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The effects of COVID-19 have resulted in peritraumatic stress experiences within various groups, including teachers. With this study we aimed to determine the prevalence of peritraumatic stress and the factors associated with each level of PTSD among teachers in South Africa. A cross-sectional study was conducted in South Africa among teachers using an online survey. A sample consisted of a total of 1,008 primary and secondary teachers responded to the COVID-19 peritraumatic distress index and the occupation-specific survey. Descriptive and multinomial logistic regression analyses were used to analyse the data. There was evidence of high levels of distress associated with the COVID-19 pandemic among teaching professionals in South Africa. Therefore, there is a need to create mental health awareness among teaching professionals and to create systems that support the uptake of psychological services among the members of this population.

In the study reported on here we investigated the impact of Ubuntu on learner behaviour and academic achievement in secondary schools in the Gweru district of Zimbabwe. The study participants comprised 38 learners and 7 teachers from 4 secondary schools in the Gweru district. Data were collected through focus-group discussions, semi-structured interviews, participant observations and document analysis. We established that teachers and learners had a satisfactory understanding of how upholding values of Ubuntu contributed to academic achievement among learners. The findings reveal that in addition to other factors affecting academic achievement, like the school and home environment, learners who upheld the values of Ubuntu were disciplined, focused on their studies, and thus attained higher levels of academic achievement compared to learners who lacked Ubuntu and engaged in substance abuse, pre-marital sex, and lacked focus on their schoolwork. Based on the study we recommend that a course on Ubuntu be introduced in teacher training complemented by professional development workshops for teachers in the field to equip them with skills of integrating values of Ubuntu into the curriculum and thus foster the same among learners.

The study aimed to investigate the Effect of Academic Stress on Students' Academic Achievements and Its Implications for Their Future Lives. A correlational research design was employed through stratified random sampling (n[subscript i] = 270, where female = 80 and male =190) to collect pertinent data through a questionnaire. Descriptive and inferential statistics were employed. Firstly, academic stress highly affects students' academic achievement, with females being more stressed (65.20%) than males (59.60%), which leads to a high dropout rate and low graduation rate. Secondly, about 69% were accustomed to drinking alcohol, chewing Khat, absenteeism, and smoking whereas about 31% were regularly engaging in unsafe sex, physical fights, smoking shisha, and poor personal sanitation. Thirdly, there were significant positive relationships among sex, age, academic batch, and student's cumulative grade point average. To conclude, academic stress hinders good academic achievement, increases college dropout rates, low graduation rates, and lack of self-confidence. It leads to drinking alcohol, absenteeism, chewing khat, reduced academic morale of students, and failure in completing assignments on time. Therefore, university authorities should ensure a good academic environment for the students and minimize academic stress through appropriate course load, appropriate lecture hours, proper lecture schedules, and non-congested lecture halls.

During the COVID-19 pandemic, students faced increased risk of contracting the virus due to the relaxation of health protocols by the Philippine government and the authorization of face-to-face instruction in schools by the Department of Education. There is little data on basic education school students' awareness of COVID-19 in the Philippines, particularly in Cebu City. A cross-sectional descriptive-correlational research design was utilized to determine junior and senior high school students' knowledge, attitudes, and practices regarding COVID-19. In this study, a survey questionnaire was used to compare and attempt to identify relationships between the demographic profile of students and their KAPs regarding COVID-19. This study also investigated the relationships between students' KAPs. JHS and SHS students exhibited outstanding KAPs for COVID-19. Students' demographic characteristics, including grade level and family income, were significantly associated with their KAPs toward the disease. However, their gender was not significantly associated with their KAPs. There was a significant relationship between students' COVID-19 KAPs. It is imperative that the DepEd develop strategies and programs to combat the situation due to pandemic and prepare for similar situations in future. With the aid of curriculum designers, science educators must adapt the science education curriculum to address current and future health concerns.

With the rising demand for virtual learning, districts are establishing virtual schools to offer more flexible education. This study investigates K-12 virtual learner characteristics, examines trends and issues in virtual academies, and outlines opportunities and challenges faced by stakeholders in a southeastern U.S. state. The study used a mixed-method design, combining quantitative survey data and qualitative interviews with virtual academy leaders. Results reveal that virtual learners opt for this mode of schooling due to busy extracurricular schedules, a desire to avoid crowded schools or health concerns. These students include those with special needs and high-achieving individuals. Collaboration between parents and teachers plays a crucial role. Essential factors include reliable internet access, teacher tech proficiency, and diverse curriculum development approaches. However, diverse curricular methods require additional implementation support. Balancing instructional flexibility with accountability poses a significant challenge. Virtual teachers need resources, professional development, and time, especially when transitioning from traditional to digital curriculum. Effective communication and interpersonal interactions are vital. Involving home learning coaches and community partnerships enhances the educational experience. While virtual schools offer flexible and personalized support, they encounter challenges related to resource access, social isolation, and student motivation.

Teachers are at high risk of voice disorders due to the heavy vocal demand of their profession as well as diverse classroom conditions that can stress the voice. Healthy vocal hygiene practices reduce this risk, but many teachers lack knowledge in these areas or have misconceptions about ways to improve their vocal health. This study aimed to identify knowledge deficits among teachers, and directly address topics with poorest performance to better generate vocal health resources for teachers and improve their overall vocal health.

Preparing students enrolled in healthcare programs for industry is paramount. While providing administrative and clinical education is essential, students must understand the health literacy levels of the population they serve and work diligently to ensure the population understands and comprehends the health information. Adults with low or limited health literacy levels need help understanding health information and making informed decisions. Research shows that improvements in health literacy result in decreased ER visits, medication errors, increased patient satisfaction, and better health outcomes. Health literacy is an issue throughout the world. This reflection seeks to provide a narrative comparing health literacy concerns in the United States and Spain. The objective is to shed light on the need for all colleges and universities to teach students about health literacy and how to determine patients' health literacy levels. Increasing students' understanding can improve the comprehension and awareness of patients and the population that they serve, thus leading to more appropriate health decisions and outcomes.

As part of the fabric of college students, minority international students undergo specific and unique challenges to their health and wellness. Little is known about how and what constitutes wellness for minoritized international students and the impact of wellness on their university adjustment. Using a systematic grounded theory approach, this study interviewed 12 (8 men & 4 women) middle eastern international students (MEI). Following the constant comparison method and theoretical sensitivity, the study generated a wellness practices model for MEI students. Results showed that wellness had two levels: primary (physical, social, mental, and mindfulness) and secondary (religious, academic, and coping). Results also showed that engaging in wellness practices was key to university adjustment. Individual factors affect how salient a wellness domain is in the student's life, such as optimism, hope, knowledge of self-care habits, and attitudes toward self-care. Implications for helping minoritized international are suggested considering wellness practices model.

The complexity of the reproductive system necessitates instructional media to facilitate comprehension, as its processes unfold internally and are not readily observable. This study aims to assess the viability of booklet sub-materials on fertilization, gestation, and childbirth, derived from the inventory findings of medicinal plants for postpartum care, as educational resources. The research and development used the Borg & Gall model which included identifying potential problems, data collection, product design, design validation, and product revision. The booklet media underwent validation by five validators using validation sheets, while the evaluation criteria encompassed format, content, and language proficiency. The validation data were analyzed using CVR (Content Validity Ratio) and CVI (Content Validity Index). The results of the booklet media validation obtained a CVR value on each criterion of 1.00 with a valid category and a CVI value of 1.00 with a valid category. The booklet on the subject of gestational fertilization and childbirth from the results of the inventory of medicinal plants for postpartum is suitable for use as a learning media.

Each August, Sugpiaq Elders, community members, and educators gather in Cape Alitak to host Akhiok Kids Camp, a week-long culture camp that provides a space for local Sugpiaq youth to learn and carry forward traditional lifeways and promotes youth's self-esteem, identity, and healthy choices. This article traces the legacy of the camp and outlines its ongoing vision and curriculum, including the Indigenous values and principles of education that guide camp activities. Of particular focus is the role of camp in fostering Sugpiaq youth's sense of connectedness to their homelands, waters, community, and culture, a focus that promotes healing, cultural resurgence, and wellbeing for Sugpiaq youth. This description of Akhiok Kids Camp highlights the valuable role that culture camps play in turning Indigenous youth toward the brilliance of their lands and lifeways, and the importance of respecting the knowledge and leadership of Indigenous families in this work.

The aim of this study was to examine the effects of gender, the number of siblings, and grade level on digital game playing motivation and addiction levels in secondary school students and to reveal the relationship between digital game motivation and addiction. A total of 394 students, 168 boys and 226 girls, participated in the study voluntarily. Personal Information Form, Digital Game Playing Motivation Scale, and Digital Play Addiction Scale for Children were used as data collection tools. Digital game playing situation (yes/no) was associated with gender and number of siblings (p<0.05) but not with grade level (p>0.05). The motivation and addiction levels for playing digital games are related to gender and grade level (p<0.05) but not to the number of siblings (p>0.05). There is a positive relationship between motivation and addiction to playing digital games (p<0.05). In light of these findings, more effort should be made to prevent digital addiction in males according to gender and in 8th graders according to grade level.

This paper explores the self-tracking information literacy practices of LGBTQ+ students, how the practices connect to LGBTQ+ identities, and whether these practices are perceived as empowering. Six semi-structured interviews were conducted with students who identified as LGBTQ+ self-trackers. Four previously discovered dimensions of IL in self-tracking framed the design. Collaborative thematic analysis revealed participants find it useful to monitor their physical health and tracking supports mental health, which is experienced as empowering. The heteronormative assumptions of apps influenced their perceived usefulness. There was some distrust about how apps used data, but this risk was accepted, typically because the convenience of the app outweighed privacy concerns. Data sharing took place--restricted due to self-consciousness or fear of judgement--and embraced when there was a feeling of working towards a shared goal. IL in this landscape is related to developing critical awareness of when and how self-tracking can support health goals; the limitations of apps and devices, particularly for those undergoing transition; privacy implications; and the nuances of social sharing.

The Choose Health Action Teens (CHAT) program of Cornell Cooperative Extension engages teens to teach a nutrition curriculum to younger youth, with the goal of enhancing the leadership skills and health behaviors of the teen teachers. Due to COVID-19, an in-person CHAT program in New York City was converted to virtual and implemented online during Summer 2020. Twelve teens, mentored by eight college interns, taught youth virtually in their homes. Quantitative and qualitative assessments demonstrated improvement in teen leadership and facilitation skills and health behaviors, and suggest that converting this type of programming to a virtual environment can be successful.

This study investigates college students' current food safety knowledge and food-handling perceptions and utilized an online survey which designed based on previous studies as method. The questionnaire measured respondents' food safety knowledge and perception, and were divided into knowledge, attitudes and perception categories. The results show that college students significantly lacked in basic food safety knowledge as well as food handling skills and implies a high need to develop enhanced food safety resources for college students, especially on topics related to cross-contamination prevention, correct food preparation procedures, time and temperature control, and awareness of pathogens that cause foodborne illness.

This paper presents an exploratory evaluation of pilot nutrition education programs, Plan Shop Save Cook (PSSC). Behavior change between two nutrition education programs, Buy Eat Live Healthy (BELH; n=92 and PSSC; n=42), was examined using pre- and post-program questionnaire responses. Both programs resulted in significant improvement in food resource management (FRM) behaviors; however, there was no significant difference in the amount of change between the programs. Qualitative data suggests participants perceived label reading as the most useful information provided in the PSSC programs. The current findings suggest short-term behavior change can be achieved with a limited dose program.

The aim of this study was to explore perceptions of mental health services from the perspectives of adolescents with no prior service experience. Thirty students in the Transition Year (fourth year) of secondary school participated in this study: 22 females and 8 males, aged 15 to 16. There was equal distribution across rural and urban settings. Participants had no prior experience of accessing mental health services. Data were collected in secondary school settings in the Republic of Ireland. An interpretive description approach guided this study. Data were collected through individual interviews. To complement interviews, participants drew images of mental health care environments and mental health staff members; drawings were not subjected to analysis. Data (participant interviews) were analyzed using qualitative content analysis. Three themes were identified. Participants suggested that "mental health services" differed from "psychiatric services," with the latter term perceived more negatively. Uncertainty about how to access these services was voiced. Considering the vulnerability of adolescents to the experience of mental distress, education around mental health services is warranted. It is expected that provision of education in this area would enhance service delivery, improve adolescents' help-seeking behaviors for mental distress, and reduce stigma.

Background: The origin of inequalities in health outcomes has been explained by health selection and social causation models. Health selection processes operate particularly at school age. We study, if student allocation to teaching groups with aptitude tests (selective vs general class) differentiates adolescents by health behaviors and mental health. Methods: Finnish schoolchildren 12-13 years from 12 selective classes, n = 248; 41 general classes, n = 703 answered a questionnaire on addictive products (tobacco, snus, alcohol, and energy drinks), digital media use, and mental health (health complaints, anxiety, and depression). Structural equation modeling was conducted to identify structures between outcomes, SEP (socioeconomic position), class type, and academic performance. Results: Students in the selective classes reported less addictive digital media and addictive products use than students in the general classes. Differences in academic performance or SEP between the class types did not solely explain these differences. Mental health was not related to the class type. SEP was indirectly associated with health behaviors via the class type and academic performance. Conclusions: Selecting students to permanent teaching groups with aptitude tests differentiates students according to risky health behaviors. The impact of education policies using student grouping should also be evaluated in terms of students' health.

Health literacy (HL) is an essential health determinant that could encourage the adoption of individual and community protective behaviours that contribute to public health. This study aims to analyse the associations between HL and medication HL (MHL) in 4015 adolescents from the Health Behaviour in School-aged Children (HBSC/WHO). Data were collected from the HBSC/WHO questionnaire. Descriptive statistics, bivariate analysis, and multinomial logistic regression were performed. 62.4% of participants have a moderate level of HL and 29.1% have a high level of HL. The youngest boys, and those who have a low level of MHL in the different dimensions presented (expiration date, recycling, side effects, illegal sale and safety), have a low level of HL. The oldest girls have a moderate level of HL. Also, girls with a high level of MHL, reported a high level of HL. MHL, namely, the expiration date, recycling, side effects and safety dimensions in adolescents is significantly related to and positively associated with HL. The results will enable us to highlight to family professionals and public policies the importance of HL and MHL promotion in adolescents.

In this article, I argue that the scalability and effectiveness of universal school-based mindfulness interventions for adolescents will always be limited by the high motivational commitment required to meditate. Mindfulness interventions rely on a single and demanding health behavior--namely, meditation--to cultivate mindfulness skills. But unlike traditional mindfulness interventions delivered in clinics to self-selected adults who are motivated to manage personal problems through meditation, universal school-based mindfulness interventions are delivered to all adolescents regardless of their desire to meditate. I review evidence from multiple randomized controlled trials of universal school-based mindfulness interventions to show that adolescents consistently report low levels of engagement in meditation and that many interventions have failed to improve adolescents' mental health. I propose that universal mindfulness interventions eliminate meditation entirely and focus on instilling contemplative viewpoints conducive to flourishing, and that the skill of mindfulness is taught only to adolescents who want to meditate.

Alcohol use ranks as one of the most prevalent health-risk behaviors among Taiwanese adolescents. Possible selves--personalized future-oriented cognitions about the self--are significant motivators of one's actions, which may potentially influence adolescent drinking behavior. This study aimed to estimate the content domain-specific possible selves and their associations with drinking behaviors among Taiwanese adolescents. A total of 225 Taiwanese seventh and eighth graders from a public junior high school were recruited. An anonymous self-reported questionnaire was used to collect data during two time-points at six-month intervals. Results showed that having a "physical appearance" related hoped-for possible self and a "friendship" related feared possible self was associated with adolescent alcohol use after six months. Whereas, having the "physical appearance" related hoped-for and feared possible selves were associated with alcohol problems, at both, baseline and six months later. Future studies could clarify the meaning behind "physical appearance" related possible selves.

Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p-values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma.

Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15-18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention.

Healthcare Professionals Working in Schools (HPWS) are responsible for providing health services to students and play a role in providing education to prevent illnesses, including tickborne diseases (TBD). Providing TBD education to children has been shown to increase prevention behaviors and knowledge of TBD symptoms, but little is known regarding the current state of TBD awareness among HPWS. In spring 2019 we conducted a cross-sectional knowledge, attitudes, and practices (KAP) survey of HPWS in two states with a high incidence of Lyme disease (LD) to inform design of TBD prevention programs. The survey queried general knowledge of TBDs, school practices regarding TBDs, and availability of TBD resources. Overall, higher confidence, experience, risk perception, prior training on TBD, and more years employed as a HPWS were independently associated with knowledge of LD transmission, symptoms, and correct tick removal practices. State and local health departments should consider prioritizing engagement with HPWS to provide educational opportunities about tickborne diseases.

Autistic adults experience stark health disparities and difficulties accessing health care. Their realities of managing complex health conditions are unknown. Our research explored the experience of Autistic adults self-managing diabetes. Interviews with Autistic adults with diabetes and their support people were thematically analysed to identify three key themes. The Autistic experience influenced diabetes self-management, including autism-unique challenges and strengths. Participants prioritised avoiding Autistic burnout over diabetes self-management; mitigating the psychosocial pressures of neurotypical systems took precedence. Health professionals often separated autism and diabetes subsequently overlooking key factors impacting diabetes self-management. To better meet the needs of Autistic adults, diabetes care and health management more broadly should be considered within the context of autism, including supports for self-management during Autistic burnout.

Objective: Using the FAST (Face, Arms, Speech, Time) Heroes educational programme, this intervention sought to educate residents in a nursing home to recognise and recall the three main stroke symptoms and prepare them to act in an appropriate way, in the event of a stroke emergency. Design: Participatory action research. Setting: A nursing home in Northern Greece. Method: Fifteen residents (n = 15, aged 78-92, mean age = 86.6 ± 4.4) were enrolled and educated through a series of FAST Heroes activities, specially tailored for this new target population. Stroke awareness was measured before, after and 3 weeks post-programme implementation. Fourteen residents completed the programme. Results: Participants demonstrated significant increases in stroke definition, stroke symptom knowledge, appropriate course of action and emergency number knowledge after completing the programme. Notably, 64.3% of participants could accurately identify stroke symptoms, and all participants (100%) correctly knew to call an ambulance in case of witnessing a stroke; 78.6% of the participants correctly identified the European emergency number 112. In the follow-up period, knowledge gain was retained as residents scored significantly higher in three out of four sections of the questionnaire. Conclusion: This study is the first attempt to utilise the FAST Heroes educational intervention in target populations which hitherto have had limited or no access to such educational programmes. This initial intervention showed promising results and could form the basis for extension to a wider population.

This paper reports on the design of a multimodal metalanguage developed by teacher education researchers to support pre-service teachers' understandings of critical literacy and critical health literacies in a changing communication landscape. The design of metalanguage constitutes the first stage of an ongoing transdisciplinary project, Multiliteracies Across Teaching Areas (MATA), which aims to design and implement cohesive disciplinary multiliteracies pedagogies across teaching areas of an initial teacher education (ITE) programme. The focus on metalanguage design is motivated by concerns shared by critical literacy scholars and scholars in health literacy to balance deconstruction of texts with actionable response through the 'deep moral grammar of narrative' Kindenberg and Freebody ("Australian Journal of Language and Literacy, 44"(2), 90-99, 2021). Such concerns also align with recent World Health Organisation calls for the use of solution-oriented literacies to empower communities. These sociocultural understandings of critical literacy and Kindenberg and Freebody's ("Australian Journal of Language and Literacy, 44"(2), 90-99, 2021) call to balance 'the analytical' and the narrative' in critical literacy practice provide the starting point for designing metalanguage for transdisciplinary research in Health and Physical Education (HPE) and English. We firstly review relevant models of the critical informing both subject areas to establish synergous understandings and then analyse expectations of critical practice in descriptions and elaborations of the HPE and English curricula. We provide an overview of the semiotic resources available for transdisciplinary conversations within the English curriculum with clarifying 'bridging' terminology informed by social semiotic descriptions. Through close analysis of four representative texts selected for critical literacy practice by English and HPE teacher educators in the MATA project, we demonstrate how such metalanguage was shared to build understandings of both critical analysis and actionable response. Along with analytical features to build and analyse issues according to disciplinary criteria, we show how stories are used to build rapport with their diverse audiences and to motivate their peers to take positive health action.

This review study aims to understand the concept of adults' digital health literacy (DHL), a recently emerging significant concept but still confused. For this, we seek to find the core competencies of digital health literacy by comparing those of existing relevant literacy concepts (i.e., health literacy and digital literacy). We identified seven core competencies of DHL across analytical, context-specific, and socioecological aspects: (a) traditional literacy, (b) information literacy, (c) media literacy, (d) health-related literacy, (e) technology literacy, (f) scientific literacy, and (g) socioecological nature. We also found the shared core aspects among DHL and digital and health literacies. The findings of this study contributed not only to grasping the concept of digital health literacy better but also to providing a fundamental basis for programs to enhance the DHL of adults. This article concludes with discussions about the findings and practical and academic implications.

Early adolescent children communicate on smartphones and social media, resulting in online sexual risks and potential adverse health outcomes. This study investigated parents' awareness of early adolescent engagement in online sexual risks on smartphones and social media and the protective practices used to mitigate these risks. Semi-structured interviews were conducted with 15 English-speaking parents of early adolescent children 11-14 years old in North and South Carolina. Data were analyzed using a qualitative descriptive approach and thematic analysis. Parents expressed awareness of online sexual risks on smartphones and social media and engaged in protective practices to mitigate online risks, including communication and restrictions tailored to accessed content and social connections with unknown individuals online. Professionals can support parents through education targeted to risks and protective measures associated with these online devices and platforms.

Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Although vaccine behaviors differ greatly by gender and age, few studies have examined vaccination at the intersection of gender and age within the Black community. We examined COVID-19 vaccination by gender and age using a survey of over 500 Black adults in Chicago, Illinois, fielded from September 2021 to March 2022. Although 54% had received at least one COVID-19 vaccine, the proportion vaccinated was considerably lower for Black men (28%) and women (37%) under 40 years old than Black men (92%) and women (86%) over 40 years (p < 0.001). Concern about vaccine side effects was the most reported barrier for unvaccinated women (56%) and men (38%) under 40 years. Our results suggest that targeted efforts to improve COVID-19 vaccine uptake in the Black community in Chicago after the initial rollout should have focused on young adults, particularly young Black men, with emphasis on addressing concern about vaccine side effects.

In the field of artificial intelligence-based fitness apps, the effective integration of behavior change techniques (BCTs) is critical for promoting physical activity and improving health outcomes. However, the specific BCTs employed by apps and their impact on user engagement and behavior change are not explored sufficiently. This study investigates the Freeletics fitness app through a mixed-methods approach to evaluate the use of BCTs. In the quantitative analysis, fifteen unique BCTs were identified based on the Behavior Change Technique Taxonomy (V1). In the qualitative analysis, user reviews (n=400) were examined to understand perspectives on the app's effectiveness in promoting behavior change. Goal setting, action planning, self-monitoring of behavior, and social support were among the most prevalent BCTs identified in the Freeletics app, and their effectiveness in enhancing user engagement and promoting behavior change was also highlighted by user reviews. Among the areas of improvement identified in the study were the need for simplifying personalization options and addressing user concerns regarding the specificity of feedback. The study underscores the importance of integrating BCTs effectively within AI-based fitness apps to drive user engagement and facilitate behavior change. It contributes valuable insights into the design and implementation of BCTs in fitness apps and offers recommendations for developers, emphasizing the significance of goal setting, feedback mechanisms, self-monitoring, and social support. By understanding the impact of specific BCTs on user behavior and addressing user concerns, developers can create more effective fitness apps, ultimately promoting healthier lifestyles and positive behavior change.

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.

Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults' opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged = 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28, p = 0.008) and =65 years (aOR = 4.54, p <0.001) (vs. 18-34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = 0.04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.

This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19.

Legislative smoking bans that prohibit smoking in public places have successfully reduced passive smoking in public areas. However, smokers only partially adhere to smoking restrictions in their homes. Young children are particularly vulnerable to exposure to tobacco smoke because they spend more time at home. In this study, we designed an intervention program based on an empowerment theory to reduce passive smoking among children. The priority participants were nonsmoking mothers living with smokers who smoke in the presence of children. The aim of this randomized control trial study was to examine the effectiveness of this intervention in reducing children's exposure to tobacco smoke at home. The intervention group received tailored educational brochures and two follow-up counseling telephone calls at 2 and 8 weeks, which provided resources to support the mothers to increase their knowledge, skill, and self-confidence in promoting behavior shaping of smokers. The control group received only tailored educational brochures. We found the intervention group demonstrated a higher rate of maternal actions to reduce their children's exposure to smoke and a higher rate than the control group of attempts to avoid smoking in the presence of children at the 16-week follow-up. These results suggest that the intervention helped reduce passive smoking among children. These findings highlight the need to empower and train mothers to help them develop rules for smoking at home. These interventions could be applied in the home of children who live with smokers who are unable or unwilling to quit smoking.

Adolescent school connectedness generally protects from risk behaviors such as tobacco use; however, its relationship to e-cigarette use is unclear. This study examines the relationship between adolescent school connectedness and e-cigarette susceptibility in a diverse longitudinal sample. This secondary analysis of a school-based intervention surveyed 608 middle (66%) and high school (34%) students from 10 schools at 3 time points over 1 year. At baseline, respondents had a mean age of 14 years, 54% were female, and 71% were BIPOC (Black, Indigenous, People of Color). Logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and e-cigarette susceptibility over time. E-cigarettes represented the most prevalent form of current nicotine-containing product use in spring 2019 (2.3%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility remained relatively stable during the study. Higher baseline school connectedness levels were associated with lower odds of e-cigarette susceptibility over time. Similarly, higher concurrent school connectedness scores were associated with lower odds of e-cigarette susceptibility over time: spring 2019 (OR, 0.39; 95% CI, 0.32, 0.47), fall 2019 (OR, 0.49; 95% CI, 0.34, 0.72), and spring 2020 (OR, 0.64; 95% CI, 0.47, 0.87). Findings were similar for middle and high school students and did not differ significantly after adjusting for other covariates. Adolescents' school connectedness appears to protect from e-cigarette susceptibility over time, underscoring the importance of promoting positive school experiences to reduce adolescent risk e-cigarette use.

International students in Australia risk financial insecurity and as a result, may make suboptimal health decisions. Limited research has explored the experiences of international students' health-related financial decision making. In-depth interviews were conducted with 31 international students to explore how financial situation influences their decisions in Australia. Data were thematically analysed. Findings highlight that limited income can impact overall wellbeing and health-related decision making. When making financial health-related decisions, participants prioritised urgent health needs and education. Participants who perceived their financial situation limited were less willing to spend money on mental health services, social activities, and food. This study suggests that students may consider the long-term financial benefits of studying abroad when making decisions, but they do not consider the long-term health implications of stress and wellbeing. Enabling students to improve their financial situation and lower their expenses could enhance wellbeing and facilitate health-related decision making.

Online reading has become an essential part of our life. Online reading has emerged as an active interdisciplinary field of scientific study in the past two decades. In order to develop a global view of the area, we conducted a bibliometric study on 7486 articles retrieved from WoS and Scopus databases published from 2004 to 2023. We analyzed the development trends in publications and citations, revealed the current major research themes, identified future research topics and most productive authors, affiliations, journals and countries. First, the publications and citations have been growing constantly in the past 20 years. Second, internet, e-book and comprehension have been the most frequently discussed topics. Third, three major themes have been revealed. The first theme emphasized the unique feature of online reading, which included the sub-themes of text features of hypertext, utilization of e-books, online health resources, and social interaction on line. The second theme had to do with education and learning. The third theme was related to health literacy. Fourth, education and medicine would attract researchers' attention in future research. Finally, the USA leads the total publications in the area of online reading. Our study contributed to the theory building by providing a detailed understanding of online reading research from an international perspective. We used two databases, WoS and Scopus, and improved the development of search terms, data filtering and data analysis. Implications for researchers, scientists and educators were discussed.

Little is known about the implications of cannabis legalization on adolescent health behaviors. This study sought to examine the relationship between recreational cannabis legalization and adolescent sexual risk behaviors. Data on 371,487 respondents who have ever had sexual intercourse from 41 states in the 2005 to 2019 Youth Risk Behavior Survey was linked with data on state-level cannabis policies. Difference-in-differences logistic regression models were conducted. Recreational cannabis legalization was associated with a reduced likelihood of respondents having 2+ sexual partners (adjusted OR [aOR] 0.63, 95% CI [0.47, 0.84]), but had no association with condom use (aOR 0.94, 95% CI [0.80, 1.11]). Changing social norms around cannabis is a potential pathway linking cannabis legalization to a reduction in sexual risk behaviors.

We aimed to explore, in a sample of systematic reviews (SRs) with meta-analyses of the association between food/diet and health-related outcomes, whether systematic reviewers selectively included study effect estimates in meta-analyses when multiple effect estimates were available. We randomly selected SRs of food/diet and health-related outcomes published between January 2018 and June 2019. We selected the first presented meta-analysis in each review (index meta-analysis), and extracted from study reports all study effect estimates that were eligible for inclusion in the meta-analysis. We calculated the Potential Bias Index (PBI) to quantify and test for evidence of selective inclusion. The PBI ranges from 0 to 1; values above or below 0.5 suggest selective inclusion of effect estimates more or less favourable to the intervention, respectively. We also compared the index meta-analytic estimate to the median of a randomly constructed distribution of meta-analytic estimates (i.e., the estimate expected when there is no selective inclusion). Thirty-nine SRs with 312 studies were included. The estimated PBI was 0.49 (95% CI 0.42-0.55), suggesting that the selection of study effect estimates from those reported was consistent with a process of random selection. In addition, the index meta-analytic effect estimates were similar, on average, to what we would expect to see in meta-analyses generated when there was no selective inclusion. Despite this, we recommend that systematic reviewers report the methods used to select effect estimates to include in meta-analyses, which can help readers understand the risk of selective inclusion bias in the SRs.

The interruption of regular physical exercise among Chinese college students is a key cause of the lack of motivation to exercise. Therefore, on the basis of self-efficacy theory, this study analysed the interrelationships between the perception of transformational leadership in physical education (PE) by teachers, physical self-efficacy, and exercise adherence among Chinese college students. A questionnaire survey was conducted using a convenience sample of 448 students from five universities in Hebei Province, China. They perceived transformational leadership by PE teachers to significantly positively influence exercise adherence. In addition, physical self-efficacy partially mediated the relationship between college students' perceptions of transformational leadership by PE teachers and exercise adherence. These findings suggest that university administrators could encourage PE teachers to make greater use of transformational leadership and improve education and guidance regarding physical self-efficacy for college students to promote exercise adherence.

The COVID-19 virus emerged in the city of Wuhan, China in December 2019, has affected the entire world in a short time, and was declared a pandemic by the World Health Organization in March 2020 (WHO, 2020b). This large-scale outbreak has been on the agenda of Turkey. The main purpose of this research is to examine the opinions of gifted students about the coronavirus and the pandemic. The study was carried out with 70 gifted students studying in the 3rd and 4th grades of the Alanya Science and Art Center which is affiliated with the Alanya District National Education Directorate in Antalya, in the spring term of the 2021-2022 academic year, over a 2-week period. The phenomenological method was used for the study since the study aims to reveal the opinions of the students about the coronavirus and the pandemic documented in writing along with student pictures. Some parts of the book named "Benim Pandemi Hikayem (My Pandemic Story)" were used to obtain the study data. The children were asked to answer the questions in order to understand their views on the coronavirus pandemic and the process it brought and draw about coronavirus. The data obtained from the study were analyzed with descriptive and content analysis. According to the frequency distribution of the categories and codes of the theme "Resources for learning about the pandemic", students learned about the pandemic most from the news (f=47). According to the frequency distributions of the categories and codes of the theme "What I learned about COVID-19", students expressed the following the most: mask, distance, and hygiene rules (f=51). When the frequency distributions of the categories and codes of the theme "When you first learned about the pandemic" were examined, most of the students stated that they were with their families (f=48). When the frequency distributions of the categories and codes of the theme "Pandemic drawings" were examined, it was seen that the students mostly drew pictures including a mask (f=29). In conclusion, knowing how children perceive the process experienced is important for educators in terms of providing individual, social, and emotional support and taking necessary measures. During the COVID-19 pandemic, teachers, students, and parents have experienced fears and concerns. For this reason, psychological support programs can be prepared for children, teachers, and parents.

The temporal focus hypothesis (TFH) entails that individuals who value the past tend to conceptualize it in front, whereas individuals who value the future tend to map the future in front instead (de la Fuente et al., 2014). This varies as a function of culture, individual differences, and context. Here, we extend this line of inquiry by testing a contextual variable, namely COVID-19 quarantine status, and an individual differences variable, namely future precautionary behavior towards COVID-19. Contrary to what the TFH would predict, we show that participants map the future to a frontal position, regardless of individual attitudes and quarantine status. However, participants who displayed more future precautionary behavior were also more future-focused than participants who displayed less such behaviour, but this did not predict their front--back mappings of the future. These findings suggest that individual differences may be stronger determinants of temporal focus than contextual variables.

The COVID-19 pandemic control measures substantially impacted the life of university students in the UK. While multiple studies investigated early stages of the pandemic, focusing on risk factors for depression and anxiety, fewer studies assessed later phases of the pandemic or examined positive protective factors for mental wellbeing. Our longitudinal study investigated changes and associations between COVID-19 experiences, lifestyle behaviours, social connectedness and mental wellbeing in the second year of the pandemic. The validated Warwick-Edinburgh Mental Wellbeing Scale was used to measure the primary outcome mental wellbeing. Self-reported data from 161 university students (18-35-year-old) in England was obtained. Data collection took place across two time points with contrasting COVID-19 epidemiological and countermeasure attributes. T1 occurred in the spring of 2021, during the tail end of the third national lockdown when indoor household mixing was prohibited and vaccination rates were low among 18-35 year olds. T2 took place 6 months later, in the autumn of 2021, when restrictions had ended and vaccination rates were high. Within-participant changes in students showed that mental wellbeing significantly improved over 6 months, suggesting positive adjustment. Fear of COVID-19 and engagement in COVID-19 protective behaviours significantly decreased as pandemic restrictions eased. Physical activity levels were high and did not change over time, while greenspace visits significantly diminished. Social support remained the same and group membership significantly increased over time. Hierarchal regressions revealed that social support was the most critical contributor to mental wellbeing. We discuss lessons for mental wellbeing promotion strategies: encouraging the use of greenspace as locations for distanced social interaction and physical activity in times of lockdown constraints.