is not clear how the knowledge from those fields is combined in actual applications. A comprehensive analysis that systematically maps and explores the use of knowledge within this emerging interdisciplinary field is required. OBJECTIVE: This study aims to provide an overview of the research area around the design and development of digital technologies for health behavior change and to explore trends and patterns. METHODS: A bibliometric analysis is used to provide an overview of the field, and a scoping review is presented to identify the trends and possible gaps. The study is based on the publications related to persuasive technologies and health behavior change in the last 18 years, as indexed by the Web of Science and Scopus (317 and 314 articles, respectively). In the first part, regional and time-based publishing trends; research fields and keyword co-occurrence networks; influential journals; and collaboration network between influential authors, countries, and institutions are examined. In the second part, the behavioral domains, technological means and theoretical foundations are investigated via a scoping review. RESULTS: The literature reviewed shows a clear and emerging trend after 2001 in technology-based behavior change, which grew exponentially after the introduction of the smartphone around 2009. Authors from the United States, Europe, and Australia have the highest number of publications in the field. The three most active research areas are computer science, public and occupational health, and psychology. The keyword "mhealth" was the dominant term and predominantly used together with the term "physical activity" and "ehealth". A total of three strong clusters of coauthors have been found. Nearly half of the total reported papers were published in three journals. The United States, the United Kingdom, and the Netherlands have the highest degree of author collaboration and a strong institutional network. Mobile phones were most often used as a technology platform, regardless of the targeted behavioral domain. Physical activity and healthy eating were the most frequently targeted behavioral domains. Most articles did not report about the behavior change techniques that were applied. Among the reported behavior change techniques, goal setting and self-management were the most frequently reported. CONCLUSIONS: Closer cooperation and interaction between behavioral sciences and technological areas is needed, so that theoretical knowledge and new technological advancements are better connected in actual applications. Eventually, this could result in a larger societal impact, an increase of the effectiveness of digital technologies for health behavioral change, and more insight in the relationship between behavioral change strategies and persuasive technologies' effectiveness.

Factor structure of a coping measure in the 2013 Canadian Forces Mental Health Survey.

BACKGROUND: Coping has been the subject of numerous studies over the past decades, yet significant debate remains regarding the structure of this construct. DATA AND METHODS: Exploratory and confirmatory factor analyses were conducted on 2013 Canadian Forces Mental Health Survey (CFMHS) data to examine the factor structure of coping items. A total of 6,696 Canadian Armed Forces (CAF) Regular Force members completed a coping inventory that assessed 14 coping strategies (e.g., problem solving, talking to others). RESULTS: Results indicated that coping among CAF Regular Force members was best represented by two factors: positive coping and negative coping. Coping strategies categorized as positive coping included active efforts to confront the stressor or improve one's well-being, whereas those categorized as negative coping reflected passive or avoidant efforts or behaviours that may compromise one's health. Positive coping factor scores were positively associated with perceptions of one's ability to handle difficult problems and day-to-day demands, while negative coping factor scores were negatively associated with such perceptions, suggesting that the factors had good concurrent validity. Additional analyses pointed to higher positive and negative coping scores among female Regular Force members compared with male Regular Force members. The additional analyses also showed generally less favourable coping scores among lower-ranking Regular Force members and those with a history of deployment to Afghanistan relative to their respective counterparts. Lastly, Regular Force members who received mental health training demonstrated higher positive coping scores. DISCUSSION: The report discusses implications for the use of coping indicators in future analyses involving the CFMHS.

An Adaptive, Data-Driven Personalized Advisor for Increasing Physical Activity.

In recent years, there has been growing interest in the use of fitness trackers and smartphone applications for promoting physical activity. Many of these applications use accelerometers to estimate the level of activity that users engage in and provide visual reports of a user's step counts. When provided, most recommendations are limited to popular general health advice. In our study, we develop an approach for providing data-driven and personalized recommendations for intraday activity planning. We generate an hour-by-hour activity plan that is based on the user's probability of adhering to the plan. The user's probability of adherence to the plan is personalized, based on his/her past activity patterns and current activity target. Using this approach, we can tailor notifications (e.g., reminders, encouragement) to each user. We can also dynamically update the user's activity plan at mid-day, if his/her actual activity deviates sufficiently from the original plan. In this paper, we describe an implementation of our approach and report our technical findings with respect to identifying typical activity patterns from historical data, predicting whether an activity target will be achieved, and adapting an activity plan based on a user's actual performance throughout the day.

Influence of self-efficacy management on adherence to self-care activities and treatment outcome among diabetes mellitus type 2 Sudanese patients

Background: High level of self-efficacy and adherence to self-care activities have a positive impact on the achievement of glycemic goal among diabetic patients. In Sudan, there is a gap in knowledge related to self-efficacy management and its influence on adherence to self-care activities and overall disease control. Objective: To identify the influence of management self-efficacy on adherence to self-care activities and treatment outcome among Sudanese patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted at two health care facilities in Sudan from April to May 2016. Patients with type 2 diabetes mellitus were included. Convenience sampling method was adopted. Diabetes Management Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were used to collect data through a face-to-face interview. Logistic regression analysis was performed. A p value <0.05 was considered to be significant. Data were processed using the software SPPS v 21.0. Results: A total of 392 patients were included. Respondents classified with high level of self- efficacy across all domains were 191 (48.7%). Moreover, high level of education [adjusted OR 0.5 (0.3-0.7), (p=0.001)] and formal health education on diabetes [adjusted OR 2.4 (1.6-3.7), (p<0.001)], were found to be significantly associated with high level of diabetes management self-efficacy. Patients who had high level of self-efficacy to manage nutrition, physical exercise activity and medication were found more adherent to general diet, exercise activity, and medication taking, respectively. Patients with controlled disease were 87(22.2%). The only predictor of diabetes control was diabetes management self-efficacy [OR 2.1(1.3- 3.5), (p=0.002)]. Conclusions: Diabetes management self-efficacy was associated with high level of education and receiving health education. Self-efficacy was significantly associated with adherence to self-care activities and glycemic control. Substantial efforts are still needed to empower the patients with self-efficacy and improving adherence to self-care activities through appropriate interventions

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Evaluation of medication adherence among Lebanese diabetic patients

Background: Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications. Objectives: The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence. Methods: A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20. Results: Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively). Conclusions: Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence

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Subgroups of lifestyle patterns among hypertension patients: a latent-class analysis.

BACKGROUND: Hypertension remains one of the most important preventable risk factors for diseases and death. Identifying clustered patterns of modifiable lifestyle risk factors for hypertension and demographics factors related to these clustered patterns allows for targeting health prevention interventions. Therefore, this study aims to identify latent classes of hypertensive patients' lifestyle risk factors based on the clustering of four modifiable lifestyle risk factors: eating, physical activity patterns, smoking habits, and blood pressure control. METHODS: A total of 750 patients (Mage = 65.38 years, SDage = 9.2 years) with diagnosed hypertension in urban and rural primary health care centers in Takab (Iran) were recruited randomly from August 2016 to February 2017. Latent class analysis was performed by using proc. LCA in SAS 9.2. RESULTS: Three classes of lifestyle patterns were identified. About 14.4% of hypertensive patients were categorized in a low-risk class (I), 54.6% in an intermediate-risk class (II), and 31% in a high-risk class (III) of lifestyle. A one-year increase in age significantly increases the risk of membership in classes II and III. Similarly, being widowed or divorced increases the risk of membership in classes II and III. Also, having a higher education level decreases the risk of membership in classes II and III. CONCLUSIONS: This study contributes to the literature on lifestyle behaviors among older adults and provides evidence that there are considerable differences in lifestyle behaviors between subgroups of older adult patients. The three profiles of hypertensive patients' conditions suggest that because behaviors often occur simultaneously within an individual level, a latent-class approach helps cluster co-occurrence risk behaviors and focuses on interventions targeted to several healthy behaviors among high-risk patients.

Which characteristics of planning matter? Individual and dyadic physical activity plans and their effects on plan enactment.

OBJECTIVE: Past research supports individual planning as an effective intervention strategy to increase physical activity in individuals. A similar strategy, dyadic planning, adds a planning partner who supports an individual's planning processes. Whether the two planning formats differ in terms of participants' entered plan content and whether and how different content characteristics are linked to plan enactment remains unknown. By investigating the content of generated plans, this study aimed at distinguishing plan characteristics of the two planning formats and examining their role as predictors of later plan enactment. METHODS: Secondary analyses of a three-arm RCT with German couples (data collection between 2013 and 2015). Couples were assigned to an individual (IPC, n = 114) or dyadic planning condition (DPC, n = 111) and formulated up to 5 physical activity plans for a target person. Couples assigned to a control condition were not included as they did not generate plans. The following characteristics were distinguished and coded for each plan: number of planned opportunities, presence of a planned routine, planned cue- or activity-related specificity, activity-related intensity, and chronological plan rank. One week before (T0) and two weeks following (T2) the intervention (T1), increase vs. no increase of the planned activity was coded as a dichotomous plan enactment variable. Multilevel logistic regressions were fit. RESULTS: Plan enactment was higher in dyadic than in individual planners. Findings indicated that routines (e.g., after work) were positively related to plan enactment, whereas a high specificity of when-cues (e.g., Friday at 6.30 p.m.) showed a negative relationship. None of the examined plan characteristics could explain differences in enactment between IPC and DPC. CONCLUSIONS: Linking health behaviours to other behavioural routines seems beneficial for subsequent plan enactment. Dyadic planning was linked with higher enactment rates than individual planning. However, as mechanisms underlying this effect remain unclear, they should be investigated further.