Preventive Medicine Reports最新文献

Objective

This study evaluated the moderating effects of socioeconomic status (SES) and geographical location on the efficacy of an eHealth school-based multiple health behaviour change intervention – Health4Life – in targeting alcohol and tobacco use, dietary intake, knowledge, behavioural intentions, and psychological distress over 24-months.

Methods

Data from the Health4Life cluster-randomised controlled trial conducted from 2019 to 2021 in 71 Australian secondary schools were analysed (N=6639; baseline age 11-14yrs). Schools were from metropolitan (89%) and regional (11%) areas, and participants’ SES was classified as low (15%), mid (37%), and high (48%) relative to the study population. Primary outcomes included alcohol and tobacco use, and a composite indicator of poor diet. Secondary outcomes were knowledge, behavioural intentions, and psychological distress. Latent growth models assessed moderating effects of SES and geographical location on between-group change over 24-months.

Results

Geographical location moderated the intervention’s effect on odds of reporting a poor diet (OR = 1.79, 95% CI = 1.32–2.43, p < 0.001) and diet-related behavioural intentions (OR = 0.71, 95% CI = 0.56–0.89, p = 0.024) over time. Subset analyses indicated that intervention participants in regional areas had higher odds of reporting a poor diet (OR = 1.61, 95% CI = 1.13–2.29, p = 0.008), while those in metropolitan areas had higher odds of improving diet-related behavioural intentions (OR = 1.13, 95% CI = 1.01–1.27, p = 0.041), compared to the control group. No other significant moderation effects were observed.

Conclusions

While significant disparities were generally not observed, the geographical differences in intervention effects on diet and diet-related intentions suggest that co-designed and tailored approaches may benefit disadvantaged adolescents to address the disproportionately high rates of lifestyle risk behaviours among these priority populations.

Objective

To investigate what overweight or obese adults with prediabetes in the United States report being told by providers about 1) having prediabetes, 2) diabetes risk, and 3) losing weight and the associations of these communications with attempted weight loss.

Methods

Data from 2015 to 2018 National Health and Nutrition Examination Surveys (NHANES) for adults with a body mass index in the overweight or obesity ranges and HbA1c in the prediabetes range were examined (n = 2085). Patient reported data on what providers told them about having prediabetes, being at risk for diabetes, and losing weight were compared with attempted weight loss.

Results

Most participants (66.4%) reported never being told they had prediabetes nor being at risk for diabetes, 13.0% reported being told they had prediabetes, 10.6% at risk for diabetes, and 8.0% both messages. 18.3% of participants reported being told to lose weight. Participants who reported being told they had prediabetes and at increased diabetes risk were more likely to report attempted weight loss (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1–3.2). Reporting that they were told to lose weight was not significantly associated with an increase in reported weight loss attempts.

Conclusions

In this cohort of individuals with overweight/obesity and prediabetic HbA1c values, low rates communications with providers about prediabetes and diabetes risk were reported. When both were discussed, patients reported greater attempted weight loss. These findings draw attention to the potential impact that provider communications about prediabetes and diabetes risk may have on lifestyle behavior change.

Objective

Hypertension has become a public health challenge for Yunnan children and adolescents. The study aims is to assess the dietary and activity habits associated with hypertension in Kunming children and adolescents and to develop effective strategies for preventing and controlling, Southwest China.

Methods

Conducted in 2019, the cross-sectional study involved 3,150 students, aged 13.25 ± 2.77 years, multistage, stratified, randomly sampled from Chenggong and Fumin areas, Southwest China.

Results

Among 3,150 participants, 6.19 % never drank milk, 3.46 % never consumed fresh fruit. 2.67 % never consumed fresh vegetables, 2.48 % never ate breakfast and 10.06 % frequently drank sugary beverages (soft drinking). Additionally, 21.56 % engaged in moderate-intensity exercise less than one Day a week, and 31.97 % performed high-intensity exercise less than one Day a week. The intraclass correlation coefficient indicated that 49.40 % of the total variance was attributed to the dietary level and 42.10 % was attributed to the activity level. Eating fresh vegetables and fruit, taking physical education classes they attended per week and the frequency of moderate-intensity and high-intensity exercise per week were independent protective factors for hypertension (P < 0.01); drinking sugary beverages (soft drinking) was a independent risk factor against hypertension (P < 0.05); breakfast skipping was a possible risk factor for hypertension (P < 0.15). No significant associations were found with fried food or sweet food weekly consumption (P < 0.15).

Conclusions

The hypertension of children and adolescents cannot be ignored in Kunming, Southwest china. Dietary and activity factors are modifiable. We should make comprehensive child-friendly health education materials as soon as possible.

Background

To prospectively assess the individual and joint effects of birth weight and the life’s essential 8 (LE8)-defined cardiovascular health (CVH) on myocardial infarction (MI) risk in later life.

Methods

In 144,803 baseline MI-free participants who were recruited in the UK Biobank cohort between 2006 and 2010, Cox proportional hazard models were used to estimate the associations of birth weight, LE8 score, and their interactions with incident MI. LE8 was defined on the basis of diet, physical activity, nicotine exposure, sleep health, body mass index, blood pressure, blood glucose, and blood lipids.

Results

Low birth weight was associated with higher risk of MI [hazard ratio (HR) 1.17, 95% confidence interval 1.02–1.35, P = 0.025], while no significant correlation between high birth weight and MI was observed after adjustment. Low CVH was associated with higher MI risk [HR 6.43 (3.71–11.15), P < 0.001). Participants with low birth weight and low CVH (vs. participants with normal birth weight and high CVH) had HR of 5.97 (2.94–12.14) for MI incidence. The relative excess risk due to interaction of low birth weight and low CVH on MI was −4.11 (−8.12, −0.11), indicating a negative interaction on an additive scale. A consistent decreasing trend of MI risk along with increased LE8 score was observed across all three birth weight groups.

Conclusion

Low birth weight was associated with increased MI risk, emphasizing the importance of the prenatal factor in risk prediction and prevention of MI. Improving LE8 can mitigate MI risk attributed to low birth weight.

Objective

Gender norms shape individuals’ perceptions and behaviours, particularly concerning health outcomes. However, the lack of comprehensive gender norm attitude measures in low- and middle-income countries, including Bangladesh, impedes gender-transformative efforts. This study introduces the Multidomain Gender Norm Attitude Scale (M−GNAS) to evaluate gender norm attitudes among Bangladeshi youths.

Method

Three sequential studies were conducted in Bangladesh in 2022 to develop the M−GNAS. Study 1 engaged 124 participants in focus group discussions, generating a 40-item pool reflecting prevalent gender norms. Study 2 involved 1374 youths (mean age 26.82, SD 5.50) to finalise the M−GNAS items and explore its latent structure through exploratory factor analysis (EFA). Study 3, with 1416 participants of similar age, used confirmatory factor analysis (CFA) to assess structural validity and structural equation modelling to evaluate measurement invariance (MI) across genders.

Results

EFA identified a four-domain solution with 13 items: gender-appropriate behaviour, family financial decisions, family responsibility, and career choice. CFA supported this four-domain solution (CFI=0.96, TLI=0.95; RMSEA=0.07; SRMR=0.04). MI across gender was well established (CFI & TLI>0.95, RMSEA≤0.06, SRMR<0.6). Higher education was associated with more egalitarian attitudes (F (_{5, 1408)} = 7.25, p < 0.001), supporting the scale’s construct validity.

Conclusion

The M−GNAS is a psychometrically robust tool for assessing youths’ attitudes toward prevalent gender norm domains in Bangladesh. It holds the potential for contributing to gender-transformative programmes and could be applied in similar initiatives across developing nations, contingent upon appropriate validation.

Objective

We assessed factors associated with engagement in lifestyle wellness programs for patients with prediabetes.

Methods

This mixed-methods study, conducted between March 2018 and April of 2021, combined a retrospective cohort study and semi-structured interviews in a Northern California cohort of patients from a randomized controlled pragmatic clinical trial aged 18–75 with body mass index $\ge$ 25 and at least one HbA1c between 5.7–6.4 % in the previous 3 months. Patients were assigned to a peer support, enhanced usual care, or control arm. We used generalized linear mixed models to analyze the association between clinical, demographic, and study-related factors and referral to and participation in wellness programs within 12 months. We conducted semi-structured interviews with intervention participants and analyzed them using thematic analysis. We integrated qualitative and quantitative findings using the “following a thread” method.

Results

We identified 2,164 eligible patients; 12.8% were referred to a wellness program and 7% attended a wellness program. Patients not exposed to peer support, males, and Asian-American participants had the lowest odds of participation in wellness programs. Qualitative interviews with 30 intervention participants provided contextual information on quantitative findings including the importance of physician referrals and formal recruitment, a need for social support and accountability, and matching patient needs to wellness program descriptions as facilitators of engaging in wellness programs.

Conclusion

Given the low percentage of patients with prediabetes referred to and participating in wellness programs, there is a need to develop health system strategies to improve wellness program engagement for patients at-risk for diabetes.

Background

A high body mass index (BMI) increases the risk of hypertension. However, little is known about the dose-dependent association between BMI and hypertension. Therefore, this study investigated the prevalence of hypertension in 7568 subjects from the Jiangsu Province, Eastern China, and analyzed the dose–response relationship between BMI and hypertension risk.

Methods

The eligible subjects completed a structured questionnaire and clinical biochemical indicators were measured according to standardized protocols. Multivariate logistic regression models were used to evaluate the association between BMI and hypertension. Restricted cubic spline (RCS) analysis was used to analyze the dose–response relationship between BMI and hypertension risk. Moreover, sensitivity analysis was performed to verify the robustness of our findings.

Results

The prevalence of hypertension was 35.3 % in the total population. BMI was significantly associated with systolic and diastolic blood pressure. The fully-adjusted odds ratio (OR) with 95 % confidence interval (CI) for hypertension was 1.17 (1.15, 1.19) for every 1 kg/m² increase in BMI. Furthermore, the OR (95 % CI) for hypertension in the highest BMI group (Obesity) was 4.14 (3.45, 4.96) after adjusting for covariates compared with the normal group. Multivariable adjusted RCS analysis showed a positive and linear dose–response relationship between BMI and hypertension risk both in male and female populations (all P for non-linearity > 0.05).

Conclusion

Our study demonstrated a positive and linear dose–response relationship between BMI and the risk of hypertension. The results of this study provide evidence for BMI-related clinical interventions to reduce the risk of hypertension.

Objective

This study investigates the association between replacement thinking, status threat perceptions, and the endorsement of political violence among non-Hispanic white adults in the United States. It explores how perceived threats to social status can drive support for extreme measures aimed at preserving white hegemony, addressing a gap in research on factors contributing to political violence, a public health concern.

Methods

The 2022 Life in America Survey provided data for this cross-sectional study, focusing on status threat and replacement thinking among non-Hispanic white respondents. Status threat was inferred from relative income, education level, and racial segregation in residential census tracts, while replacement thinking was derived through agreement with the statement “in America, native-born white people are being replaced by immigrants.” The outcome was the endorsement of political violence. Analysis utilized a survey-weighted robust modified Poisson model.

Results

Among 5,976 non-Hispanic white respondents, 18.7 % supported political violence in at least one scenario. A U-shaped relationship was observed between racial segregation and political violence endorsement: respondents from more diverse communities were less likely to support political violence. Those endorsing replacement thinking were 233 %–229 % more likely to endorse political violence than those who did not, dependent on income levels. White respondents without a high school degree were 29 % more likely to endorse political violence.

Conclusion

The study found a positive association between replacement thinking, markers of status threat, and political violence endorsements among non-Hispanic white Americans. These findings emphasize the need for research and interventions to mitigate these perceptions and prevent political violence.

Objective

Targeted Health Dialogues (THD) is a public health intervention program that aims at preventing cardiovascular disease. THDs were implemented in the Swedish region Scania, in 2020, with the novelty of being conducted in a metropolitan area with a multiethnic population.

This study investigated the prevalence of obesity among 40-year-old THD participants in Scania by region of birth, and its associations with self-efficacy and additional metabolic risk factors.

Methods

Cross-sectional data were retrieved from measurements in the THDs. Study participants included 1831 40-year-olds. Differences in characteristics by region of birth were assessed using chi-squared and ANOVA tests. The associations between overweight, obesity, and high waist-hip ratio (WHR) and self-efficacy and metabolic risk factors (blood pressure, LDL cholesterol, plasma glucose) were assessed using binominal and ordinal logistic regression, adjusted for sex and education and tested for interactions by region of birth.

Results

35.1 % of the participants were overweight (BMI 25–29.9), and 18.7 % were obese (BMI ≥30) with the highest levels among participants born outside Sweden (p = 0.005). Abdominal obesity was also more prevalent among participants born outside Sweden (p = 0.002). Obesity was associated with increased odds of having low self-efficacy (OR per BMI-level: 1.48 (CI 1.24–1.76) and additional metabolic risk factors. No interactions with region of birth were detected.

Conclusions

The prevalence of obesity differed between region of birth and obesity was associated with having low self-efficacy. These findings underline the need to customise lifestyle interventions in a multiethnic population to increase health equity.

Background

To investigate the association of marital status on cardiovascular death risk in lung cancer patients.

Methods

Using data from the Surveillance, Epidemiology, and End Results (SEER) database in the United States from 2011 to 2015 (N = 118,293), the association between marital status and cardiovascular death (CVD) risk in patients with lung cancer was assessed by competing-risks regression models.

Results

Unmarried status was associated with increased risk of cardiovascular death in lung cancer patients [hazard ratio (HR)  =  1.398, 95 % confidence interval (CI): 1.268–1.542], which remained significant even after adjusting for potential covariates (HR = 1.407, 95 % CI: 1.276–1.551). Further unmarried subgroups analysis showed that the different unmarried status were associated with increased cardiovascular death risk as follows: single (HR = 1.397, 95 % CI: 1.236–1.1.580), separated (HR = 1.630, 95 % CI: 1.153–2.305), divorced (HR = 1.318, 95 % CI: 1.158–1.500), and widowed (HR = 1.561, 95 % CI: 1.393–1.749). Further subgroup analysis by sex revealed that compared to male lung cancer patients with married, CVD risk was significant increased in their counterparts with widowed (adjusted HR = 1.509, 95 % CI: 1.291–1.764, P<0.001), single (adjusted HR = 1.361, 95 % CI: 1.168–1.585, P<0.001) and divorced (adjusted HR = 1.353, 95 % CI: 1.177–1.555, P<0.001) rather than those with separated. However, similar phenomena was only observed in female lung cancer patients with widowed (adjusted HR = 1.414, 95 % CI: 1.220–1.640, P<0.001) and single (adjusted HR = 1.438, 95 % CI: 1.195–1.730, P<0.001).

Conclusion

Unmarried status was associated with increased cardiovascular death risk in patients with lung cancer, which highlighted that more attention and humanistic/supportive care should be offered to unmarried lung cancer patients for improving the prognosis.