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Competing Interests: Competing interests: The author declares no competing interests.

Objectives: The COVID-19 pandemic continues, and evidence on infection- and vaccine-induced immunity is key. We assessed COVID-19 immunity and the neutralizing antibody response to virus variants across age groups in the Swiss population., Study Design: We conducted a cohort study in representative community-dwelling residents aged five years or older in southern Switzerland (total population 353,343), and we collected blood samples in July 2020 (in adults only, N = 646), November-December 2020 (N = 1457), and June-July 2021 (N = 885)., Methods: We used a previously validated Luminex assay to measure antibodies targeting the spike (S) and the nucleocapsid (N) proteins of the virus and a high-throughput cell-free neutralization assay optimized for multiple spike protein variants. We calculated seroprevalence with a Bayesian logistic regression model accounting for the population's sociodemographic structure and the test performance, and we compared the neutralizing activity between vaccinated and convalescent participants across virus variants., Results: The overall seroprevalence was 7.8% (95% CI: 5.4-10.4) by July 2020 and 20.2% (16.4-24.4) by December 2020. By July 2021, the overall seroprevalence increased substantially to 72.5% (69.1-76.4), with the highest estimates of 95.6% (92.8-97.8) among older adults, who developed up to 10.3 more antibodies via vaccination than after infection compared to 3.7 times more in adults. The neutralizing activity was significantly higher for vaccine-induced than infection-induced antibodies for all virus variants (all p values < 0.037)., Conclusions: Vaccination chiefly contributed to the reduction in immunonaive individuals, particularly those in older age groups. Our findings on the greater neutralizing activity of vaccine-induced antibodies than infection-induced antibodies are greatly informative for future vaccination campaigns.

Objectives: The aim of this scoping review was to map out the existing evidence of the impact of the COVID-19 lockdown on parents of children and adolescents. We sought to: 1) identify parenting domains that were particularly affected by lockdown measures, 2) describe the challenges and opportunities of lockdown measures in these domains, and 3) define protective and exacerbating factors modulating the effect of lockdown measures on parents. Methods: We identified five main domains investigated in the context of parenting during the early COVID-19 lockdown derived from 84 studies: health and wellbeing, parental role, couple functioning, family and social relationships, and paid and unpaid work. For each domain, we listed challenges and opportunities, as well as discriminant factors. Results: The lockdown impacted all five different but interconnected domains, introduced new roles in parents' lives, and particularly affected women and vulnerable populations. Conclusion: This scoping review highlights the importance of approaching public health policymaking from a social justice perspective. Such an approach argues for social and public health policies to promote health accounting for its social, economic, political, and commercial determinants., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2023 Fadda, Melotto, Caiata-Zufferey, Puhan, Frei, Albanese and Camerini.)

Background: During the COVID-19 lockdown in 2020, adolescents' mental health was largely undermined. A general increment in screen time was reported. However, the long-term effects of the latter on adolescents' mental health are still little explored., Methods: In the present natural experiment, we investigated these effects using longitudinal data collected before and after the first lockdown in Switzerland. Data come from 674 Swiss adolescents (56.7% females, M age = 14.45, SD age = 0.50) during Spring 2019 (T1) and Autumn 2020 (T2) as part of the longitudinal MEDIATICINO study. Self-reported mental health measures included somatic symptoms, inattention, anxiety, irritability, anger, sleep problems, obsessive-compulsive symptoms, loneliness, and depression. Measures for screen-media activities included time spent on the Internet, smartphones, social media, video gaming, instant messaging, and television viewing. They were all assessed at T1 and T2., Results: Paired-sample t -tests with Bonferroni's correction showed that most mental health problems increased over time with an overall medium effect size (Hedge's g = 0.337). In particular, medium effect sizes were found for anxiety, depression, and inattention; small-to-medium effect sizes were reported for loneliness, sleep problems, and obsessive-compulsive symptoms; and a small effect size was found for somatic symptoms. Screen-media activities increased, with the exception of television viewing and video gaming. The results of the hierarchical regression analyses showed that, controlling for covariates, increased time spent on social media - calculated as the difference between T2 and T1 - was the only screen-media activity significantly associated with worse mental health at T2 (β = 0.112, p = 0.016). More time spent in structured media activities like television viewing diminished levels of inattention (β = -0.091, p = 0.021) and anxiety (β = -0.093, p = 0.014). Among covariates, being female, experiencing two or more life events, having mental health problems at T1, and using screens for homeschooling negatively influenced mental health at T2., Conclusion: These results align with literature indicating a small but negative effect of social media time on mental health. Underlying mechanisms are manifold, including increased exposure to COVID-19 news, heightened fear of missing out, social comparison, and time-displaced for activities such as physical activity and green time. However, in line with the structured days hypothesis , getting involved in media-structured activities like television viewing might protect against mental health symptoms., 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 © 2022 Marciano, Viswanath, Morese and Camerini.)

Objectives: To describe changes in adherence to recommendations for physical activity (PA), screen time (ST), and sleep duration over the first two waves of the pandemic in Switzerland, and to assess the associations of these lifestyle behaviours with life satisfaction and overall health as well-being indicators. Methods: In this observational study, we included 2,534 participants (5-16 years) from four Swiss cantons. Participants, or their parents, completed repeated questionnaires and reported on their (child's) lifestyle and well-being, between June 2020 and April 2021. We used linear and logistic regression models to assess the associations between lifestyle and well-being. Results: The percentage of children meeting the recommendations for PA and ST decreased from the pre-pandemic period to the first wave, with a slight recovery during the second wave. Participants meeting all three recommendations during the second wave were more likely to report excellent health (OR: 1.65 [95% CI: 1.00-2.76]) and higher life satisfaction ( β : 0.46 [0.16-0.77]) in early 2021 than participants not meeting any recommendation. Conclusion: We showed a substantial impact of the COVID-19 pandemic on children's and adolescents' lifestyle, and a positive association between meeting lifestyle recommendations and well-being., 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 © 2022 Peralta, Camerini, Haile, Kahlert, Lorthe, Marciano, Nussbaumer, Radtke, Ulyte, Puhan and Kriemler.)

The COVID-19 pandemic has affected the life of children and adolescents in an unprecedented way. In the present study, we focused on two activities that have been likely affected by mitigation measures: screen time and green time. We investigated how both influenced each other during the pandemic, how they affected children's and adolescents' mental health, and which role socio-demographic characteristics have in predicting screen time, green time, and mental health. We used data collected between autumn 2020 and spring 2021 from 844 participants aged 5 to 19 of a population-based, prospective cohort study in Canton Ticino, Italian-speaking Switzerland. We analyzed the data using an extended version of the Random Intercept Cross-Lagged Panel Model with time-invariant socio-demographic covariates and mental health as outcome. Results showed that, at the between-person level, screen time was a risk factor and green time a protective factor of mental health. However, within-person deviations of screen time and green time during the pandemic did not consistently predict mental health. Furthermore, they did not influence each other over time. Gender, age, perceived economic situation of the family, Body Mass Index and the availability of green space nearby all influenced stable measures of green time and screen time (i.e., random intercepts). Our results highlight the need for targeted actions to promote green time and raise awareness about the detrimental effect of screen time on children's and adolescents' mental health., (© 2022 The Authors.)

Background: We aimed to determine whether living in a household with children is associated with SARS-CoV-2 seropositivity in adults and investigated interacting factors that may influence this association., Methods: SARS-CoV-2 serology testing was performed in randomly selected individuals from the general population between end of October 2020 and February 2021 in 11 cantons in Switzerland. Data on sociodemographic and household characteristics, employment status, and health-related history was collected using questionnaires. Multivariable logistic regression was used to examine the association of living with children <18 years of age (number, age group) and SARS-CoV-2 seropositivity. Further, we assessed the influence of reported non-household contacts, employment status, and gender., Results: Of 2393 working age participants (18-64 years), 413 (17.2%) were seropositive. Our results suggest that living with children and SARS-CoV-2 seropositivity are likely to be associated (unadjusted odds ratio (OR) 1.22, 95% confidence interval [0.98-1.52], adjusted OR 1.25 [0.99-1.58]). A pattern of a positive association was also found for subgroups of children aged 0-11 years (OR 1.21 [0.90-1.60]) and 12-17 years (OR 1.14 [0.78-1.64]). Odds of seropositivity were higher with more children (OR 1.14 per additional child [1.02-1.27]). Men had higher risk of SARS-CoV-2 infection when living with children than women (interaction: OR 1.74 [1.10-2.76])., Conclusions: In adults from the general population living with children seems associated with SARS-CoV-2 seropositivity. However, child-related infection risk is not the same for every subgroup and depends on factors like gender. Further factors determining child-related infection risk need to be identified and causal links investigated., Trial Registration: https://www.isrctn.com/ISRCTN18181860 ., (© 2022. The Author(s).)

Instant messaging (IM) is a highly diffused form of communication among younger populations, yet little is known about the emotional experience during IM. The present study aimed to investigate the emotional experience during IM by drawing on the Circumplex Model of Affect and measuring heart rate and electrodermal activity as indicators of arousal in addition to self-reported perceived emotional valence. Using an experimental design, we manipulated message latency (i.e., response after 1 min versus 7 min) and message valence (positive versus negative response). Based on data collected from 65 young adults (50% male; M age = 23.28, SD = 3.75), we observed arousal as participants' electrodermal activity levels increased from the time a fictitious peer started typing a response to the receipt of that response, especially in the delayed condition. Electrodermal activity levels also increased in both the positive and the negative message conditions. No changes were observed for heart rate. Participants' self-report perceived emotional valence revealed that positive messages were evaluated as more pleasant and the peer as more available, while no difference in the self-report was found for message latency. These findings shed light on the emotional experience during IM by adding valuable insights on the physiological processes underlying the anticipation of social reward, but only during delayed IM exchange that can be observed in Human-Computer-Interaction., 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 © 2022 Camerini, Marciano, Annoni, Ort and Petrocchi.)

Objectives: This study examined factors associated with COVID-19 vaccination intention at the very beginning of the vaccination campaign in a representative sample of the population in southern Switzerland. Methods: In March 2021, we measured vaccination intention, beliefs, attitudes, and trust in a sample of the Corona Immunitas Ticino study. Results: Of the 2681 participants, 1933 completed the questionnaire (response rate = 72%; 55% female; mean age = 41, SD = 24, range age = 5-91). Overall, 68% reported an intention to get vaccinated. Vaccination intention was higher in social/healthcare workers, and increased with age, trust in public health institutions, and confidence in the vaccine efficacy. Prior infection of a family member, predilection for waiting for more evidence on the safety and efficacy of the vaccine, and for alternative protective means were negatively associated with intention. Conclusion: In view of needs of COVID-19 vaccine boosters and of suboptimal vaccination coverage, our results have relevant public health implications and suggest that communication about vaccine safety and efficacy, and aims of vaccination programs, should be bi-directional, proportionate, and tailored to the concerns, expectations, and beliefs of different population subgroups., Competing Interests: Author LS served on the MSD European Vaccines Advisory Board in 2019. The remaining 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 © 2022 Fadda, Camerini, Fiordelli, Corna, Levati, Amati, Piumatti, Crivelli, Suggs and Albanese.)

Problematic smartphone use (PSU) during adolescence has been associated with negative short- and long-term consequences for personal well-being and development. Valid and reliable predictors and indicators of PSU are urgently needed, and digital trace data can add valuable information beyond self-report data. The present study aimed to investigate whether trace data (duration and frequency of smartphone use), recorded via an app installed on participants' smartphone, are correlated with self-report data on smartphone use. Additionally, the present study aimed to explore which usage indicators, i.e., duration, frequency, and time distortion of smartphone use, better predict PSU levels cross-sectionally and longitudinally, one year later. Results from a sample of 84 adolescents showed that adolescents tend to rely on the frequency of smartphone use when reporting on the time they spent with the smartphone. Traced duration of smartphone use as well as time distortion, i.e., over-estimation, are significant predictors of PSU. Methodological issues and theoretical implications related to predictors and indicators of PSU are discussed., Competing Interests: The authors have declared that no competing interests exist.

The Covid-19 physical distancing measures had a detrimental effect on adolescents' mental health. Adolescents worldwide alleviated the negative experiences of social distancing by spending more time on digital devices. Through a systematic literature search in eight academic databases (including Eric, Proquest Sociology, Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, Pubmed, and Web of Science), the present systematic review and meta-analysis first summarized the existing evidence from 30 studies, published up to September 2021, on the link between mental health and digital media use in adolescents during Covid-19. Digital media use measures included social media, screen time, and digital media addiction. Mental health measures were grouped into conceptually similar dimensions, such as well-being, ill-being, social well-being, lifestyle habits, and Covid-19-related stress. Results showed that, although most studies reported a positive association between ill-being and social media use ( r = 0.171, p = 0.011) and ill-being and media addiction ( r = 0.434, p = 0.024), not all types of digital media use had adverse consequences on adolescents' mental health. In particular, one-to-one communication, self-disclosure in the context of mutual online friendship, as well as positive and funny online experiences mitigated feelings of loneliness and stress. Hence, these positive aspects of online activities should be promoted. At the same time, awareness of the detrimental effects of addictive digital media use should be raised: That would include making adolescents more aware of adverse mechanisms such as social comparison, fear of missing out, and exposure to negative contents, which were more likely to happen during social isolation and confinement due to the pandemic., 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 © 2022 Marciano, Ostroumova, Schulz and Camerini.)

Background: Instagram is one of the most popular social media platforms among young females. Idealized body images shared on the platform have been associated with lower levels of body satisfaction in this population, likely due to social comparison processes. In the present study, we tested a mediation model linking Instagram use (i.e., browsing through others' profiles, commenting on others' looks, posting one's own photos or stories) to body dissatisfaction (i.e., body image discrepancy and lack of body appreciation), mediated by upward social comparison with close peers, distant peers, and social media influencers., Methods: We applied structural equation modeling to self-report cross-sectional data collected from 291 female adolescents and young women (M age = 19.8, SD = 4.6; 94.8% Italian)., Results: Our final model results show that browsing on Instagram was associated with lower levels of body appreciation, fully mediated by upward social comparison with social media influencers, not close or distant peers. Commenting on others' looks and posting own content were not associated with body dissatisfaction. Being an adolescent female (compared to a young woman) and having a higher BMI were associated with worse body appreciation., Conclusions: Our findings highlight the need for public health interventions to raise awareness about the posting practices of social media influencers and to strengthen a positive body image among young females susceptible to social comparison processes.

Well-being and smartphone use are thought to influence each other. However, previous studies mainly focused on one direction (looking at the effects of smartphone use on well-being) and considered between-person effects, with self-reported measures of smartphone use. By using 2548 assessments of well-being and trace data of smartphone use collected for 45 consecutive days in 82 adolescent participants (M age  = 13.47, SD age  = 1.62, 54% females), the present study disentangled the reciprocal and individual dynamics of well-being and smartphone use. Hierarchical Bayesian Continuous Time Dynamic Models were used to estimate how a change in frequency and duration of smartphone use predicted a later change in well-being, and vice versa. Results revealed that (i) when participants used the smartphone frequently and for a longer period, they also reported higher levels of well-being; (ii) well-being positively predicted subsequent duration of smartphone use; (iii) usage patterns and system dynamics showed heterogeneity, with many subjects showing reciprocal effects close to zero; finally, (iv) changes in well-being tend to persist longer than changes in the frequency and duration of smartphone use., (© 2022. The Author(s).)

Objectives: This study aimed to investigate how meeting international recommendations for screen time (<2 h/day), moderate-to-vigorous physical activity (MVPA; at least 60 min/day) and sleep (8-10 h/night), as well as media multitasking (MMI) as a form of screen time, impact academic achievement in early adolescence., Study Design: A prospective design was used, where self-report measures were collected during the spring semester and academic achievement at the end of the school year., Methods: A total of 1208 grade 3 middle school students (M age  = 13.55 years, SD age  = 0.60) in 37 Swiss schools filled out a paper-and-pencil questionnaire including measures of screen time (covering watching television, playing video games, Internet use, smartphone use and social media use), MMI, sleep time and time for MVPA. To evaluate academic achievement, end-term grades were provided by the collaborating education administration for Italian, Maths, Science, History, Geography, Music and Visual arts., Results: After adjustment for covariates, such as gender, socio-economic status, body mass index and stressful life events, multivariate linear mixed-effect models, nesting participants in schools, showed that meeting recommendations for screen time (B = 0.12, β = 0.105, P < 0.001) and MVPA (B = 0.09, β = 0.09, P = 0.001), but not sleep (B = 0.05, P = 0.087), were associated with higher academic achievement. Considering the number of recommendations met, meeting all three recommendations improved academic achievement the most (B = 0.24, β = 0.21, P < 0.001), followed by meeting the guidelines for screen time + MVPA (B = 0.20, β = 0.15, P < 0.001) and for screen time + sleep (B = 0.21, β = 0.13, P < 0.001). In the fully adjusted model, multitasking with two or more media was related to a worse academic achievement., Conclusions: Screen time (including MMI), sleep and MVPA impact academic achievement in adolescence; hence, governmental organisations and schools should raise awareness about the positive and negative effects of following or not recommendations for MVPA, sleep and screen time among adolescents and their parents. In addition, support should be provided to promote sufficient sleep and MVPA while limiting overall screen time and parallel device use., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The widespread diffusion of screen-based devices in adolescence has fueled a debate about the beneficial and detrimental effects on adolescents' well-being and development. With the aim of summarizing the existing literature on the associations between screen time (including Internet-related addictions) and adolescent brain development, the present scoping review summarized evidence from 16 task-unrelated and task-related neuroimaging studies, published between 2010 and 2020. Results highlight three important key messages: (i) a frequent and longer duration of screen-based media consumption (including Internet-related addictive behaviors) is related to a less efficient cognitive control system in adolescence, including areas of the Default Mode Network and the Central Executive Network; (ii) online activities act as strong rewards to the brain and repeated screen time augments the tendency to seek short-term gratifications; and (iii) neuroscientific research on the correlates between screen time and adolescent brain development is still at the beginning and in urgent need for further evidence, especially on the underlying causality mechanisms. Methodological, theoretical, and conceptual implications are discussed., 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 © 2021 Marciano, Camerini and Morese.)

Background: The pervasiveness of smartphones has raised concerns about an increase in the prevalence of problematic smartphone use (PSU), which depends on a set of psychological and behavioral risk factors. Previous research has yielded mixed results on factors predicting PSU, including social anxiety and trust. In particular, the role of trust remained largely unexplored. In the present study, we aimed to investigate the relationship between social anxiety and PSU, via the mediating role of time spent on the phone, and to explore the moderating role of dispositional trust toward others, by using a moderated mediation model with PSU as the outcome., Methods: A total of 240 young adults (M age = 23.33, SD = 3.90, 50% male) answered an online questionnaire, which included the 12-item Social Anxiety Scale, a question on the daily duration of smartphone use, a single-item measure of dispositional trust, and the 10-item Smartphone Addiction Scale Short Version. Gender and occupational status were included as covariates., Results: Social anxiety was significantly and positively related to PSU; however, smartphone use did not mediate this relationship. Although the relationship between smartphone use and PSU was significant and positive, the link between social anxiety and smartphone use was not. Dispositional trust moderated and strengthened the direct relationships between social anxiety and PSU as well as smartphone use and PSU., Conclusions: Heavy smartphone users as well as socially anxious individuals, with the tendency of trusting others, are more at risk of PSU, which can be explained by their preference and search for online connections.

Bullying and substance use among adolescents have been increasingly studied in the field of developmental psychology, but research to date has primarily investigated the cross-sectional relationship and, to a lesser extent, the long-term impact of bullying on substance use. Grounded in the General Theory of Crime, this study focused on the longitudinal reciprocal relationships between bullying and substance use (i.e., smoking and alcohol consumption) during early to mid-adolescence, which is a critical developmental phase. We aimed to investigate the hypothesis of a reinforcing downward spiral at the within-person level. Moreover, we intended to examine gender differences in the expected longitudinal relationships. Our analyses are based on self-report data for bullying and substance use collected from 1,495 adolescents (746 males; M age at T 1 = 12.42, SD = 0.58) at three waves between 2017 and 2019. We applied the random intercept cross-lagged panel model to separate within-person from between-person effects. At the between-person level, the mutual association between bullying and substance use, previously demonstrated in cross-sectional studies, was confirmed. At the within-person level, results provide evidence of a significant age-dependent change in bullying and substance use from 13 to 14 years old, where the significant increase in bullying could be attributed to females but not to males. We also found a gender-independent significant positive effect of bullying at 12 years old on substance use at 13 years, but not vice versa. Thus, the hypothesis of a reinforcing downward spiral, shown by significant positive reciprocal effects, did not find support. According to the General Theory of Crime, our findings underline that bullying can be considered a context-related factor inasmuch as it pushes adolescents to smoke and drink, which are both expressions of low levels of self-control, which need to be considered in intervention programs to effectively prevent unhealthy and risky behaviors in adolescence., (Copyright © 2020 Filipponi, Petrocchi and Camerini.)

Nowadays, smartphone-Mediated Communication (SMC) has become a popular form of social interactions. The present experimental study manipulated three aspects of messaging in a WhatsApp chat as a form of SMC: synchronicity (immediate vs. time-lagged response), modality (with or without emojis), and valence (empathic accurate vs. empathic inaccurate response). The aim of this study was to investigate whether these three aspects had an impact on perceived social support, interpersonal trust, and personality attribution of the communication partner. The partial mediation of perceived social presence (the evaluation of the communication partner's accessibility) and subjective social presence (the perception of being concordant with him/her) was also examined. Participants were 160 young adults, balanced in gender. They were randomly assigned to different the experimental conditions where they engaged in a manipulated WhatsApp chat with a fictitious same-gender communication partner. Post-questionnaire data were analyzed using Structural Equation Modeling. Message valence (empathic accurate response) and modality (with emojis) significantly predicted higher levels of both forms of social presence. Synchronicity (immediate response) predicted higher levels of perceived but not subjective social presence. Social presence, in turn, was positively associated with social support, while subjective, but not perceived social presence, was positively associated with personality attribution. Neither perceived nor subjective social presence were related to interpersonal trust. Our results show that both what is said and how it is said impact the experience of interpersonal relations in SMC., Competing Interests: no authors have competing interests.

Background: Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment., Data Sources: Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018., Methods: Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included., Results: The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment., Discussion: Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

Switzerland has not yet reached the measles vaccination coverage of 95 percent that is recommended by the World Health Organization to achieve herd immunity. Within the overall objective of informing effective ways to promote the combined Measles, Mumps, Rubella (MMR) vaccination in Switzerland, the aim of this study was to identify predictors of parents' intention to adhere to official MMR vaccination recommendations. Between October 2012 and January 2013, we surveyed 554 parents of middle school students aged 13 to 15 in Ticino, Switzerland. Guided by Protection Motivation Theory (PMT), the survey covered predictors related to threat and coping appraisal with regards to measles and the MMR vaccine, MMR-related social attitudes and social norms, past experience with the disease and the vaccine, and information sources in the MMR vaccine context. Data were analyzed using Structural Equation Modelling. Among central PMT concepts describing people's threat and coping appraisal, only response (vaccination) efficacy showed to be directly related to parents' intention to adhere to MMR vaccination recommendations ( B  = .39, p  < .001). In addition, social attitudes ( B  = .38, p  < .001) were a direct predictor. Furthermore, social attitudes, social norms, knowing somebody who experienced MMR vaccination side effects, and having sought MMR information from public health institutions, all indirectly predicted parents' intention to adhere to MMR recommendations by activating different threat and coping appraisal mechanisms. To conclude, future communication measures from public health institutions should highlight the altruistic aspect (herd immunity) of the immunization practice as well as present evidence on the high effectiveness of the vaccination in reducing the risk at both the individual and collective levels of getting infected with measles.

Self-reported health literacy measures have seen increased application throughout the last years, among those are the brief health literacy screeners (BHLS) developed by Chew and colleagues (2004). There has been little systematic research on the performance of these measures across different contexts, including countries and languages, to draw conclusions about their predictive power outside of the United States. This study aimed at replicating the original validation of the BHLS. Receiver operating characteristic (ROC) analysis was applied to data from Hungary, Italy, Lebanon, Switzerland, and Turkey. In addition, logistic regression models incorporating ROC analysis using BHLS as predictors were compared to models using socio-demographics only to identify individuals with inadequate and inadequate or marginal health literacy as measured with the Short Test of Functional Health Literacy in Adults. Analyses showed that in all cases the BHLS were not sufficiently able to identify individuals with different health literacy levels. Logistic regression models using socio-demographics only as predictors outperformed models using the BHLS. The findings highlight the limitations of using the BHLS outside the United States. Further, they question in how far self-reported health literacy measures are comparable across different contexts and whether thresholds for different health literacy levels are universally applicable.

Objectives: To explore micro-cultural differences in patients' need for information provision, perceived participation in decision making, and related concepts during the doctor-patient consultation between French- and Italian-speaking patients in Switzerland., Methods: In 2012, 153 French- and 120 Italian-speaking patients with chronic low back pain (cLBP) were surveyed on their need for information provision, perceived participation in decision making, cLBP knowledge, psychological empowerment, and trust in their doctor. T-tests and regression analyses with interaction terms were performed., Results: Results show that French- and Italian-speaking patients significantly differed in their participation in decision making, with French-speaking patients reporting higher involvement. Need for information provision was related to empowerment among French- and to trust among Italian-speaking patients. For participation in decision making, trust was the only related concept among French-, and cLBP knowledge among Italian-speaking patients. Significant interaction terms indicate a moderation of micro-cultural background., Conclusion: Findings point towards differences in the relationships between individual patient characteristics (i.e. knowledge, empowerment) and relational doctor-patient characteristics (i.e. trust) and patients' need for information provision and participation in decision making between French- and Italian-speaking patients in Switzerland., Practice Implications: Doctors should be aware of these differences when dealing with patients of different micro-cultural backgrounds., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: While health literacy has been widely considered key to patient empowerment, an alternative approach separates both concepts and distinguishes between different types of patients according to their levels of health literacy and empowerment. These types are deemed to vary in their health-related actions and outcomes. In this study, we examine the relationship between health literacy and patient empowerment and compare socio-demographic characteristics, health-related activities, and health outcomes in four types of patients suffering from chronic low back pain (cLBP)., Methods: In a cross-sectional study, 273 cLBP patients from four Swiss cantons (Vaud, Geneva, Fribourg, Ticino) and Lombardy (Italy) were invited by their healthcare providers to complete a self-administered paper-and-pencil questionnaire which assessed patients' health literacy, empowerment, involvement in the medical encounter, medication non-adherence, and perceived pain and functionality as a measure of health outcomes., Results: Health literacy and patient empowerment were not significantly correlated with each other, r(271) = .09, p > .05, allowing to differentiate between four types of patients based on their levels of health literacy and patient empowerment. Subsequent chi-square tests and analyses of variances revealed significant differences among patients that could, however, only be attributed to health literacy, as in the case of age and educational attainment, or patient empowerment, as in the case of patients' involvement in the medical encounter. No significant differences were evident for gender, medication non-adherence, and health outcomes., Conclusion: The study provides empirical evidence for the need to consider health literacy and patient empowerment as independent concepts in the context of cLBP but calls for further studies to be able to conclude on how the two concepts interact and determine health-related activities and outcomes.

Background: Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective., Objective: This study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes., Methods: A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden., Results: All patients completed the study. Overall, the intervention had a moderate effect (F1.52=2.83, P=.03, η(2)=0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=-1.5, P=.04, d=0.28; final assessment: mean difference=-1.6, P=.03, d=-0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups., Conclusions: Results suggest that interactive sections as part of Internet-based interventions can positively alter patients' feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed., Trial Registration: ClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR).

Objectives: To evaluate the effectiveness of an Internet-based patient education intervention, which was designed upon principles of personalization and participatory design., Methods: Fifteen months after the first release of the website, 209 fibromyalgia patients recruited through health professionals completed an online questionnaire to assess patients' use of the website, health knowledge, self-management behavior, and health outcomes. These constructs were combined into an a-priory model that was tested using a structural equation modeling approach., Results: Results show that the usage of certain tools of the website - designed and personalized involving the end users - impacts patients' health knowledge, which in turn impacts self-management. Improvements in self-management ultimately lower the impact of Fibromyalgia Syndrome leading to better health outcomes., Conclusion: This study empirically confirmed that the adoption of a participatory approach to the design of eHealth interventions and the use of personalized contents enhance the overall effectiveness of systems., Practice Implications: More time and effort should be invested in involving patients in the preliminary phases of the development of Internet-based patient education interventions and in the definition of models that can guide the systems' evaluation beyond technology-related variables such as usability, accessibility or adoption., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Although public health offices have a detailed record of the vaccination coverage among adolescents in Switzerland, little is known about the factors that determine the decisions of parents to get their children vaccinated. Based on Schulz & Nakamoto's Extended Health Empowerment Model, the present study aims at surveying parents of adolescents in Ticino (Switzerland) to get insights into the role of health literacy, health empowerment, information search behaviour and potential confounding variables that influence whether adolescents are not at all vaccinated, undervaccinated or fully covered against measles, mumps and rubella (MMR)., Methods and Analysis: A survey including concepts of the Extended Health Empowerment Model will be administered to all families with adolescents attending the third year of middle school in Ticino. Subsequently, survey responses will be matched with actual data on MMR vaccination coverage of adolescents collected from the Cantonal Office of Public Health in Ticino., Discussion: The results of this study will allow one to draw more comprehensive conclusions about the factors that play a role in parents' decisions regarding the vaccination of their children. At the same time, the study will provide useful insights on which are the main issues to be considered when addressing parents (on an interpersonal as well as a mass communication level) regarding the vaccination of their children.