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The Satisfaction With Life Scale (SWLS) is a widely used self-report measure of subjective well-being, but studies of its measurement invariance across a large number of nations remain limited. Here, we utilised the Body Image in Nature (BINS) dataset-with data collected between 2020 and 2022 -to assess measurement invariance of the SWLS across 65 nations, 40 languages, gender identities, and age groups (N = 56,968). All participants completed the SWLS under largely uniform conditions. Multi-group confirmatory factor analysis indicated that configural and metric invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional SWLS model has universal applicability. Full scalar invariance was achieved across gender identities and age groups. Based on alignment optimisation methods, partial scalar invariance was achieved across all but three national groups and across all languages represented in the BINS. There were large differences in latent SWLS means across nations and languages, but negligible-to-small differences across gender identities and age groups. Across nations, greater life satisfaction was significantly associated with greater financial security and being in a committed relationship or married. The results of this study suggest that the SWLS largely assesses a common unidimensional construct of life satisfaction irrespective of respondent characteristics (i.e., national group, gender identities, and age group) or survey presentation (i.e., survey language). This has important implications for the assessment of life satisfaction across nations and provides information that will be useful for practitioners aiming to promote subjective well-being internationally., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Swami et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study examined the effects of the Nirvana Fitness (NF) program on state body appreciation (BA) and its correlates, as well as the mechanisms that could explain these changes. The study participants were allocated to NF (n = 21) and functional training (control, n = 22) groups and participated in an 8-week exercise intervention. The mean age was 24.4 ± 6.7. The participants filled out online questionnaires on state measures of BA, body surveillance (BS), functionality appreciation, body-mind connection, mindfulness in physical activity (SMS-PA), intrinsic exercise motivation (IM), satisfaction of basic psychological needs, and perceived physical fitness (PPF) immediately after the first and last sessions. The results revealed a significant improvement in state BA and its correlates in both groups, with no changes in PPF in the NF group or IM in either group. An interaction between group and time effects was revealed in a change of relatedness, indicating a stronger effect in the NF group. Positive changes in SMS-PA, BS, and satisfaction of the need for relatedness significantly predicted improvement in state BA. These findings highlight the importance of targeting mindfulness, body surveillance, and relatedness during physical activity in interventions aimed at promoting positive body image in university-aged women.

This cross-sectional study aimed to analyse the factors contributing to state body appreciation (SBA) during exercise. After providing their informed consent, 200 study participants (mean age 30.0 ± 9.4 years, 72.0% were men) filled in an online questionnaire immediately after the completion of resistance training (n = 125), cardiovascular exercise (n = 55), or functional/interval group exercise (n = 20) sessions. The study measures included socio-demographic variables, body mass index (BMI), the duration of involvement in sports, SBA, state body surveillance (SBS), state mindfulness in physical activity, state intrinsic exercise regulation, and perceived pleasantness during exercise. The results showed that exercisers involved in sports for >2 years and those whose body weight was within a healthy range (<25.0 kg/m 2 ) demonstrated higher SBA and mindfulness during exercise, lower SBS, more intrinsic exercise regulation, and higher satisfaction during physical activity compared to exercisers with less exercise experience (≤2 years) and a body weight higher than a healthy range (≥25.0 kg/m 2 ). The negative effects of being overweight or obese were more pronounced in individuals with ≤2 years of sports participation, except regarding body surveillance and monitoring the mind. The factors significantly contributing to SBA during the exercise sessions were a longer duration of involvement in sports, a lower BMI and SBS, and greater mindful body acceptance and exercise pleasantness. Decreasing SBS and enhancing mindful body acceptance, pleasantness, and intrinsic motivation during exercise might significantly contribute to SBA in physical activity. These results can inform physical-activity-based programmes aiming to promote a positive body image. Also, these results show that it is important to increase education and develop competencies for fitness coaches to create inclusive and positive-body-image-promoting sports environments.

Introduction: Exercise is an important intervention used to improve body image. The present non-randomized controlled trial aimed to examine the effects of Nirvana Fitness (NF) and functional training (FT) on body appreciation and its correlates in young women., Methods: Twenty-two students participated in FT, 21 in NF, and 47 in the control (CN) group. The mean age of the study participants was 22.79 ± 6.14 years. The FT and NF groups participated in sessions 2 days per week for 8 weeks, and the CN group did not participate in any sessions. All the participants were evaluated at pre- and post-intervention, filling in the Body Appreciation Scale 2 (BAS-2), Mind-Body Connection from the Physical Activity Body Experiences Questionnaire (PABEQ), Body Surveillance from the Objectified Body Consciousness Scale (OBCS), the Functionality Appreciation Scale (FAS), intrinsic exercise motivation from Behavioral Regulation in Exercise Questionnaire 2 (BREQ-2), and perceived physical fitness., Results: Significant improvements were found in terms of all outcome measures in the FT group, and improvements of body and mind connection and body surveillance in the NF group, while no improvements were observed in the CN group. FT's effect on body appreciation appeared to operate through the improvement of the mind-body connection in the FT and NF groups and via decreased body surveillance in the FT group., Conclusion: These findings support the developmental theory of embodiment and provide initial evidence that professionally delivered FT and NF might be used as effective strategies for the promotion of positive body image in young women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jankauskiene, Balciuniene, Rutkauskaite, Pajaujiene and Baceviciene.)

Introduction: The study aimed to extend research on the possible mechanisms that explain the associations between physical activity (PA), mindfulness during PA and positive body image. In the present study, we tested the mediating role of state mindfulness during PA in the association between PA and trait body appreciation. We also explored the moderating roles of sex and body mass index (BMI) in these associations., Methods: In total, 759 students participated in the study but after applying the inclusion criteria 539 questionnaires were approved for analysis, with a mean age of 23.3 ± 7.2 years (49.7% were women). Study participants completed the online survey, which included sociodemographic details, PA data, the State Mindfulness Scale for Physical Activity 2 (SMS-PA-2) and the Body Appreciation Scale 2 (BAS-2)., Results: Monitoring and accepting the body during exercise mediated the association between PA and body appreciation. BMI moderated the association between accepting the body during exercise and body appreciation: for heavier individuals with BMI > 24.99 kg/m 2 , the associations between accepting the body during exercise and body appreciation were higher ( B  = 0.53, p  < 0.001) compared to those whose body weight was in the normal range ( B  = 0.21, p  < 0.001)., Conclusion: Strengthening mindfulness and promoting mindful body acceptance during exercise might enhance a positive body image, especially in individuals with a higher BMI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Jankauskiene and Baceviciene.)

The aim of the present study was to test the sociocultural Petrie and Greenleaf's (2007) model of disordered eating (DE) in competitive female athletes. Specifically, we tested a model of general sociocultural and coach-related pressures towards body weight and appearance of female athletes as the factors associated with athletes' DE through the mediators such as internalization of appearance ideals and overweight preoccupation. 515 athletes participated in this study. The mean age of the sample was 19.0 ± 5.9 years. Athletes were provided with study measures on general sociocultural and coach-related appearance and body weight pressures, internalization of appearance ideals, overweight preoccupation and DE. Path analyses showed that general sociocultural pressures were associated with DE directly and through internalization of appearance ideals and overweight preoccupation. Pressures from coaches were associated with DE through overweight preoccupation and through the internalization of appearance ideals and overweight preoccupation. The models were invariant across body weight sensitivity in sports and age groups. These results inform DE prevention for female athletes. It is important to increase resistance to sociocultural pressures and pressures from coaches in DE prevention programmes for female competitive athletes of all ages and participating in sports irrespective of sports group (weight-sensitive or less weight-sensitive).

The aim of the present study was to examine the psychometric properties of the Lithuanian translation of State Mindfulness in Physical Activity (SMS-PA-2) in a sample of physically active students. A total sample of 539 students from universities and colleges (50.3% men; mean age 23.3 ± 7.2 years) were asked to provide demographical data, report physical activity (PA) and PA habits and fill in measures of trait awareness, autonomous motivation in physical activity, trait body appreciation, trait body functionality appreciation and disordered eating attitudes and behaviours and self-esteem via an online anonymous survey. Students also provided information about their participation in organized team sports, organized individual sports, recreational sports and home exercise. Results. The SMS-PA-2 replicated the original four-factor structure, with good internal consistency (except for the Accepting Mind subscale). Invariance analyses across sex groups revealed an acceptable fit of the configural, metric and scalar models. However, in the multi-group analysis, metric invariance and scalar invariance were not confirmed. The SMS-PA-2 was positively associated with leisure-time PA, PA habits, more self-determined motivation for exercise, trait awareness, trait body appreciation, trait body functionality appreciation and self-esteem. A negative association was observed between the SMS-PA-2 and disordered eating attitudes and behaviours. Home exercisers and students engaged in team sports demonstrated lower levels of state mindfulness in PA than those engaged in organized individual and recreational sports. The Lithuanian version of the SMS-PA-2 is a reliable and valid instrument for measuring state mindfulness in PA. This instrument is recommended for researchers who aim to investigate the role of state mindfulness in the PA in Lithuanian-language-speaking samples of young adults. Future studies should explore the Lithuanian version of the SMS-PA-2 by asking participants to fill questionnaires in immediately after the PA session, and measurement invariance between sexes should be further tested.

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of the present study was to compare disordered eating (DE), body image, and sociocultural and coach-related pressures between athletes of different age groups (adolescents and adults) and between athletes participating in weight-sensitive (WS) and less WS groups. A total of 1003 athletes participated in this study. The age range of the sample was 15 to 44 years, and the mean age was 18.9 ± 5.8 years (51.3% were female). Athletes who voluntarily agreed to participate in the study were provided with the study measures on DE, body image and sociocultural attitudes towards appearance. Vomiting, laxative misuse and excessive exercise were more prevalent in adolescent female athletes than adults, while dietary restraint was more common in adult male athletes than adolescents. Adolescent female athletes experienced higher sociocultural (family, peers) and sport-related (coach) pressures and a less positive body image compared with adult female athletes. Adult male athletes experienced higher overweight preoccupation, more DE and unhealthy eating habits, and engaged in more frequent self-weighing behaviour compared with adolescent males. When the effect of weight sensitivity in sports was tested, a higher prevalence of DE and overweight preoccupation, more frequent self-weighing, and higher body-image-related pressure from coaches were observed in female athletes participating in aesthetic weight-sensitive (WS) sports as compared with those participating in less WS sports. No differences in positive body image were observed in female WS and less WS sports. Special DE prevention and positive body image promotion programs are necessary for female competitive athletes and parents of adolescent female athletes, especially those participating in aesthetic ones. For adult male athletes, special programs aiming to promote healthy eating should be implemented to prevent DE and body image concerns. Special education about DE prevention is compulsory for coaches who train female athletes.

The aim of this study was to test the moderating role of sport participation in the mediation model of media pressures, internalisation of appearance ideals and body dissatisfaction in adolescent boys. Five hundred and seventy adolescent boys (mean age 17.2 ± 0.45; range 15-19 years) participated in the cross-sectional study. Adolescents completed a questionnaire consisting of measures of attitudes towards sociocultural pressures on appearance, body dissatisfaction and sport participation (participation in achievement sport, leisure exercising and non-participation in any sports). Sports participation moderated the associations between the internalisation of stereotyped appearance ideals and body dissatisfaction. In athletes, the effect of internalisation of thin body ideals on body dissatisfaction was not significant, while the effect of internalisation of muscular/athletic body ideals was negative. In leisure exercisers, the effect of internalisation of muscular body ideals on body dissatisfaction was not significant, yet internalisation of thin body ideals had a significant effect on body dissatisfaction. The strongest associations between appearance ideals internalisation and body dissatisfaction were found in adolescent boys who reported no participation in sports. Sports participation might be an effective tool in decreasing the negative effect of internalisation of stereotyped appearance ideals on adolescent boys' body image.

Concerns about body image might prevent adolescents from participating in physical education (PE) classes and physical activities during leisure-time. In this cross-sectional study, we assessed the relationships between teacher support of autonomy, student motivations for PE, and positive body image, in a sample of Lithuanian adolescents. A total of 715 adolescents (51.89% girls) participated in the study. Ages ranged from 14 to 18 years, with a mean age of 16.00 (SD = 0.79) for girls and 15.99 (SD = 0.75) for boys. The questionnaire consisted of demographic questions, the Learning Climate Questionnaire, the Revised Perceived Locus of Causality in Physical Education Questionnaire, the Body Appreciation Scale-2, the Self-Report Habit Index for Physical Activity (PA), perceived physical fitness (PPF), and Godin Leisure-Time Exercise Questionnaire. The results showed that teacher support for students' autonomy was associated with higher positive body image. In adolescent girls, autonomous motivation for PE was the mediator between teacher support of autonomy and positive body image. The associations between self-determined motivation in PE and positive body image were mediated by PPF on one hand, and through PA habits and PPF on the other hand of the structural equation model (in girls). PA habits moderated associations between PE motivation and PPF. Associations between PE motivation and PPF were stronger in girls with the lowest PA habits compared to girls with mean PA habits. These results suggest that PE classes are important for promoting students' positive body images. PE teachers are advised to use pedagogical strategies that promote the self-determined motivation of students for PE. Increased self-determined motivation for physical education might be an effective strategy for physical self-perception and positive body image promotion in adolescent girls, especially those with low PA habits.

Purpose: The aim of the present study was to test a partial sociocultural model of integrated tripartite influence and objectification theories in adolescent girls and to assess the moderating role of participation in sport., Methods: This study is part of a larger research that involved a sample of adolescent girls and boys from the 11 th grade. In the present study, data on 842 girls were analysed. The mean age of the sample was 16.9 ± 0.5 years. The adolescent girls completed online questionnaires assessing internalization of thin body ideals, disordered eating attitudes and behaviours, and self-objectification, as well as various aspects of participation in sports. To assess the primary hypotheses, moderated mediation models were tested., Results: Self-objectification mediated associations between internalization of thin body ideals and disordered eating attitudes and behaviours in adolescent girls. Participation in an achievement sport moderated the association between internalization of thin body ideals and self-objectification, but not between the latter and disordered eating attitudes and behaviours. Internalization of thin body ideals was not significantly associated with self-objectification in girls participating in achievement sport. The association between internalization of thin body ideals and self-objectification was stronger in adolescent girls not involved in any sports activities than in leisure-time exercisers., Conclusion: It is important to promote involvement in sport for all adolescent girls, since it might help them to decrease the negative effect of internalization of thin body ideals on self-objectification and to value body functions over appearance. Decreasing self-objectification and teaching about body functionality might be an effective strategy in programmes aimed at decreasing disordered eating in adolescent girls participating in achievement sport., Level of Evidence: Level of evidence V, cross-sectional descriptive study., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

In this cross-sectional study, we tested the associations between teacher autonomy support, self-determined motivation for physical education (PE), physical activity habits and non-participation in physical education in a sample of adolescents. A total of 715 adolescents (of whom 371 (51.89%) were girls) participated. The ages ranged from 14 to 18 years, with mean ages of 16.00 (SD = 0.79) for girls and 15.99 (SD = 0.75) for boys. The study questionnaire consisted of demographic questions and the Learning Climate Questionnaire, Revised Perceived Locus of Causality in Physical Education Questionnaire, Behavioural Regulation in Exercise Questionnaire 2, Self-Report Habit Index for Physical Activity, Godin Leisure-Time Exercise Questionnaire, Rosenberg Self-Esteem Scale, perceived physical fitness and frequency of non-participation in PE classes. The results showed that perceived teacher autonomy support was directly positively associated with physical activity habits and negatively with non-participation in physical education classes. Autonomous motivation for PE was a mediator between perceived teacher autonomy support and physical activity habits, meaning that higher autonomous motivation was related to higher physical activity habits. Motivation for PE was also a mediator between teacher autonomy support and non-participation in PE. Higher autonomous motivation for PE was associated with less frequent non-participation in PE classes. The findings can inform PE teachers' practice by showing that supporting students' autonomy and strengthening their self-determined motivation can facilitate increased participation in PE classes and the formation of students' physical activity habits.

The aim of the present study was to test associations between self-objectification and health-related lifestyle habits in a large sample of adolescents. In 2019-2020, a large sample of adolescents ( n = 1402, 40.4% boys) participated in the survey and, as a part of a larger study, filled in questionnaires on self-objectification and lifestyle. Self-objectification was assessed using the Self-Objectification Questionnaire (SOQ). The lifestyle questionnaire had three batteries: eating attitudes and behaviors, dietary habits, and questions on harmful behaviors together with time spending patterns: sedentary lifestyle and physical activity. The ages ranged from 15-19 years with a mean age of 16.97 ± 0.46 years. Self-objectification (SO) was associated with a less healthy lifestyle: more frequent dieting and unhealthy eating habits in girls, skipping breakfast, and a lower number of meals per day. Adolescent boys and girls with higher SO demonstrated more frequent smoking and alcohol consumption until they felt dizzy and more frequent consumption of soft drinks, energy drinks, and fast foods. Girls with higher SO demonstrated lower perceived physical activity and longer duration of internet browsing for non-educational purposes. The results of the present study inform healthy lifestyle promotion programs for adolescents, suggesting that including psychoeducation about self-objectification, body functionality, and positive embodiment might be an effective strategy.

The most acceptable model explaining the associations between physical exercise and self-esteem is the exercise and self-esteem model (EXSEM). The present cross-sectional study tested the mediating role of body appreciation and physical fitness perception in the associations between physical activity and self-esteem in modified EXSEM. Overall, 1412 Lithuanian adolescents (40.2% were boys, mean age 17.0 (SD = 0.5) years) completed online questionnaires. The study was implemented in 2019 from October to December. Perceived physical fitness and body appreciation mediated the associations in the EXSEM. Physical fitness perception was directly associated with the self-esteem of girls, but not boys. Gender moderated EXSEM associations in body appreciation and perceived physical fitness showed stronger mediation effects for the adolescent girls compared to boys. Increasing physical activity, positive body image and perception of physical fitness might help to foster mental health, especially in girls.

The aim of the present study was to test the moderating role of body appreciation in the mediation model of media pressures, internalization of appearance ideals, and disordered eating in adolescents. One thousand four hundred and twelve Lithuanian adolescents (40.4% were boys, age range: 15-18 years) participated in the cross-sectional study. The mean age of the sample was 16.9 (SD (standard deviation) = 0.5) for girls and 17.0 (SD = 0.4) for boys. Adolescents completed a questionnaire consisting of measures of body appreciation (Body Appreciation Scale-2 (BAS-2)), disordered eating (Eating Disorder Examination Questionnaire 6 (EDE-Q 6)), attitudes towards sociocultural pressures towards appearance (Sociocultural Attitudes towards Appearance Questionnaire 4 (SATAQ-4)), and time browsing internet for leisure purposes. To assess the primary hypotheses, moderated mediation models were tested separately in boys and girls. In girls, body appreciation moderated associations between media pressures and internalization of thin body ideals and between internalization of thin appearance ideals and disordered eating. In boys, body appreciation moderated only the association between media pressures and disordered eating. The effect of media pressures on disordered eating was the highest in boys with the lowest body appreciation. Body appreciation protects adolescent girls from internalization of thin appearance ideals in the presence of media pressures and from disordered eating in the case of internalization of thin body appearance ideals. In boys, body appreciation provides a protective effect from media pressures towards appearance to disordered eating behaviors. The findings of the present study could inform intervention programs that aim to prevent disordered eating, strengthen positive body image, and promote healthy eating in adolescent girls and boys. Specific programs might be beneficial in preventing disordered eating in boys with low body appreciation.

Purpose: The aim of this study was to test the effectiveness of an 8-week classroom education and mindfulness-based physical activity intervention for the promotion of positive body image in female students., Methods: A quasi-experimental study was carried out with 110 Lithuanian female students (mean age 21.5 ± 3.5, range 19-35 years). Thirty students voluntarily participated in the intervention programme and 80 students volunteered in the assessment-only control group. The intervention comprised five cognitive behavioural therapy classroom education sessions and mindfulness-based exercise (one exercise workout per week). The intervention group was evaluated with a pre-test and post-test and the control group completed measures at parallel times., Results: Compared with the control group participants, the intervention group participants reported greater improvements in positive body image and a reduction in body dissatisfaction and drive for thinness and internalisation of stereotyped beauty ideals, with medium to large effects. There were significant time × group interactions for pre-test to post-test changes in internalisation of beauty ideals, body area satisfaction, body dissatisfaction and body appreciation. In all cases, the interaction reflected greater pre-test to post-test changes in the intervention group compared with the control group, whose scores remained stable. A decrease in appearance orientation, overweight preoccupation, disordered eating and physical activity was observed in the control group, but the effect sizes were low., Conclusion: The preliminary findings of this study support the efficacy of cognitive behavioural therapy methods and mindfulness-based exercise intervention aimed to promote positive body image in student-aged women. Future studies should test the efficacy of the introduced programme in larger randomised samples of young women., Level Iv: Evidence obtained from multiple time series with or without an intervention., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

This study aimed to test the mediating effects of nature restorativeness, stress, and nature connectedness in the association between nature exposure and quality of life (QoL). Urban and rural Lithuanian inhabitants (n = 924; 73.6% were women), mean age of 40.0 ± 12.4 years (age range of 18-79) participated in the study. In total, 31% of the respondents lived in rural areas. Study participants completed an online survey form with measures on sociodemographic factors, nature proximity, nature exposure, nature connectedness, and nature restorativeness, stress, and QoL assessed by the abbreviated version of the World Health Organization's Quality of Life Questionnaire's (WHOQOL-BREF). Path analysis was conducted to test the mediating effects of nature restorativeness, stress, and nature connectedness in the model of nature exposure and QoL. Nature exposure was directly associated with a greater QoL (β = 0.14; B = 2.60; SE = 0.57; p < 0.001) and mediated the association between nature proximity and QoL. Nature restorativeness and lower stress levels were mediators between nature exposure and QoL. Nature connectedness was a mediator between nature exposure and QoL. A path model was invariant across genders and the urban and rural place of residence groups: patterns of loadings of the pathways were found to be similar. Nature restorativeness (β = 0.10-0.12; p < 0.01) had a positive effect on the psychological, physical, social, and environmental domains of QoL. Connectedness to nature positively predicted psychological (β = 0.079; p < 0.05) and environmental (β = 0.082; p < 0.05) domains of QoL. Enhancing nature exposure and nature connectedness might help strengthen QoL in urban and rural inhabitants.

Research shows that nature exposure is directly and indirectly associated with more positive body image, which is an important facet of well-being more generally. In this study, we tested the mediating roles of physical activity in nature, perceived restoration in nature, autonomous motivation, and connectedness to nature in explaining the association between nature exposure and positive body image. An online sample of 924 Lithuanian adults (age M = 40.0 years, 73.6% women) completed a survey that included the Nature Exposure (NE) Scale, the Body Appreciation Scale-2, a measure of frequency of physical activity in nature (PAN), the Behavioral Regulation in Exercise Questionnaire-2, the Restoration Outcome Scale, and the Connectedness to Nature Scale. Path analysis was conducted to examine hypothesized direct and indirect effects. Results showed that both greater NE (B = 0.564, SE = 0.057, p < 0.001) and autonomy in exercise motivation (B = 0.039, SE = 0.006, p < 0.001) were associated with more frequent PAN. Direct effects from exercise autonomy to nature restorativeness (B = 0.017, SE = 0.006, p = 0.004) and body appreciation (B = 0.041, SE = 0.004, p < 0.001) were observed. Associations were also found between connectedness to nature and body appreciation (B = 0.166, SE = 0.040, p < 0.001), nature restorativeness and body appreciation (B = 0.075, SE = 0.019, p < 0.001), and frequency of PAN and body appreciation (B = 0.064, SE = 0.019, p < 0.001). PAN mediated the relationship between NE and body appreciation. The final model was invariant across place of residence (urban vs. rural) and gender. Including self-determined physical activity in nature may increase the effectiveness of intervention programs aimed at promoting more positive body image.

Background: The coronavirus pandemic resulted in national lockdowns that are associated with a rise in important macro-stressors for populations worldwide. The aim of the present study was to assess the impact of the COVID-19-related lockdown period on the sociocultural attitudes towards appearance, body image, eating attitudes and behaviours, physical activity, and quality of life of Lithuanian university-aged students of both genders., Method: A total of 1850 students completed the body image, health-related behaviour and quality of life assessments three months before the first lockdown, of which 959 provided consent and an e-mail to be contacted by for further surveys. Of these 959, 230 completed the same questionnaire during the second lockdown providing the informed consent for the participation in the COVID-19-impact for the lifestyle study and use their first round data for the comparison with the lockdown. The age of the participants was 23.9 ± 5.4 years. Independent comparisons were used to test lifestyle and body image differences between men and women before and during the lockdown. Paired-sample statistics were conducted to evaluate any changes in the male and female groups separately with Cohen's d employed to represent effect sizes., Results: No body image or disordered eating changes were found, however, body appearance evaluation increased in women (effect size 0.15). Significant increases in media pressures (in women, effect size 0.16) and the internalization of thin/low body fat beauty ideals (effect size 1.18-1.46) were observed during the lockdown when compared to baseline. No changes in quality of life were evident for men, however, for women, an increase in general and psychological domain was observed (effect size 0.17). We observed a significant decrease in physical activity (in men, effect size 0.46), an increase in internet browsing time (effect size 0.52-0.8), a decrease in unhealthy eating habits (effect size 0.49-0.60), an increase in sleep duration (in women, effect size 0.40) and lower self-rated health (in men, effect size 0.42) during the lockdown when compared to baseline., Conclusions: These findings suggest that the majority of students cope with lockdown-related situation well. However, based on the Tripartite influence model, we can speculate that a drastic increase in the internalization of stereotyped thin/low body fat ideals might trigger body image concerns and increase disordered eating after the lockdown. Specific interventions helping students to decrease internalization of stereotyped body ideals, to promote positive body image and physical activity may be beneficial during and after the COVID-19-related lockdown., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: The present study aimed to test the sociocultural Tripartite Influence Model (TIM) that helps to explain the associations between the sociocultural pressures to achieve stereotyped body ideals and disordered eating in young Lithuanian women and men of different body mass., Methods: A mixed-gender sample of students (n = 1850, 58.8% female, the mean age of men was 20.4 (SD = 3.1) years, of women 22.4 (SD = 5.8) years) filled in series of questionnaires including the social attitudes towards appearance, body image, disordered eating and drive for muscularity. Mediation analyses were performed to estimate the size of total, direct, and indirect effects of variables in the models., Results: For women of different body weight, the TIM model was fully replicated. For men of normal weight, internalization of the muscular/athletic ideal, drive for muscularity and greater investment towards appearance mediated the relationships between peers' pressures and disordered eating. For overweight men, internalization of the thin and muscular/athletic ideals, poorer body image mediated associations between pressure from the peers and disordered eating. However, the internalization of the muscular/athletic ideal and the greater appearance evaluation mediated the associations between sociocultural pressures and disordered eating for overweight and obese men., Conclusion: The TIM was replicated in women of different body weight. However, internalization of the thin/low fat ideal was not relevant for men of normal body weight and internalization of the muscular ideal had different outcomes for men of different body mass index. The implications of the results for practice are discussed., Level of Evidence: V, Cross-sectional descriptive study., (© 2020. Springer Nature Switzerland AG.)

This cross-sectional study aimed to examine the associations between body appreciation, body functionality and disordered eating in a large adolescent sample of different levels and types of sports practice., Method: The sample consisted of 1412 adolescents (59.8% were girls). The ages ranged from 15 to 18 years old, with a mean age of 16.9 (SD = 0.5) for girls and 17.0 (SD = 0.4) for boys. Participants completed an anonymous questionnaire assessing the nature of sports participation, body appreciation, body functionality, self-esteem, body dissatisfaction, internalisation of sociocultural beauty ideals and disordered eating. A two-way ANOVA was employed to test the differences in body image concerns, body appreciation, perceived physical fitness and disordered eating behaviours in gender groups and groups of different sport types and levels. Multiple linear regression analyses were performed to predict disordered eating behaviours of different study variables., Results: Participants of leisure and competitive sports reported greater body appreciation, self-esteem and lower body dissatisfaction compared to non-participants. No differences in body appreciation and disordered eating were observed in adolescents involved in weight-sensitive and less weight-sensitive sports. Body appreciation and body functionality were associated with lower disordered eating in adolescent girls not participating in sports, leisure exercisers and participants of competitive sport as well as in boys participating in competitive sports, controlling for body mass index. Adolescent boys demonstrated greater body appreciation compared to girls., Conclusions: The results of this study support the knowledge of the protective role of positive body image preventing dysfunctional eating in adolescent girls of various sports practice and in competitive sports involved boys. Disordered eating prevention and clinical treatment programs for adolescents of different physical activity might benefit from including education about body appreciation and functionality.

Body appreciation is one of the main facets of a positive body image. The present study aimed to examine the psychometric properties of the Lithuanian version of the Body Appreciation Scale-2 (BAS-2-LT) and test the associations between body appreciation and disordered eating in a large sample of adolescents of both genders. Method: The sample consisted of 1412 adolescents (40.2% were boys). The ages ranged from 15 to 18 years (92.4% were 17), with a mean age of 16.9 (SD = 0.5) for girls and 17.0 (SD = 0.4) for boys. Participants completed the BAS-2-LT alongside the measures of body dissatisfaction, disordered eating, body mass index, self-esteem, body functionality, and participation in sports. Linear regressions were used to test the associations between study variables and disordered eating. Results: BAS-2-LT replicated the original one-dimensional structure in girls and boys. Invariance across genders was established. The instrument showed good internal consistency and temporal stability. Body appreciation was negatively correlated with higher levels of body mass index, body dissatisfaction, and disordered eating. Positive associations were observed between body appreciation, self-esteem, body functionality, and sports participation. Higher levels of body appreciation decreased the risk of disordered eating behaviors in both genders. Conclusions: The results of the present study support the psychometric properties of BAS-2-LT. Body appreciation is associated with lower disordered eating in adolescent girls and boys. These findings present empirical support for the development of interventions programs that promote positive body images and aim to prevent disordered eating in adolescent boys and girls., Competing Interests: The authors declare no conflict of interest.

Purpose . The present study aimed to explore the associations between body image concerns (BI), disordered eating (DE), health-related lifestyle, and the different domains of the quality of life (QoL) in a Lithuanian sample of student-aged men and women. Methods . A mixed-gender sample of students ( N = 1850, 58.8% were women, average age 21.6 ± 5.0 years) completed a series of questionnaires, including health-related lifestyles, BI, DE, and QoL. A series of simultaneous multiple linear regression analyses were conducted. Mediation analyses were performed to estimate the size of the total, direct, and indirect effects of variables in the models. Results . The analysis of the linear regressions demonstrated that the positive trait of body areas satisfaction was associated with the significantly enhanced QoL in all domains in both genders (for men β = 0.29-0.34; for women β = 0.26-0.33; p < 0.001). DE was associated with a poorer psychological QoL domain in women only (β = -0.07; p = 0.047). The drive for muscularity was associated with a lower QoL in men (β = -0.06-(-0.141); p < 0.05). Body areas satisfaction mediated the associations between body mass index and psychological and physical QoL in both genders (TLI (Tucker Lewis Index) = 0.975; CFI (comparative fit index) = 0.997; RMSEA (Root of the Mean Square Error) = 0.053). Conclusions. Positive traits of BI play essential roles in the QoL of student-aged women and men. The present study adds empirical evidence emphasizing the importance of integrating education about positive body image while implementing healthy lifestyle and QoL promotion programs in student-aged men and women.

Background and Objectives: The Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) is one of the most broadly used self-report tools that assesses attitudes and behaviors associated with eating disorders (EDs). The aim of the present study was to examine the reliability, validity, and factor structure of the Lithuanian version of the EDE-Q 6.0 (LT-EDE-Q 6.0) in a nonclinical student sample., Materials and Methods: A sample of 382 students (mean age 24.0 ± 6.4) participated in the study. The students completed a self-report questionnaire measuring the risk of EDs (LT-EDE-Q 6.0), body image (LT-MBSRQ-AS), quality of life (LT-WHOQOL-BREF), and self-esteem (RSES). Cronbach's alpha assessed the internal consistency of the EDE-Q 6.0. Pearson's correlations were used for the analyses of the construct and concurrent validity with the subscales of LT-MBSRQ-AS, LT-WHOQOL-BREF, and RSES. Intraclass correlation coefficients (ICC) were calculated for assessing test-retest reliability., Results: The mean score of the LT-EDE-Q 6.0 in the mixed sample was 1.5 ± 1.02. For women and men, the general mean scores were higher than in the majority of the samples of Western Europe but lower than in the United States. Acceptable internal consistency for the four subscales (0.75-0.88) and the LT-EDE-Q 6.0 general score (0.94) was obtained. Test-retest reliability was good to excellent for all subscales (0.66-0.91) and for the items that assessed essential behavioral features of EDs (0.84-0.90, except item 14 ICC = 0.4). The LT-EDE-Q 6.0 scores had adequate concurrent validity. However, the original 4-factor structure or other proposed models of EDE-Q were not obtained by CFA., Conclusions: The results of the current study support the applicability, validity, and reliability of the LT-EDE-Q 6.0 in a nonclinical Lithuanian student sample. However, we recommend assessing the general scale score without the application of the subscales. The Lithuanian version of this instrument should be further investigated with clinical samples to identify clinically diagnosed cases., (© 2020 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

The Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) is one of the most broadly used self-report tools that assess the general role of sociocultural influences on body image and appearance-related internalization. The present study aimed to examine the reliability, validity, and factor structure of the Lithuanian version of the SATAQ-4 (LT-SATAQ-4), as a screening self-report instrument for assessing the role of sociocultural influences on body image. A mixed-gender sample ( N = 1850) of undergraduate students (88.7%) and graduate students (11.3%) from different state universities and colleges participated in this study (average age 21.6 ±5.0). The students completed a self-report online questionnaire. Intraclass correlation coefficients (ICCs) were calculated for assessing test-retest reliability. The construct validity of the Lithuanian Sociocultural Attitudes Towards Appearance Questionnaire-4 (LT-SATAQ-4) was studied performing exploratory factor analysis (EFA), and then confirmatory factor analysis (CFA). The mean scores for the LT-SATAQ-4 subscales ranged from 1.6 ± 0.9 (Pressure subscale: Peers) to 2.7 ± 1.2 (Internalization subscale: Thin/Low Body Fat). Test-retest reliability was good to excellent for the general and subscale scores (0.85-1.00) except for the Pressure subscale: Peers (0.60). The original 5-factor structure was confirmed by EFA and CFA. Good to excellent internal consistency for each subscale (attempted 0.9 and more) and for the LT-SATAQ-4 global scale (0.91) was obtained. The LT-SATAQ-4 scores had adequate concurrent validity with the measures of the body image, disordered eating, self-esteem, and body mass index. The results support the psychometric properties of the LT-SATAQ-4 and its' use in Lithuanian student samples. The Lithuanian SATAQ-4 is a useful measure to examine the pressures to internalize appearance ideals in Lithuanian-speaking samples of young individuals.

Disordered eating in adolescents who participate in sports is an issue of great concern. However, very few studies have examined the prevalence of sport-related determinants of disturbed eating attitudes and behaviours (DEABs) in sport-involved adolescents. The present study aims to assess body image and DEABs in the sample of adolescents involved in a sport of different characteristics (competitive sport, leisure sport; weight-sensitive and less-weight-sensitive sport) and to compare the results with those of the controls. A total sample of 732 adolescents (437 (59.4%) were female) participated in the study. The participants ranged in age from 16 to 19 years (mean = 17.2, SD = 0.6). Study participants completed a questionnaire assessing sports characteristics, body image, disordered eating, and health-compromising eating behaviours. Analysis of covariance was used to test the differences of major study variables between controls and weight-sensitive and less-weight-sensitive leisure and competitive sports groups. There was no significant difference observed in DEABs between the sports groups. Competitive athletes reported more satisfaction with body image than controls. The girls participating in weight-sensitive leisure sports reported higher overweight preoccupation and greater DEABs compared to those participating in less-weight-sensitive leisure sports. Boys participating in weight-sensitive leisure sports reported a greater drive for muscularity-related behaviour compared to those participating in less-weight-sensitive leisure sports. There was no observed interaction between gender and weight sensitivity in the competitive sports group. Adolescents involved in a competitive sport demonstrated greater body image satisfaction and did not seem to present a greater risk for DEABs than controls. Special prevention attempts for lowering body image concerns and DEABs should be addressed for adolescents participating in a weight-sensitive leisure sports.

The general aim of the present study was to examine how physical activity, participation in sports, and beliefs about personal physical activity and physical fitness are associated with adolescents' psychosomatic health complaints (PHC) in relation to their lifestyles., Methods: A total of 3284 11-19-year-old adolescents (average age 14.9 ± 2.0; 48.6% male) participated in the population-based cross-sectional study. Self-administered questionnaires addressed lifestyle, sports participation, physical activity, physical fitness perception, and PHC., Results: Female gender (OR = 1.92; 95% CI = 1.57-2.35), smoking (OR = 1.31; 95%PI = 1.01-1.68), alcohol consumption (OR = 1.60; 95%PI = 1.30-1.97), unhealthy foods (OR = 1.14; 95%PI = 1.04-1.26), hours of internet use (OR = 1.14; 95%PI = 1.07-1.21), and poor personal fitness perception (OR = 1.60; 95% CI = 1.27-2.02) were associated with PHC in adolescents. Lower physical activity and self-perceived insufficient physical activity, perception of physical fitness as being poor, and not participating in sports were associated with greater somatic and psychological complaints controlling for age, gender, and BMI. Participation in sports and physical activity did not change PHC in adolescents involved in unhealthy behaviour. However, a positive perception of one's own physical activity and physical fitness decreased PHC in adolescents who reported an unhealthy lifestyle., Conclusions: Adolescents demonstrating poorer health-related behavioural profiles showed higher PHC. Physical activity and sports participation were related to lower PHC. Positive physical activity and physical fitness perception changed the associations between PHC and unhealthy lifestyle: adolescents perceiving themselves as sufficiently physically active and those evaluating their physical fitness as good showed lower PHC, despite the presence of unhealthy habits (high screen time, drinking alcohol, smoking, and consuming unhealthy foods). It is important to study cognitive factors when exploring the associations between adolescent lifestyles and PHC. These results are important for health promotion and education programmes aimed at improving healthy lifestyle and psychosocial well-being in adolescents.

The present study aimed to assess the-prevalence of health-compromising eating and physical activity behaviours, and to test their associations with physical activity, internalisation of sociocultural attitudes towards appearance, and body image in a sample of adolescents of both genders. A total sample of 736 adolescents (437 or 59.4% were girls) participated in the study. The participants ranged in age from 16 to 19 years (x = 17.2, SD = 0.6). The sample completed a questionnaire measuring body mass index, the risk of eating disorders, body image, internalisation of sociocultural ideals of appearance, health-compromising eating behaviours (HCEB), and health-compromising weight control related to physical activity behaviours (HCPAB). Logistic regressions were used to assess the associations between the study variables and predictors of HCEB and HCPAB. The results of the study showed a relatively high prevalence of HCEB with a significantly higher prevalence in girls and participants with a higher BMI. The study also demonstrated that the prevalence of adolescent HCPAB was higher than HCEB. The internalisation of sociocultural attitudes towards appearance and body image concerns were higher in the HCEB and HCPAB groups. Female gender (OR = 1.88; 95% PI = 1.10⁻3.18), HCPAB (OR = 1.19; 95% PI = 1.10⁻1.28), a preoccupation with being overweight (OR = 3.43; 95% PI = 2.52⁻4.66), and body weight evaluation as too high (OR = 2.40; 95% PI = 1.57⁻3.68) were significant predictors of HCEB. More frequent physical activity (OR = 3.02; 95% PI = 1.76⁻5.17), HCEB (OR = 1.22; 95% PI = 1.11⁻1.32), and perceived pressures to conform to popular beauty ideals (OR = 1.51; 95% PI = 1.12⁻2.03) predicted higher HCPAB. HCPAB is an important variable associated with adolescents' body image, physical activity, and weight control. The results of the present study are important for health promotion and education programs addressing adolescents' healthy lifestyle, weight control, and body image concerns.

The present study aimed to explore the associations between body image concerns, body weight evaluation, disordered eating, nutrition habits, self-esteem, and physical activity (PA) in a mixed sample of adolescents of both genders. Methods. A total sample of 579 adolescents (299, 51.6% were girls) participated in this study. The participants ranged in age from 14⁻16 years old ( M = 15.0, SD = 0.4). Respondents provided their answers filling in the questionnaires consisting of a battery of self-report questionnaires. An analysis of covariance was employed to test the hypothesis about the differences in body image concerns in the groups of BMI and body weight estimation controlling for gender. Results. Adolescents with a higher body mass index (BMI) and those overestimating body weight reported a higher body dissatisfaction (BD), a drive for thinness (DT), social physique anxiety (SPA), disordered eating, and lower self-esteem, but there were no differences in PA. Body weight overestimation was more prevalent in girls, yet body weight underestimation was more prevalent in boys. In girls, a higher BMI and body weight overestimation were associated with having less sweets, a lower frequency of having breakfast and for just a lower BMI alone-with consuming less fats, spreads, and oils. In boys, the BMI was associated with consuming less fruits and berries. The boys' body weight overestimation was related to a lower reported number of meals, a lower frequency of breakfast, and a lower consumption of milk, cheese, yogurt, fats, spreads, and oils. Body dissatisfaction in boys and girls was negatively related to the number of meals, DT is related to a lower breakfast consumption (in girls), SPA was related to a lower nutrition score (in boys), the number of meals (boys and girls), and a lower use of meat and vegetables (boys). Conclusions. Adolescents with a higher BMI and body weight overestimation demonstrated higher body image concerns, lower self-esteem and a poorer eating-related behavioural profile. Body image concerns and body weight overestimation did not promote healthy behaviour in adolescents. It is critical to promote a positive body image, adequate body weight evaluation, self-esteem, and a healthy lifestyle in health promotion and health education programs for adolescents of both genders and different BMIs.

Introduction: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years., Methods: Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014., Results: A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively., Conclusions: Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

A 60-day intervention study was conducted in which the participants took a low dose of a multivitamin and mineral supplement. The study consists of a final number of 66 volunteers (30 males and 36 females), divided into two age groups of 30-35 and 60-65 years. For 30 days they took a multivitamin and mineral supplement with 1× the recommended daily intake (RDI) followed by another 30 days with 2× the RDI. The aim of the study was to monitor oxidative stress and redox status of both young and old age groups. In serum, the expected increase of the water-soluble vitamins folate and vitamin B12 was observed with a concomitant decrease in homocysteine. Serum biomarkers of oxidative stress, the reactive oxygen metabolites, of the antioxidant status, the biological antioxidant potential did not change. However, the total thiol levels in serum, biomarker of the redox status, decreased significant, only in both groups of elderly after 60 days. In erythrocytes, there was a change in the glutathione metabolism as observed by an increase in glutathione reductase and to a lower extend in glutathione peroxidase, indicating an increase in oxidative stress in all groups. It is concluded that a low-dosed multivitamin and -mineral supplementation have different effects on the redox status in young versus old. It remained to explain why a low dose of a multivitamin and -mineral supplement cause increased oxidative stress.

Background: Statins increase the risk of new-onset type 2 diabetes mellitus. We aimed to assess whether this increase in risk is a consequence of inhibition of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), the intended drug target., Methods: We used single nucleotide polymorphisms in the HMGCR gene, rs17238484 (for the main analysis) and rs12916 (for a subsidiary analysis) as proxies for HMGCR inhibition by statins. We examined associations of these variants with plasma lipid, glucose, and insulin concentrations; bodyweight; waist circumference; and prevalent and incident type 2 diabetes. Study-specific effect estimates per copy of each LDL-lowering allele were pooled by meta-analysis. These findings were compared with a meta-analysis of new-onset type 2 diabetes and bodyweight change data from randomised trials of statin drugs. The effects of statins in each randomised trial were assessed using meta-analysis., Findings: Data were available for up to 223 463 individuals from 43 genetic studies. Each additional rs17238484-G allele was associated with a mean 0·06 mmol/L (95% CI 0·05-0·07) lower LDL cholesterol and higher body weight (0·30 kg, 0·18-0·43), waist circumference (0·32 cm, 0·16-0·47), plasma insulin concentration (1·62%, 0·53-2·72), and plasma glucose concentration (0·23%, 0·02-0·44). The rs12916 SNP had similar effects on LDL cholesterol, bodyweight, and waist circumference. The rs17238484-G allele seemed to be associated with higher risk of type 2 diabetes (odds ratio [OR] per allele 1·02, 95% CI 1·00-1·05); the rs12916-T allele association was consistent (1·06, 1·03-1·09). In 129 170 individuals in randomised trials, statins lowered LDL cholesterol by 0·92 mmol/L (95% CI 0·18-1·67) at 1-year of follow-up, increased bodyweight by 0·24 kg (95% CI 0·10-0·38 in all trials; 0·33 kg, 95% CI 0·24-0·42 in placebo or standard care controlled trials and -0·15 kg, 95% CI -0·39 to 0·08 in intensive-dose vs moderate-dose trials) at a mean of 4·2 years (range 1·9-6·7) of follow-up, and increased the odds of new-onset type 2 diabetes (OR 1·12, 95% CI 1·06-1·18 in all trials; 1·11, 95% CI 1·03-1·20 in placebo or standard care controlled trials and 1·12, 95% CI 1·04-1·22 in intensive-dose vs moderate dose trials)., Interpretation: The increased risk of type 2 diabetes noted with statins is at least partially explained by HMGCR inhibition., Funding: The funding sources are cited at the end of the paper., (Copyright © 2015 Swerdlow et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.)

Aims: This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population., Methods: Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45-64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD., Results: Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006-2008 than in 1983-1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5-6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15-0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12-0.97) but not in women (HR 0.38, 95% CI 0.09-1.67)., Conclusions: An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

Aims: To assess the relationship between green space proximity, use of green space and depressive symptoms and perceived general health among a random sample men and women., Methods: Cross-sectional study of a population-based sample of 6,944 45-72 year old Kaunas city residents. Self-reported questionnaires provided information on sociodemographic variables, health behaviours, depressive symptoms and poor and very poor perceived general health. Residential proximity to green spaces was defined as living less than 300 m, within interval of 300-999 m, and equal or more than 1 km from a park. The use of the park was divided into two categories: no park use or use <4hrs/week and use of the park ≥4 h/week. The study received approval from the Kaunas Regional Research Ethics Committee. Multiple logistic regression assessed the associations controlling for confounding variables., Results: The prevalence of depressive symptoms and poor and or very poor perceived general health was higher in women than in men. The association between the use of the park and residential proximity to the park revealed that women living >300 m from a green space and who used the space ≥4 h/week showed higher odds 1.92 (1.11-3.3) and 1.68 (0.81-3.48) of depressive symptoms and poor and very poor perceived general health as compared to those who used the park <4 hrs/week and residential proximity was >300 m., Conclusions: The results of our study confirmed an association between use of the green space, residential proximity, and depressive symptoms and poor and very poor perceived general health among women only., (© 2014 the Nordic Societies of Public Health.)

Purpose: The study aimed to examine the prevalence of depressive symptoms and their correlates in urban middle-aged and elderly Lithuanian adults., Methods: Data from the survey was collected within the framework of the international project HAPIEE (Health, Alcohol and Psychosocial Factors in Eastern Europe). A random sample of 7,115 individuals aged 45-72 years was screened in 2006-2008., Results: Depressive symptoms were differently associated with independent variables by sex. In men, deprivation (OR 1.85, 95 % CI 1.54-2.17), being divorced (OR 2.34, 95 % CI 1.61-3.39) or widowed (OR 3.64, 95 % CI 2.40-5.52), physical inactivity (OR 1.30, 95 % CI 1.02-1.65), having a history of spine and joint disease (OR 1.72, 95 % CI 1.36-2.17), average perceived health (OR 2.14, 95 % CI 1.55-2.95), poor perceived health (OR 5.13, 95 % CI 3.39-7.76), average quality of life (OR 2.0, 95 % CI 1.55-2.95), or poor quality of life (OR 8.86, 95 % CI 5.19-15.13) were significantly associated with depressive symptoms. In women, deprivation (OR 1.28, 95 % CI 1.15-1.43), being widowed (OR 1.52, 95 % CI 1.23-1.88), mean dose of alcohol per occasion 40-79.9 g (OR 1.65, 95 % CI 1.18-2.30) and more than 80 g (OR 2.09, 95 % CI 1.14-3.82), physical inactivity in leisure time (OR 1.27, 95 % CI 1.04-1.57), having a history of spine and joint disease (OR 1.26, 95 % CI 1.06-1.51), average perceived health (OR 2.56, 95 % CI 1.89-2.72), poor perceived health (OR 5.07, 95 % CI 3.62-7.11), average quality of life (OR 2.27, 95 % CI 1.89-2.72), or poor quality of life (OR 7.21, 95 % CI 4.73-11.00) were significantly associated with depressive symptoms., Conclusions: Health status and lifestyle factors are associated with depressive symptoms. Associations between depressive symptoms and long-term health problems are partially mediated by self-rated quality of life and self-rated health.

Unlabelled: The aim of this study was to provide reliable information on dyslipidaemias, to estimate the trend of the prevalence of dyslipidaemias and other selected cardiovascular disease (CVD) risk factors at population level, and to evaluate the risk of all-cause and CVD mortality in relation to presence of mixed dyslipidaemias and other CVD risk factors., Methods: Data from the five surveys (1983-2008) are presented. A random sample of 9,209 subjects aged 45-64 was selected for statistical analysis. During follow-up there were 1653 death cases from any cause, 864 deaths from CVD. Estimates of hazard ratios (HR) and 95% confidence intervals (CI) were based on the multivariate Cox proportional hazards regression for all-cause mortality and CVD mortality., Results: During 25 year period the prevalence of normal total cholesterol level (<5.2 mmol/L) significantly increased only in women; triglycerides and high density lipoprotein (HDL) cholesterol did not change in men and women. Findings in our longitudinal study showed that in men and women mixed dyslipidaemias (HDL cholesterol <1.03 mmol/L plus triglycerides ≥1.70 mmol/L) significantly increased the risk for all-cause and CVD mortality (respectively in men HR = 1.30; HR = 1.15, in women HR = 1.83; HR = 2.13). These mixed dyslipidaemia combinations combination with the other risk factors such as arterial hypertension, high fasting glucose level increased all-cause and CVD mortality risk in men and women; while, these mixed dyslipidaemias plus smoking increased all-cause and CVD mortality risk only in men compared to never smokers without these dyslipidaemias (respectively HR = 1.89; HR = 1.92); and these dyslipidaemias plus obesity increased all-cause and CVD mortality risk in women (respectively HR = 2.25; HR = 2.39) and CVD mortality risk in men (HR = 1.72), as compared to responders without obesity and these dyslipidaemias., Conclusion: Mixed dyslipidaemias (reduced HDL cholesterol plus elevated triglycerides) significantly increased the risk for all-cause and CVD mortality in this Lithuanian population aged 45-64 years.

Background: The aims of this study were to explore associations of the distance and use of urban green spaces with the prevalence of cardiovascular diseases (CVD) and its risk factors, and to evaluate the impact of the accessibility and use of green spaces on the incidence of CVD among the population of Kaunas city (Lithuania)., Methods: We present the results from a Kaunas cohort study on the access to and use of green spaces, the association with cardiovascular risk factors and other health-related variables, and the risk of cardiovascular mortality and morbidity. A random sample of 5,112 individuals aged 45-72 years was screened in 2006-2008. During the mean 4.41 years follow-up, there were 83 deaths from CVD and 364 non-fatal cases of CVD among persons free from CHD and stroke at the baseline survey. Multivariate Cox proportional hazards regression models were used for data analysis., Results: We found that the distance from people's residence to green spaces was not related to the prevalence of health-related variables. However, the prevalence of cardiovascular risk factors and the prevalence of diabetes mellitus were significantly lower among park users than among non-users. During the follow up, an increased risk of non-fatal and fatal CVD combined was observed for those who lived ≥629.61 m from green spaces (3rd tertile of distance to green space) (hazard ratio (HR) = 1.36), and the risk for non-fatal CVD-for those who lived ≥347.81 m (2nd and 3rd tertile) and were not park users (HR = 1.66) as compared to men and women who lived 347.8 m or less (1st tertile) from green space. Men living further away from parks (3rd tertile) had a higher risk of non-fatal and fatal CVD combined, compared to those living nearby (1st tertile) (HR = 1.51). Compared to park users living nearby (1st tertile), a statistically significantly increased risk of non-fatal CVD was observed for women who were not park users and living farther away from parks (2nd and 3rd tertile) (HR = 2.78)., Conclusion: Our analysis suggests public health policies aimed at promoting healthy lifestyles in urban settings could produce cardiovascular benefits.

Background: The purpose of this study was to examine associations between cardiovascular risk factors and cognitive ability in middle aged and elderly Lithuanian urban population., Methods: Data from the survey performed in the framework of the HAPIEE (Health, Alcohol, Psychosocial Factors in Eastern Europe) study were presented. A random sample of 7,087 individuals aged 45-72 years was screened in 2006-2008., Results: The scores of immediate recall and delayed verbal recall, cognitive speed and attention were significantly lower in men than in women; yet numerical ability scores were higher in men. Significant associations between lowered cognitive functions and previous stroke (in male OR = 2.52; 95% CI = 1.75-3.64; in female OR = 2.45; 95% CI = 1.75, 3.64) as well as ischemic heart disease history (among male OR = 1.28; 95% CI = 1.03-1.60) have been determined. Higher level of physical activity in leisure time (among female OR = 1.32; 95% CI = 1.03-1.69), poor self-rated health (among male OR = 1.57; 95% CI = 1.15-2.14) and poor quality of life (in male OR = 1.67; 95% CI = 1.07-2.61; in female OR = 2.81; 95% CI = 1.92-4.11) were related to lowered cognitive function., Conclusions: The findings of the study suggest that associations between cardiovascular risk factors and lowered cognitive function among healthy middle-aged and elderly adults strongly depend on gender.

Objective: The objective of the study was to assess mortality risk in the subjects with diagnosed metabolic syndrome (MS) using National Cholesterol Educational Program (NCEP-ATPIII), American Heart Association and National Heart Lung and Blood Institute (AHA/NHLBI) International Diabetes Federation (IDF) and Joint Interim Societies (JIS) definitions., Methods: Two random samples aged 35-64 years were examined in 1992-2002 in the framework within the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study (N=2455). The follow-up was carried out in terms of the end points reached from the baseline health examinations until December 31, 2009., Results: Cox regressions demonstrated that MS defined by IDF and JIS definitions remained the only significant determinants for all-cause mortality (RR=1.48 and RR=1.41; p<0.05) and cardiovascular disease (CVD) mortality in men (RR=1.81 and RR=1.66; p<0.05). In men (without previous CVD) the NCEP-ATPIII definition had increased mortality risk from CVD (RR=1.98; p=0.012), than in men with identified MS by the IDF and the new JIS definition. In women the MS was not associated with risk of mortality from CVD., Conclusion: The MS definitions according to the IDF and JIS criteria appear to be a slightly better predictor of all-cause mortality and mortality from CVD; MS according to the NCEP-ATPIII criteria appears to be a better predictor of mortality from CVD in men., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Arterial hypertension (AH) is a main risk factor for the risk from cardiovascular (CVD) and stroke mortality. Only few data was published on prevalence, awareness and management of AH in Lithuania. Development of objective approaches to the treatment and control of AH reduces the risk of mortality. The aim of this study was to evaluate time trends, the prevalence, awareness, treatment and control of AH and risk of mortality among Lithuanian urban population aged 45-64 years during the period of 1983-2009., Methods: Time trends of AH and risk of mortality were examined in three MONICA health surveys in 1983, 1986, 1992, and in one health survey according to MONICA protocol in 2002 included randomly recruited of 2,218 men and 2,491 women. AH was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP of ≥90 mmHg or current use of antihypertensive medication. The main outcome measures were all-cause mortality, mortality from CVD, coronary heart disease (CHD) and stroke. The mean duration of follow-up was 11.8 ± 9.2 years. All survey periods were age standardized to the year 2006 of Kaunas population. The estimates of hazard ratio and 95% confidence interval were based on the multivariate Cox proportional hazards regression., Results: In men during 1983-2002 period hypertension prevalence was 52.1-58.7% and did not significantly change whereas in women decreased from 61.0 to 51.0%. There was a significant increase in hypertension awareness among hypertensive men and women (45.0 to 64.4% and 47.7 to 72.3%, respectively) and in treated hypertensives (55.4 to 68.3% in men and 65.6 to 86.2% in women). Adjusted Cox proportional hazard regression analyses revealed a strong dose-response association between blood-pressure level and all-cause, CVD, CHD and stroke-mortality risk in both men and women groups., Conclusion: In Lithuanian urban population the prevalence of hypertension remains high. Despite positive changes in hypertension awareness and treatment, hypertension control remains poor. A strong dose-response association between the level of BP and all-cause, CVD, CHD and stroke mortality risk was indicated.

Objectives: The purpose of this study was to compare the prevalence of metabolic syndrome diagnosed, using four different definitions in the Lithuanian urban population, and determine their association with ischemic heart disease., Methods: Data from the survey performed in the framework of the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study were presented. A random sample of 7087 individuals aged 45-72 years was screened in 2006-2008., Results: In Kaunas city, Lithuania, the highest prevalence of metabolic syndrome, in the urban population aged 45-72 years, was determined according to the new Joint Interim Societies (JIS) definition (44.1% of men and 48.7% of women). After adjusting for age, education, and smoking habits, the metabolic syndrome (irrespective of definition) was associated with a significantly higher risk of ischemic heart disease., Conclusion: All four metabolic syndrome definitions were associated with ischemic heart disease risk; however, the odds of this disease were higher in people with the metabolic syndrome as defined by the American Heart Association/National Heart Lung Blood Institute and the National Cholesterol Education Program Adult Treatment Panel III than by the new JIS definition.