Health lifestyles across the transition to adulthood: Implications for health

Health lifestyles of six Zhiguo ethnic groups in China: a latent class analysis

BACKGROUND

Zhiguo ethnic groups, commonly known as "the directly-entering-socialism ethnic groups", represent Chinese ethnic minorities who have undergone a unique social development trajectory by transforming directly from primitive societies to the socialist stage. In recent decades, significant lifestyle transformations have occurred among Zhiguo ethnic groups. Understanding their health lifestyles can play a strategic role in China's pursuit of universal health coverage. This study aims to examine patterns of health-related lifestyle among Zhiguo ethnic groups and explore whether sociodemographic features and specific indicators related to health status are associated with particular classes.

METHODS

A cross-sectional study was conducted in Yunnan Province, China, from July to December 2022. Stratified random sampling method was employed to recruit residents belonging to six Zhiguo ethnic groups aged between 15 and 64. Latent class analysis was performed to identify clusters of health-related behaviors within each ethnic group. Logistic regression was utilized to determine the predictors of health lifestyles.

RESULTS

A total of 1,588 individuals from the Zhiguo ethnic groups participated in this study. Three latent classes representing prevalent health lifestyles among the Zhiguo ethnic groups were identified: "unhealthy lifestyle" (31.80%), "mixed lifestyle" (57.37%), and "healthy lifestyle" (10.83%). In the overall population, individuals belonging to the "healthy lifestyle" group exhibited a higher likelihood of being non-farmers (OR: 2.300, 95% CI: 1.347-3.927), women (OR: 21.459, 95% CI: 13.678-33.667), married individuals (OR: 1.897, 95% CI: 1.146-3.138), and those residing within a walking distance of less than 15 min from the nearest health facility (OR: 2.133, 95% CI: 1.415-3.215). Conversely, individuals in the age cohorts of 30-39 years (OR: 0.277, 95% CI: 0.137-0.558) and 40-49 years (OR: 0.471, 95% CI: 0.232-0.958) showed a decreased likelihood of adopting a healthy lifestyle.

CONCLUSIONS

A considerable proportion of the Zhiguo ethnic groups have not adopted healthy lifestyles. Targeted interventions aimed at improving health outcomes within these communities should prioritize addressing the clustering of unfavorable health behaviors, with particular emphasis on single male farmers aged 30-49, and expanding healthcare coverage for individuals residing more than 15 min away from accessible facilities.

Examining provider anticipatory guidance for adolescents' preventive health: A latent class approach

BACKGROUND

Low rates of anticipatory guidance (AG) are reported across studies with adolescents, and little is known about how these conversations differ across early versus middle adolescence. This study explored adolescent-provider AG conversations for preventive health skills; the study objectives were to (1) identify patterns of provider-adolescent AG conversations across early and middle adolescence and (2) determine socio-demographic characteristics associated with these AG conversations.

DESIGN AND METHOD

Data from the 2019 National Survey of Children's Health were used to identify patterns of provider-adolescent AG conversations. The sample included 5500 early and 6730 middle adolescents (Mage = 14.67 years old, SD = 1.71, 51.7% boys, 79% White). Multiple group latent class analysis and multinomial regressions were estimated using four indicators of AG conversations (i.e., skills to manage health and healthcare, changes in healthcare that happen at 18, making positive choices about health, and receiving a medical history summary).

RESULTS

Three types of AG conversations were identified: high AG, low AG, and parent unaware. Among early and middle adolescents, adolescents that were older, girls, had private health insurance, and a personal provider were less likely to receive high AG compared to other types of AG.

CONCLUSIONS

Policies and strategies to engage adolescents in AG conversations during and outside of the medical appointment are needed.

PRACTICE IMPLICATIONS

Tools, such as brief screeners, can be used to ensure all adolescents are receiving high AG. School-based health centers, community centers and organizations, and telehealth appointments with medical professionals may be additional opportunities for adolescents to receive AG.

Associations between healthy lifestyle behavioral patterns and mental health problems: A latent class analysis of 161,744 Chinese young adults

BACKGROUND

Youth mental health problems are a public health priority. Multiple healthy lifestyle behaviors may cluster into healthy lifestyle behavioral patterns (HLBPs) that increase mental health risks in adolescents and older adults, but little is known regarding young adults. This study aimed to explore the associations between cluster HLBPs and mental health problems in young adults.

METHODS

We selected 161,744 young adults aged 20-39 as participants from the database of a Chinese general hospital health management center for the years 2015-2020. The latent class analysis was used to identify HLBPs.

RESULTS

A total of 15.0 % of young adults have at least one mental health problem. Five clusters of HLBPs were identified, characterized as low-risk class (1.6 %), moderate-risk class 1 (12.0 %), moderate-risk class 2 (2.1 %), moderate-risk class 3 (56.8 %), and high-risk class (27.4 %). The odds ratios (ORs) for young adults with two mental health problems increased with the risk grade of HLBPs, while the ORs for young adults with one or three mental health problems ranged from high to low according to the risk grade of HLBPs: high-risk class, moderate-risk class 2, moderate-risk class 3, moderate-risk class 1.

LIMITATIONS

Cross-sectional design and no causal conclusions could be drawn.

CONCLUSION

Young adults demonstrated a cluster phenomenon of healthy lifestyle behaviors and significant associations between HLBPs and mental health problems. Young adults with a higher risk grade for HLBPs were more likely to have mental health problems. Different HLBPs should be taken into account when implementing mental health interventions.

Child and adolescent patterns of commuting to school

The World Health Organization stipulate children and adolescents should accumulate 60 min of physical activity (PA) daily; globally only 25% achieve this. Active travel to school (ATS) is a method of integrating PA into daily life with a documented health benefit accruing. Understanding factors associated with ATS is essential to inform a systems approach to increase ATS participation. This study described patterns of commuting to school and examined factors associated with ATS. Children's Sport Participation & Physical Activity Study 2018 data was used, an all-Ireland cross-sectional study of 6,650 students. Logistic regression analysis was performed to determine factors independently associated with ATS. Most common commute to school methods were private car for primary (57%) and public transport for secondary (39%) students. The recommended 60 min of daily PA a week prior to the survey was achieved by 19.5% for primary and 12.6% for secondary students. Republic of Ireland (ROI) nationality (OR 1.09 95 %CI 1.02-1.16), meeting PA guidelines (OR 1.26 95 %CI 1.08-1.46), attending a ROI school (OR 2.27 95 %CI 2.02-2.57), attending a non-Delivering Equality of Opportunity in Schools (DEIS) school (OR 2.47 95 %CI 1.87-3.24), attending an urban school (OR 3.96 95 %CI 3.41-4.59) were each independently statistically significantly associated with ATS. Living in a family with a car (OR 0.27 95 %CI 0.19-0.39), attending secondary school (OR 0.69 95 %CI 0.62-0.78), attending a small sized (<33rd percentile) school (OR 0.68 95 %CI 0.60-0.77), living >5 km from school (OR 0.22 95 %CI 0.2-0.24) were each significantly negatively associated with ATS. ATS is a means of increasing youth PA and health. Factors associated with ATS can inform further research and intervention to increase ATS participation.

Living arrangements, health lifestyles, and health outcomes among Chinese oldest-old

Background

Prior literature has documented a strong correlation between living arrangements and older adults' health outcomes. However, few studies have explained why this association exists. This study took the health lifestyle theory approach and brought health lifestyles into the link between living arrangements and Chinese oldest-old health outcomes. It examined (1) whether healthy lifestyle behaviors among the oldest-old varied by household contexts and (2) whether the health disparities among the Chinese oldest-old in different household contexts could be partially explained by their healthy lifestyles.

Methods

Using the most recent 2018 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among the Chinese oldest-old aged 85-105 years. Regression analyses were used to test the mediating effect of health lifestyles.

Results

Three distinct classes representing the health lifestyles of Chinese oldest-old emerged; health lifestyle patterns were found to vary by elders' living arrangements. The respondent's health lifestyles in diverse residential structures served as a mediator which can partially explain the health disparities among the oldest-old.

Conclusion

The results suggested that health lifestyles can serve as a mediator to explain the association between oldest-old living arrangement patterns and their health outcomes. The findings highlighted the importance of family, lifestyles, and cultural contexts to the health of the oldest-old.

Disparities in trajectories of cigarette and E-cigarette use across sexual orientation groups of young adult men and women in the US

INTRODUCTION

Limited research has examined differences in cigarette/e-cigarette use trajectories among specific subgroups of sexual minority (SM) young adult (SMYA) men and women.

METHODS

Repeated measures latent profile analyses (RMLPAs) examined past 6-month cigarette and e-cigarette use trajectories across 5 waves of data (2018-2020) among men (n = 1235; Mage = 25.56, SD = 4.85; 8.0% bisexual, 12.7% gay; 36.4% racial/ethnic minority) and women (n = 1574; Mage = 24.64, SD = 4.72; 23.8% bisexual, 5.9% lesbian; 35.3% racial/ethnic minority) residing in 6 US metropolitan statistical areas. Multinomial logistic regressions examined associations among sexual orientation (bisexual, gay/lesbian, heterosexual) and tobacco use trajectories among men and women, separately.

RESULTS

RMLPAs yielded a 6-profile solution: stable low-level cigarette and e-cigarette use (66.6%), stable low-level cigarette and high-level e-cigarette use (12.2%), stable low-level cigarette and decreasing e-cigarette use (6.2%), stable mid-level cigarette and low-level e-cigarette use (6.2%), stable high-level cigarette and low-level e-cigarette use (4.5%), and stable high-level cigarette and e-cigarette use (4.2%). Gay (vs. heterosexual) men were less likely to display stable low-level cigarette and stable high-level e-cigarette use. Bisexual (vs. heterosexual) women were more likely to display stable low-level cigarette and stable high-level e-cigarette use, stable low-level cigarette and decreasing high-level e-cigarette use, and stable high-level cigarette and stable low-level e-cigarette use.

CONCLUSIONS

Bisexual women were at greatest risk for displaying several problematic cigarette and e-cigarette use trajectories, whereas few differences emerged for men. Tailored interventions and campaigns are needed to curtail ongoing tobacco use disparities among SMYA men and women, particularly bisexual women.

Health Lifestyle Theory in a Changing Society: The Rise of Infectious Diseases and Digitalization

Social change produces alterations in society that necessitate changes in sociological theories. Two significant changes affecting health lifestyle theory are the behaviors associated with the COVID-19 pandemic and the digitalization of society. The health-protective practices emerging from the ongoing pandemic and the recent parade of other newly emerging infectious diseases need to be included in the theory's framework. Moreover, the extensive digitalization of today's society leads to the addition of connectivities (electronic networks) as a structural variable. Connectivities serve as a computational authority influencing health lifestyle practices through health apps and other digital resources in contrast to collectivities (human social networks) as a normative authority. The recent literature supporting these features in an updated and expanded model of health lifestyle theory is discussed.

Health-promoting behavior among undergraduate students in the COVID-19 era: Its association with problematic use of social media, social isolation, and online health information-seeking behavior

OBJECTIVE

To examine the association between problematic use of social media, online health information-seeking, social isolation, and health-promoting behaviors among Korean undergraduate students.

METHODS

In total, 178 undergraduate students participated in this study. A multiple linear regression analysis was performed.

RESULTS

Predictors of health-promoting behaviors included overall time spent on social media, problematic social media use, social isolation, and online information-seeking, explaining 33.5 % of the variance in health-promoting behaviors.

CONCLUSION

Prolonged social media use and social isolation negatively affected undergraduate students' health-promoting behaviors, while online information-seeking positively affected them. Nurses should assist young adults in improving health-promoting behaviors by preventing problematic social media uses, reducing social isolation, and strengthening their online health information-seeking ability.

Health behavior of Austrian tertiary students focusing on diet type linked to sports and exercise-first glimpse of results from the "sustainably healthy-from science 2 high school and university" study

Background

There is a strong association between lifestyle behavior and health status. While young adulthood is a critical period for adopting and stabilizing lifelong healthy behavior, university life is independently associated with psychological stressors that may further affect health and well-being.

Objective

The present multidisciplinary study aimed to examine the health behavior of Austrian college and university students, differentiated based on diet types (vegan, vegetarian, and omnivorous) and physical activity (PA) habits.

Methods

Following a cross-sectional study design, a total number of 6,148 students (65.3% females; 66.1% bachelor students, 67.0% from urban areas; mean age: 24.8 years) from 52 Austrian college/universities participated in an online survey and provided data on sociodemographic characteristics, dietary patterns, PA habits, and other lifestyle behavior characteristics, including alcohol intake and smoking.

Results

Across the total sample, 74.0% had a normal weight (BMI = 18.5-25.0 kg/m2), while the prevalence of overweight/obesity (BMI ≥ 30.0 kg/m2) was lower in females than males and more in rural than urban students (p < 0.01). The general prevalence of vegetarian and vegan diets was 22.8 and 6.0%, respectively, with a predominance of females, graduates, and urban students compared to their peers (p < 0.01). The majority of students (79.3%) had a regular engagement in sport/exercise, with a predominance of vegetarian or vegan students compared to omnivores (p < 0.01). Vegans and vegetarians had a lower alcohol intake (p < 0.01) but no differences in smoking habits (p > 0.05) compared to omnivores. Students engaging in sport/exercise had a lower smoking rate and higher intake of fruits, vegetables, and fluids compared to inactive students (p < 0.01).

Conclusion

The present findings suggest that diet type and PA habits of college/university students have an impact on other health behaviors, highlighting the interconnected nature of lifestyle habits and health behavior.

Assessment of food consumption, smoking, alcohol use, and physical activity by sex and major of study among a sample of college students in Jordan

This study aimed to assess the food frequency and health-related risk behaviors based on gender and major of study (health and non-health majors) in a sample of undergraduate university students. A cross-sectional study was conducted among 708 undergraduate university students (37.4% males; 62.6% females) with a mean age of 20.88(SD = 2.20), ranging from 18 to 37 years from five universities. A self-reported questionnaire was administered in the university classrooms to collect data. Results showed that 47.3% of students reported consuming fruits and vegetables (38.1%), and 54% reported consuming unhealthy foods at least once in the preceding 24 h. About 16% of the students were cigarette smokers, 17% were waterpipe smokers, and slightly more than 4% were alcohol consumers. Significant associations were found between the participants based on their sexes, and study majors (P < 0.001). Male students smoked and consumed alcohol at significantly higher rates than female students. As with regards to the physical activity in the preceding week, students had not carried out any stretching activities (52.8%), strengthening activities (62.4%), cycling (35%), or taken part in any physical activity classes (68.4%). The rates of physical activity were significantly higher among male students than female students (p < 0.001). The results showed that non-health major students differ from those in health majors in the consumption of cigarettes (p < 0.001) and waterpipe smoking (p = 0.027). Students in non-health majors were more likely than students in health majors to have carried out stretching activities (p = 0.021) and participated in physical activity classes (p = 0.02). Our findings highlighted the importance of identifying health-related risk behaviors among university students to develop a health-promoting intervention tailored to a specific group of students considering their sex and study majors.

A longitudinal study of lifestyle behaviours in emerging adulthood and risk for symptoms of depression, anxiety, and stress

BACKGROUND

Little research has examined how lifestyle behaviours cluster together to contribute to mental health outcomes. The current study aimed to identify latent classes of emerging adult lifestyle behaviours (diet, physical activity, sedentary time, smoking, alcohol, cannabis, and other drug use) at age 20 years and their associations with depression, anxiety, and stress symptoms at age 22 and 27 years.

METHODS

Participants were 616 emerging adults enrolled in the Raine Study. Lifestyle classes at baseline were identified using latent class analysis. Longitudinal associations between latent class membership and risk of depression, anxiety, and stress symptoms were examined using logistic regression models.

RESULTS

Three lifestyle classes were identified: Class 1 (healthier pattern, n = 399 [64.8 %]), Class 2 (predominantly female, high substance-use, low physical activity pattern, n = 121 [19.6 %]), and Class 3 (predominantly male, high substance-use, poor diet pattern, n = 96 [15.6 %]). Following adjustment, Class 2 were at a higher risk of depression, anxiety, and stress symptoms at age 22 years, and a higher risk of anxiety and stress symptoms at age 27 years, compared to Class 1.

LIMITATIONS

This study was limited by reliance on self-report data, lack of available indicators for parental socioeconomic status, and some measurement inconsistencies across variables. Adherence to lifestyle clusters over time was not assessed.

CONCLUSIONS

Latent classes of lifestyle behaviours were identified among emerging adults, and differences in mental health outcomes were found among the classes at two prospective time points. Future research and prevention strategies for common mental disorders should target emerging adults and focus on lifestyle patterns.

Health lifestyles during adolescence: clustering of health behaviours and social determinants in Italian adolescents

BACKGROUND

Health behaviours in adolescence have a high impact on both current and future health. The literature claims a focus on social determinants and shows that these behaviours are associated. The concept of 'health lifestyles' should be considered to account for co-occurring health behaviours and determinants interactions. The aim of this study is to increase our understanding of adolescents' health lifestyles and to (i) cluster adolescents according to a comprehensive number of health behaviours and (ii) describe these groups according to sociodemographic characteristics, perceptions of life contexts (family, school, peers or neighbourhood) and perceived physical and psychosocial health conditions.

METHODS

In Italy, 906 15-year-old students participated in the cross-national Health Behaviour of School-aged Children study. Clusters were identified by applying the KAMILA clustering method and compared using analysis of variance and chi-squared tests.Results: Four clusters were identified: 'substance consumers', 'media lovers', 'active students' and 'passive students'. Each cluster exhibited different characteristics related to health behaviours and social determinants.

CONCLUSIONS

Interesting associations between health behaviours were identified, which showed the relevance of considering the adolescents' overall lifestyles. The description of each cluster permitted the identification of risks and protective factors, which may be important for designing effective health promotion activities.

Identifying patterns of lifestyle behaviours linked to sociodemographic characteristics and health conditions among young adults in South Korea

AIMS

To identify specific patterns of lifestyle behaviours among young adults and examine the relationships of the patterns to sociodemographic characteristics and health conditions (hypertension, diabetes and obesity).

DESIGN

Descriptive, correlational study.

METHODS

Data from a nationally representative sample of 4562 young adults aged 19-39, who participated in the 2016-2018 Korea National Health and Nutrition Examination Survey, were analysed. Latent class analysis was used to identify the patterns of lifestyle behaviours, including smoking, alcohol use, physical activity and vaccination. Generalized linear regression analysis was used to examine the relationships among lifestyle behaviour patterns, sociodemographic characteristics and health conditions.

RESULTS

Three patterns of lifestyle behaviours were identified: physically active (6.9%), high risk (21.5%) and passive (71.6%). The membership of these three patterns was significantly associated with sociodemographic characteristics (age, sex, education level, occupation and living arrangement). Among the three groups, young adults in the high-risk group were found to be significantly associated with all three health conditions (hypertension, diabetes and obesity) while controlling for sociodemographic characteristics.

CONCLUSION

These results indicate that young adults are likely to engage in unhealthy lifestyle behaviours that are related to individual socioeconomic conditions, which could negatively affect their health conditions.

IMPACT

This study provides insights into the lifestyle behaviours among young adults who have been recognized to be socially disadvantaged. This could help develop education and prevention programmes tailored to specific patterns of lifestyle behaviours for improving health while considering their socioeconomic contexts.

NO PATIENT OR PUBLIC CONTRIBUTION

This applies to this research as the focus was on young adults in South Korea only.

The Impact of COVID-19 on the Cardiovascular Health of Emerging Adults Aged 18-25: Findings From a Scoping Review

There is limited knowledge regarding the cardiovascular impact of coronavirus disease 2019 (COVID-19) on emerging adults aged 18-25, a group that disproportionately contracts COVID-19. To guide future cardiovascular disease (CVD) research, policy, and practice, a scoping review was conducted to: (i) examine the impact of the COVID-19 pandemic on the cardiovascular health of emerging adults; and (ii) identify strategies to screen for and manage COVID-19-related cardiovascular complications in this age group. A comprehensive search strategy was applied to several academic databases and grey literature sources. An updated search yielded 6738 articles, 147 of which were extracted and synthesized. Reports identified COVID-19-associated cardiac abnormalities, vascular alterations, and multisystem inflammatory syndrome in emerging adults; based on data from student-athlete samples, prevalence estimates of myocarditis and cardiac abnormalities were 0.5%-3% and 0%-7%, respectively. Obesity, hypertension, CVD, congenital heart disease, and marginalization are potential risk factors for severe COVID-19, related cardiovascular complications, and mortality in this age group. As a screening modality for COVID-19-associated cardiac involvement, it is recommended that cardiac magnetic resonance imaging be indicated by a positive cardiac history and/or abnormal "triad" testing (cardiac troponin, electrocardiogram, and transthoracic echocardiogram) to improve diagnostic utility. To foster long-term cardiovascular health among emerging adults, cardiorespiratory fitness, health literacy and education, and telehealth accessibility should be priorities of health policy and clinical practice. Ultimately, surveillance data from the broader emerging adult population will be crucial to assess the long-term cardiovascular impact of both COVID-19 infection and vaccination, guide screening and management protocols, and inform CVD prevention efforts.

Barriers and Facilitators to High School Meal Program Participation: A Qualitative Study of Students and Their Caregivers

BACKGROUND

The school food environment is a critically important area to target the health of millions of students, especially those experiencing food insecurity. However, both students and caregivers have noted significant barriers to participation in the school meal program, including taste, lunchroom experience, and limited availability of fresh, healthy foods. There is a lack of qualitative research which considers both caregiver and adolescent perspectives, particularly among youth of color.

METHODS

Forty-seven students (77% Black) and 24 caregivers across 4 midwestern high schools participated in focus groups and key informant interviews assessing barriers and facilitators to school meal participation. We conducted thematic analysis of the data using matrix intersection queries and reviewing frequencies of relevant nodes to identify themes.

RESULTS

Themes about the importance of freshness and quality of the foods served in the lunchroom emerged from both students and caregivers.

CONCLUSIONS

Future research may explore differences in meal participation depending on types of vender, farm to school program status, and other local variations in public schools and determine whether they increase participation, reduce food insecurity, and increase diet quality.

Neighborhood Socioeconomic Deprivation in Early Childhood Mediates Racial Disparities in Blood Pressure in a College Student Sample

The influence of childhood contexts on adult blood pressure is an important yet understudied topic. Using a developmental perspective, this study examines the association between neighborhood socioeconomic disadvantage in early childhood (0-5 yrs), middle childhood (6-12 yrs) and adolescence (13-18 yrs) on subsequent blood pressure in young adulthood. Data were from 263 college students (52% Black; M_age = 19.21 years) and neighborhood socioeconomic disadvantage was measured using a tract-level Area Deprivation Index. Neighborhood disadvantage in early childhood was significantly associated with diastolic blood pressure and explained 22% of the race difference between Black and White adults. The findings are consistent with the notion that early childhood may be a sensitive period for the effects of neighborhood disadvantage on blood pressure.

A cluster analysis of health behaviours and their relationship to mental health difficulties, life satisfaction and functioning in adolescents

Research has documented relationships between individual health behaviours and mental health, but few studies have examined patterns of health behaviours (i.e., health lifestyles) and mental health outcomes. This study investigated the relationship between health lifestyles and mental health and psychological wellbeing in adolescents. Data from the My World Survey 2 - Second Level (MWS2-SL), a random national sample of 9493 adolescents (44.2% male) aged 12-18 years (M = 14.8, SD = 1.66) in second level education in Ireland were used. TwoStep cluster analysis identified clustering of health behaviours (sleep, alcohol use, cannabis use, social media use, sport and hobby participation). ANOVA and Chi Square tests identified potential differences in demographic characteristics (age, gender, socioeconomic status, ethnicity) and psychological outcomes (anxiety, depression, life satisfaction, daily functioning) across clusters. Three clusters were identified; 1. Low (22.0%), 2. Moderate-high (41.5%) and 3. High (36.5%), health promoting. The 'Low' health-promoting cluster, characterised by high alcohol, cannabis and social media use, moderate sport and hobby participation, and low sleep duration, demonstrated the highest levels of anxiety and depression and the lowest levels of life satisfaction, self-esteem and daily functioning. The 'High' health-promoting cluster reported the most favourable psychological outcomes. Cluster 1 were more likely to be older and male, Cluster 3 were more likely to be younger and female. Findings demonstrate the potential for health promotive lifestyles to mitigate mental health difficulties and promote life satisfaction and daily functioning in adolescents. Health lifestyles represent important indicators of mental health and targets for prevention/promotion efforts.

Associations of Dietary-Lifestyle Patterns with Obesity and Metabolic Health: Two-Year Changes in MeDiSH® Study Cohort

This study aimed to evaluate changes in diet, adiposity, and metabolic outcomes after two years. In all, 358 Polish men aged 19-40 years old participated in the study. Data regarding dietary and lifestyle characteristics as well as family, socio-economic, and demographic status were collected using the food frequency questionnaire KomPAN^®. Dietary lifestyle patterns were previously derived from data for 358 men by principal component analysis (PCA). Changes over time were examined in 95 men who returned after two years by calculating relative differences (RD, %) in mean values and markers distribution. Diet quality was described with two predefined scores: pro-Healthy-Diet-Index (pHDI) and non-Healthy-Diet-Index (nHDI). After two years, changes were observed in diet quality and metabolic health markers. No significant changes were observed in family, socio-economic, and demographic status, as well as other lifestyle factors. In the "sandwiches and convenience foods" pattern, an nHDI decrease (RD = -25.3%) was associated with a fasting blood glucose decrease (RD = -6.1%). In the "protein food, fried-food and recreational physical activity" and the "healthy diet, activity at work, former smoking" patterns, pHDI decreases (RD = -13.6% and -14.6%, respectively,) were associated with an adiposity increase. In the "fast foods and stimulants" pattern, no changes in pHDI and nHDI were observed, while adiposity markers and systolic blood pressure worsened. Conclusion: in the two-year perspective, dietary improvement was associated with improved glycemic control, despite no changes in body weight, while worsening of the diet quality or maintenance of unhealthy dietary behaviours were associated with the deterioration of metabolic health.

Actions Speak Louder Than Words: Health Behaviours and the Literacy of Future Healthcare Professionals

Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczyński’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.

Actions Speak Louder Than Words: Health Behaviours and the Literacy of Future Healthcare Professionals

Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczyński’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.

Daily-level associations between sleep duration and next-day alcohol and cannabis craving and use in young adults

STUDY OBJECTIVES

To examine the effects of sleep duration on next-day alcohol and cannabis craving and use among young adults.

METHOD

A community sample of young adults who reported recent simultaneous alcohol and cannabis use at screening (N = 409; Mage = 21.61; 50.9% female) completed twice daily surveys (morning and afternoon) for five 14-day sampling bursts (i.e., 70 days total). Daily measurements included sleep duration, alcohol and cannabis craving, and alcohol and cannabis use (i.e., number of drinks, hours high). Multilevel models enabled examining associations between sleep duration and substance use/craving at three distinct levels: daily-level, burst-level, and person-level.

RESULTS

At the day-level, sleep duration was inversely associated with craving for both alcohol and cannabis: Stronger craving was reported on mornings and afternoons after relatively shorter sleep duration. At the burst-level, sleep duration was inversely associated with morning and afternoon alcohol craving indicating stronger alcohol craving, but not cannabis craving, during two-week periods when young adults have accumulated shorter sleep duration. Pertaining to alcohol and cannabis use, no daily-level effects were found, but the burst-level effect showed that participants engaged in greater alcohol use during two-week bursts with shorter sleep duration.

CONCLUSIONS

Based on a non-clinical sample of young adults reporting substance use, results suggest shorter sleep duration may be a modifiable risk factor as it pertains to substance use and cravings. Results highlight day-level effects of shorter sleep duration on substance use cravings and adverse effects of cumulative sleep deficit on alcohol use.

Levels of abdominal adipose tissue and metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 years: the CARDIA Study

BACKGROUND

Higher levels of intra-abdominal adipose tissue (IAAT) comprising visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT), and liver fat are posited drivers of obesity-related chronic disease risk. Fast food is hypothesized to contribute to IAAT patterns.

OBJECTIVES

We quantified levels of abdominal subcutaneous adipose tissue (SAT), IAAT, and odds of metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 y.

METHODS

We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent 6 clinical exams and measurements over 25 y with computed tomography-measured VAT, SAT, and IMAT (n = 3156), plus MAFLD defined by liver attenuation (≤40 Hounsfield units) and 1 metabolic abnormality at year 25 (2010, n = 3001, n cases = 302). We estimated means of VAT, SAT, IMAT, and liver attenuation at the year 25 exam according to categories of average fast-food intake over the previous 25 y adjusted for sociodemographic and lifestyle factors and logistic regression to estimate the odds ratio of MAFLD at year 25.

RESULTS

With higher average fast-food intake over 25 y (categorized as follows: never-1×/mo, >1×-3×/mo, 1-<2×/wk, 2-<3×/wk, ≥3×/wk), there were monotonic higher levels of VAT (98.5, 127.6, 134.5, 142.0, 145.5 cm3), P-trend < 0.0001, which were consistent across anthropometrically classified obesity categories. There was a similar pattern with liver fat. There were higher levels of IMAT and SAT with higher fast-food intake (P-trend = 0.003, 0.0002, respectively), with amounts leveling off at ≥2×/wk. In addition, compared with participants who ate fast food never-1×/mo, there were monotonic higher odds of having MAFLD at year 25 with higher average fast-food intake, with participants who ate fast food ≥3×/wk having an OR of MAFLD = 5.18 (95% CI: 2.87, 9.37).

CONCLUSIONS

There were monotonic higher levels of VAT, liver fat, and odds of having MAFLD in middle age according to higher average fast-food intake over the preceding 25 y.

Theoretical Approaches to Research on the Social Determinants of Obesity

This article reviews selected theoretical approaches explaining the social determinants of obesity. The significance of this topic for medicine, public health, and other areas of obesity-related research is the growing body of evidence showing that the social environment is often key to understanding the risk of obesity. A review of relevant literature and analysis of empirical evidence linking theory to data in studies of obesity was performed. Several studies show that differences in social behavior and living conditions associated with SES, lifestyles, inequality, and other social variables have important roles in weight gain. Because the social determinants of obesity often begin in childhood, life course theory and its concepts of cumulative advantage/disadvantage and cumulative inequality are initially reviewed, followed by a discussion of how fundamental cause theory, health lifestyle theory, and cultural capital theory can be applied to obesity research. The stress process model and the concepts of social networks and neighborhood disadvantage concerning obesity are also included.

Fungal-Derived Mycoprotein and Health across the Lifespan: A Narrative Review

Mycoprotein is a filamentous fungal protein that was first identified in the 1960s. A growing number of publications have investigated inter-relationships between mycoprotein intakes and aspects of human health. A narrative review was undertaken focusing on evidence from randomized controlled trials, clinical trials, intervention, and observational studies. Fifteen key publications were identified and undertaken in early/young adulthood, adulthood (mid-life) or older/advanced age. Main findings showed that fungal mycoprotein could contribute to an array of health benefits across the lifespan including improved lipid profiles, glycaemic markers, dietary fibre intakes, satiety effects and muscle/myofibrillar protein synthesis. Continued research is needed which would be worthwhile at both ends of the lifespan spectrum and specific population sub-groups.

Peer Network Processes in Adolescents' Health Lifestyles

Combining theories of health lifestyles-interrelated health behaviors arising from group-based identities-with those of network and behavior change, we investigated network characteristics of health lifestyles and the role of influence and selection processes underlying these characteristics. We examined these questions in two high schools using longitudinal, complete friendship network data from the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses characterized each school's predominant health lifestyles using several health behavior domains. School-specific stochastic actor-based models evaluated the bidirectional relationship between friendship networks and health lifestyles. Predominant lifestyles remained stable within schools over time, even as individuals transitioned between lifestyles. Friends displayed greater similarity in health lifestyles than nonfriend dyads. Similarities resulted primarily from teens' selection of friends with similar lifestyles but also from teens influencing their peers' lifestyles. This study demonstrates the salience of health lifestyles for adolescent development and friendship networks.

Association of Psychological Resilience With Healthy Lifestyle and Body Weight in Young Adulthood

PURPOSE

Childhood adversity is associated with adverse health outcomes, in part owing to its effects on healthy lifestyle. We examined whether psychological resilience to adversity may promote healthier behaviors and body weight in young adulthood.

METHODS

Data are from the Growing Up Today Study, a longitudinal cohort of young adults (n = 3,767) who are children of participants of the Nurses' Health Study II, a separate longitudinal cohort. After characterizing psychological resilience as per levels of adversity exposure before the age of 18 years and young adult psychological health (defined by a composite of low psychological distress and high positive affect), we derived a categorical measure by cross-classifying adversity (exposed vs. unexposed) and psychological health (high vs. lower). We considered five outcomes self-reported at baseline (2010) and five years later: healthy body weight and four healthy lifestyle components including being a nonsmoker, moderate alcohol consumption, regular physical activity, and healthy diet. Poisson regression models evaluated associations of each outcome with psychological resilience, comparing psychologically resilient individuals with those who were not resilient or who were unexposed to adversity, adjusting for relevant covariates.

RESULTS

We did not identify differences between psychologically resilient individuals and those unexposed to adversity who were psychologically healthy with respect to meeting recommendations for most healthy lifestyle components and associations were largely stable over time. Across most outcomes, nonresilient individuals were less likely to be healthy relative to resilient individuals.

CONCLUSIONS

Psychological resilience may disrupt negative effects of childhood adversity on having a healthy lifestyle in young adulthood.

Developing Health Lifestyle Pathways and Social Inequalities across Early Childhood

Lifestyles are a long-theorized aspect of social inequalities that root individual behaviors in social group differences. Although the health lifestyle construct is an important advance for understanding social inequalities and health behaviors, research has not theorized or investigated the longitudinal development of health lifestyles from infancy through the transition to school. This study documented children's longitudinal health lifestyle pathways, articulated and tested a theoretical framework of health lifestyle development in early life, and assessed associations with kindergarten cognition, socioemotional behavior, and health. Latent class analyses identified health lifestyle pathways using the US Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N≈6,550). Children's health lifestyle pathways were complex, combining healthier and unhealthier behaviors and changing with age. Social background prior to birth was associated with health lifestyle pathways, as were parents' resources, health behaviors, and non-health-focused parenting. Developing health lifestyle pathways were related to kindergarten cognition, behavior, and health net of social background and other parent influences. Thus, family context is important for the development of complex health lifestyle pathways across early childhood, which have implications for school preparedness and thus for social inequalities and well-being throughout life. Developing health lifestyles both reflect and reproduce social inequalities across generations.

Contributions and Challenges in Health Lifestyles Research

The concept of health lifestyles is moving scholarship beyond individual health behaviors to integrated bundles of behaviors undergirded by group-based identities and norms. Health lifestyles research merges structure with agency, individual-level processes with group-level processes, and multifaceted behaviors with norms and identities, shedding light on why health behaviors persist or change and on the reproduction of health disparities and other social inequalities. Recent contributions have applied new methods and life course perspectives, articulating health lifestyles's dynamic relationships to social contexts and demonstrating their implications for health and development. Culturally focused work has shown how health lifestyles function as signals for status and identity and perpetuate inequalities. We synthesize literature to articulate recent advances and challenges and demonstrate how health lifestyles research can strengthen health policies and inform scholarship on inequalities. Future work emphasizing health lifestyles's collective nature and attending to upstream social structures will further elucidate complex social processes.

Associations between health-related skills and young adults' work ability within a structural health literacy model

Young adults have a high societal relevance but are still an under-represented target group in health promotion. Health literacy is widely acknowledged as one of the strongest predictors and key determinant of health, so its influence on work ability is of great interest. The purpose of the study was to examine the associations between health-related skills and work ability within the structural model of health literacy of Lenartz, Soellner and colleagues, which explains health behaviour and health through the indirect and direct influence of six 'advanced skills' ('self-perception', 'proactive approach to health', 'dealing with health information', 'self-control', 'self-regulation' and 'communication and cooperation'). The cross-sectional study was based on baseline data of a health literacy promotion intervention (495 vocational school students, 59.0% female, age span 18-25 years). Structural equation modelling with partial least squares was used to examine the associations between the six constructs of the model and the Work Ability Index (WAI). Mean WAI score was 39.7 ± 4.5 (51.1% categorized 'moderate'/'poor'). Five out of six constructs of the model showed a statistically significant indirect or direct effect, respectively, on work ability. The model explained 24.8% of the WAI score variance. Our findings show associations between the health literacy model and the work ability among young employees. In view of demographic change, it is crucial to develop and analyse target group-specific health literacy interventions. The model offers new facets in the modelling of health literacy.

Multiple Health Behavior Programs in School Settings: Strategies to Promote Transfer-of-Learning Through Life Skills Education

Typically, schools implement health promotion programs that focus on a single behavioral domain. Multiple related health topics may be addressed using separate interventions, potentially producing overlap in program content. However, integrative approaches in health promotion have the potential to produce interventions capable of improving multiple health behaviors. In particular, more research is needed to identify the conditions and the factors that can promote the transfer of learning to broaden the target outcomes of health promotion programs. The present study aims to identify the characteristics of an evidence-based life skills education program that can facilitate the transfer of learning to different health behaviors not initially targeted by the program, and the strategies for achieving successful transfer. A two round Delphi method was used with a diverse group of 21 experts in health promotion, life skills education, and methods of pedagogy for early adolescent students. Questionnaires with open and closed-ended questions were administered on-line. Content qualitative analysis was run, integrating codes, subcategories, and categories of the two rounds of the study. Results showed strong consensus among experts about the potential for promoting the transfer of skills from one health domain to another. Many elements were identified as important factors that facilitate the transfer of learning. Strategies for successful transfer were related to teaching methods, educational approaches, and consistency with the broader school curriculum. Findings suggest that the successful transfer of learning to a new health domain requires that educators recognize its importance and explicitly designate it as an educational aim.

How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review

BACKGROUND

Children in care (CiC) have often experienced trauma and, as a result, are at high risk for poor health outcomes. It is imperative that human-service stakeholders provide trauma-informed health services and interventions. However, little is known about how health promotion is addressed in the standards and guidelines for CiC. For this scoping review, the aim was to examine and compare how nutrition and physical activity are discussed in: 1) federal standards for CiC across the United Kingdom, the United States, New Zealand, and Australia; and 2) state and territory guidance in Australia.

METHOD

The grey literature was searched for documents outlining key child-welfare standards, guidelines, or policies for the provision of care across foster, kinship, or residential care. Documents were examined for the inclusion of recommendations and/or strategies focused on primary health and the promotion of nutrition and/or physical activity.

RESULTS

A total of 52 documents were included in this review: 28 outlining international federal guidance and 24 Australian documents. In the United States, New Zealand, and Australia, references to physical activity were often broad, with minimal direction, and nutrition was often neglected; the United Kingdom provided more detailed guidance to promote nutrition and physical activity among CiC.

CONCLUSION

There is a lack of consistency and specificity in guidelines supporting healthy lifestyle interventions for CiC both internationally and within Australia. It is recommended that 1) specific trauma-informed health promotion guidelines are developed for CiC; and 2) trauma-informed health promotion training is provided to carers. Doing so will ensure that care is provided in a manner in which stakeholders recognize the signs and consequences of trauma in order to determine the most appropriate health interventions to improve outcomes and prevent ongoing trauma for this population.

"Melanincholy": A Qualitative Exploration of Youth Media Use, Vicarious Racism, and Perceptions of Health

PURPOSE

We sought to (1) characterize teens' experiences with news and social media, focusing on news depicting racism, (2) assess youth perceptions of how these experiences may impact their own health, and (3) explore how teens cope with racism encountered in media. We hypothesized that teens access news primarily through social media, and vicarious racism experienced via news increases negative perceptions of health.

METHODS

Eighteen teens (aged 13-19 years) were recruited to participate in focus group interviews (N = 4). These were recorded, transcribed, and coded using qualitative methods.

RESULTS

Youth spend much of each day online and frequently access social media, including news shared on these platforms. Many participants identified concerns surrounding "fake" news on social media. Participants reported encountering racially charged news and described their responses to these stories. Some reported feeling overwhelmed by racism in the news. Most participants perceived negative mood changes after exposure to racism in online news, although few associated this exposure with changes in their own health behaviors. Youth indicated that peer discussion was important for coping with vicarious racism exposure.

CONCLUSIONS

This study provides insight into the way teens access and share information through social media, including news involving racism, and the effect that this information may have on them. Their vicarious experiences of racism in the news may be associated with feelings of desensitization and mood changes, with potential downstream effects on health. Peer support may help teens cope with vicarious racism. Longitudinal studies examining these exposures' health effects and opportunities for cross-sector intervention are needed.

"The Way you Interpret Health": Adolescent Definitions and Perceptions of Health Literacy

BACKGROUND

Adolescents are required to take increased responsibility for their health. Although health literacy is implicated in adults' health decision-making and health behaviors, little is known about adolescents' health literacy and its relationship to their health behaviors. Furthermore, adolescent health literacy research overlooks adolescent development-specific needs and skills. Therefore, we qualitatively explored adolescents' (1) definitions of health literacy, preventive health behaviors, and health risk behaviors; and (2) perception of the health literacy/health behavior relationship.

METHODS

Six semi-structured focus groups were conducted with adolescents (N = 37) who answered questions about their perceptions of health literacy, preventive health behaviors, and health risk behaviors. Focus groups were coded using thematic analysis. Themes representing adolescents' definitions of health literacy were secondarily coded for alignment with definitions in the literature.

RESULTS

Some of adolescents' health literacy definitions aligned with the adult health literacy literature. They considered health literacy a tool for informed decision-making, but acknowledged not always using these skills.

CONCLUSIONS

Adolescents' definitions of health literacy were multidimensional, going beyond numeracy and literacy skills. Developmental characteristics and adolescents' definition of health risk behaviors were related to use of health literacy skills. Opportunities for adolescents to develop and practice health literacy skills are discussed.

Youth Leisure-Time Sedentary Behavior Questionnaire (YLSBQ): Reliability and Validity in Colombian University Students

Sedentary behavior (SB) is influenced by variations in social, cultural and economic contexts. This study assesses the test–retest reliability and validity of the Youth Leisure-time Sedentary Behavior Questionnaire (YLSBQ), a self-report tool that examines total and domain-specific SB in a cohort of young adults from Colombia. A cross-sectional validation study was conducted among 447 Colombian college students (52.8% men; mean (± standard deviation) age of 19.55 ± 2.54 years). To assess the reliability of the YLSBQ, Kappa statistics (k) were used. A confirmatory factor analysis (CFA) was conducted to determine validity. The Cronbach alpha for the 12 behaviors of the YLSBQ showed a good-to-excellent internal consistency (0.867, ranging from 0.715–0.935). Intraclass correlation coefficient (ICC) indicated that 10 items (83.0%) and two items (17.0%) showed excellent and good reliability, respectively. Furthermore, ICC between the total sedentary time was 0.926 (95% confidence interval [CI] = 0.912 − 0.939), which was interpreted as excellent. The goodness-of-fit tests provided evidence that overall, a four-factor solution was an adequate fit with the time scores. In conclusion, the YLSBQ could be considered a reliable, valid and usable tool for the assessment of SB in young adults in a Latin American country. We found that the psychometric properties of the questionnaire were similar to those of the original Spanish validation study.

Daily-level effects of alcohol, marijuana, and simultaneous use on young adults' perceived sleep health

STUDY OBJECTIVES

Simultaneous alcohol and marijuana (SAM) use is increasingly prevalent among young adults but has adverse health consequences. The current study examined daily-level associations between perceived sleep health and SAM use, relative to non-substance-use days and alcohol- or marijuana-only days. We also estimated linear associations between alcohol/marijuana use and perceived sleep health and explored whether effects were moderated by combined use of alcohol and marijuana.

METHODS

A community sample of SAM-using young adults (N=409; Mage=21.61, SD=2.17; 50.9% female; 48.2% White; 48.9% college students) completed twice-daily surveys for five 14-day sampling bursts. Daily measurements assessed substance use and perceived sleep health in terms of subjective sleep quality, negative impact of sleep on functioning, and symptoms of insomnia.

RESULTS

Multilevel models indicated that, relative to non-substance-use days, participants reported poorer perceived sleep health on alcohol-only days, better perceived sleep health on marijuana-only days, and mixed evidence regarding SAM use (i.e., fewer perceived symptoms of insomnia, but poorer perceived next day functioning attributed to sleep). Daily-level estimates showed increased alcohol use was associated with poorer perceived sleep health, while stronger effects from marijuana were associated with better perceived sleep health. Across all indices of sleep health, only one linear association was moderated by combined use: The adverse association between alcohol and next day functioning was weaker on days alcohol was combined with marijuana.

CONCLUSIONS

Findings provide additional evidence for daily-level effects of alcohol and marijuana use on perceived sleep health and address an important literature gap regarding potential adverse effects of SAM use.

Investigation of the associations between physical activity, self-regulation and educational outcomes in childhood

It is common knowledge that physical activity leads to physiological and psychological benefits. The current study explored the association between physical activity and self-regulation longitudinally and the indirect relationship this may have on academic achievement, using secondary data on primary and secondary school children from the Millennium Cohort Study, a cohort of infants born in 2000–2001 in the United Kingdom. There are two main findings. First, there is a positive link between physical activity and emotional (not behavioural) regulation both concurrently and longitudinally across all three time points, 7-years-old, 11-years-old and 14-years-old. The relationship was negative for emotional regulation and negligible for behavioural regulation when controlling for socioeconomic status. Second, across two time points (due to data availability), physical activity positively predicted academic achievement through emotional regulation for 7-year-olds and behavioural regulation in 11-year-olds. The impact of this relationship was more pronounced when controlling for socioeconomic status. Together these findings indicate that emotional regulation is linked to physical activity in early childhood. Subsequently, emotion regulation predicts academic attainment, suggesting that early interventions might focus on attention rather than behaviour.

Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study

Background

The year 2020 has been challenging for many, particularly for young adults who have been adversely affected by the COVID-19 pandemic. Emerging adulthood is a developmental phase with significant changes in the patterns of daily living; it is a risky phase for the onset of major mental illness. College students during the pandemic face significant risk, potentially losing several protective factors (eg, housing, routine, social support, job, and financial security) that are stabilizing for mental health and physical well-being. Individualized multiple assessments of mental health, referred to as multimodal personal chronicles, present an opportunity to examine indicators of health in an ongoing and personalized way using mobile sensing devices and wearable internet of things.

Objective

To assess the feasibility and provide an in-depth examination of the impact of the COVID-19 pandemic on college students through multimodal personal chronicles, we present a case study of an individual monitored using a longitudinal subjective and objective assessment approach over a 9-month period throughout 2020, spanning the prepandemic period of January through September.

Methods

The individual, referred to as Lee, completed psychological assessments measuring depression, anxiety, and loneliness across 4 time points in January, April, June, and September. We used the data emerging from the multimodal personal chronicles (ie, heart rate, sleep, physical activity, affect, behaviors) in relation to psychological assessments to understand patterns that help to explicate changes in the individual’s psychological well-being across the pandemic.

Results

Over the course of the pandemic, Lee’s depression severity was highest in April, shortly after shelter-in-place orders were mandated. His depression severity remained mildly severe throughout the rest of the months. Associations in positive and negative affect, physiology, sleep, and physical activity patterns varied across time periods. Lee’s positive affect and negative affect were positively correlated in April (r=0.53, P=.04) whereas they were negatively correlated in September (r=–0.57, P=.03). Only in the month of January was sleep negatively associated with negative affect (r=–0.58, P=.03) and diurnal beats per minute (r=–0.54, P=.04), and then positively associated with heart rate variability (resting root mean square of successive differences between normal heartbeats) (r=0.54, P=.04). When looking at his available contextual data, Lee noted certain situations as supportive coping factors and other situations as potential stressors.

Conclusions

We observed more pandemic concerns in April and noticed other contextual events relating to this individual’s well-being, reflecting how college students continue to experience life events during the pandemic. The rich monitoring data alongside contextual data may be beneficial for clinicians to understand client experiences and offer personalized treatment plans. We discuss benefits as well as future directions of this system, and the conclusions we can draw regarding the links between the COVID-19 pandemic and college student mental health.

How Early Stressful Life Experiences Combine With Adolescents' Conjoint Health Risk Trajectories to Influence Cardiometabolic Disease Risk in Young Adulthood

Research has primarily focused on additive (unique) associations between early stressful life experiences (specifically, socioeconomic adversity and maltreatment) and young adults' cardiometabolic disease risk without considering multiplicative (synergistic) influences. Furthermore, research has not fully considered the varying patterns of health risk trajectories (e.g., substance use, obesogenic-related behaviors, depressive symptoms) across adolescence and the transition to young adulthood that may link earlier stressful experiences and later cardiometabolic disease risk. This study examined heterogeneity in conjoint health risk trajectories from adolescence to the transition to young adulthood and their additive and multiplicative (synergistic) influences with early stressful life experiences on cardiometabolic disease risk in young adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (n = 9,421; 55.6% female) over a period of 13 years. Four distinct conjoint health risk trajectories were identified considering trajectories of substance use behaviors, obesogenic-related behaviors, and depressive symptoms: (a) overall high-risk, (b) behavioral risks, (c) psycho-obesogenic risks, and (d) overall low-risk. Socioeconomic adversity and maltreatment were additively and multiplicatively associated with cardiometabolic disease risk in young adulthood. Individuals with overall high-risk conjoint trajectories averaged higher cardiometabolic disease risk in young adulthood when they were exposed to early socioeconomic adversity. Implications for personalized interventions for individuals who have experienced multiple forms of health risks are discussed.

Adolescent Technology, Sleep, and Physical Activity Time in Two US Cohorts

The advent of internet-enabled mobile digital devices has transformed US adolescent technology use over the last decade, yet little is known about how these changes map onto other health-related behaviors. We provide a national profile of how contemporary technology use fits into adolescents' daily health lifestyles compared to the previous generation, with particular attention to whether and for whom technology use displaces time spent in sleep or physical activity. Time diaries were collected from 11-17 year olds in 2002-03 (N=1,139) and 2014-16 (N=527) through the US Panel Study of Income Dynamics Child Development Supplement. Contemporary adolescents spent 40 minutes more per week in technology-focused activities, but their composition was more varied compared to the earlier cohort. Contemporary technology use was predictive of less time in physical activity, and adolescents engaged in frequent video game play spent less time in physical activity compared to peers with other technology use profiles.

Multiple Health Risk Behaviors in Young Adult Smokers: Stages of Change and Stability over Time

BACKGROUND

Health risk behaviors (HRBs) are common, yet not well understood in young adult smokers.

PURPOSE

We examined HRB profiles over 12 months in young adult smokers participating in a Facebook smoking cessation intervention clinical trial.

METHODS

Participants (N = 500; age M = 20.9 years; 54.6% women) were recruited online and randomized to receive either a 3-month Facebook smoking cessation intervention or referral to Smokefree.gov (control). A Health Risk Assessment determined risk for 10 behaviors at baseline and 3, 6, and 12 months. Latent class analysis (LCA) and latent transition analysis (LTA) were used to identify patterns of HRBs and changes over time.

RESULTS

At baseline, participants reported an average of 5.4 (standard deviation [SD] = 1.7) risk behaviors, including smoking (100%), high-fat diet (84.8%), poor sleep hygiene (71.6%), and low fruit and vegetable intake (69.4%). A 3-class model fit the data best at baseline and all follow-up time points: low risk (28.8% at baseline) with low likelihood of risk on all behaviors except smoking, substance use risk (14.0% at baseline) characterized by heavy episodic drinking, cannabis use, and other illicit drug use, and metabolic risk (57.2% at baseline), with a high percentage of members at risk for a low fruit and vegetable intake, high-fat diet, inactivity, stress, and poor sleep hygiene. Classes were very stable at 3, 6, and 12 months, with few participants transitioning between classes.

CONCLUSIONS

Most young adult smokers engaged in multiple risk behaviors, with meaningful clustering of behaviors, and demonstrated stability over a year's time. In addition to smoking, targets for intervention are co-occurring substance use and metabolic risk behaviors.

CLINICAL TRIALS REGISTRATION

NCT02207036.

Adherence to the Mediterranean Diet in College Students: Evaluation of Psychometric Properties of the KIDMED Questionnaire

No prior studies have examined the reliability properties of the 16-item Mediterranean Diet Quality Index (KIDMED) questionnaire among young adults from a non-Mediterranean country. The objective of this study was to determine the psychometric properties in terms of the reliability and validity of the KIDMED questionnaire in young adults from Colombia. A cross-sectional validation study was conducted among 604 Colombian college students (47.51% men and 52.48% women; mean age of 21.60 ± 2.02 years). Kappa statistics were used to assess the reliability of the KIDMED questionnaire. A categorical principal components analysis was used to determine validity. Based on the KIDMED score, 58.4% of students had a good adherence to the Mediterranean diet (MedDiet). Good agreement in the general score of the questionnaire was observed (κ = 0.727, 95% confidence interval = 0.676 to 0.778, p < 0.001). A five-factor model was identified which explained almost 51.38% of the variability, showing the multidimensionality of the questionnaire. In conclusion, this study provides reasonable evidence for the reliability and validity of the KIDMED questionnaire for assessing adherence to MedDiet in college students within a Latin American country. The evaluation of the psychometric properties of this tool in early adulthood and in a non-Mediterranean country will be useful in clinical practice and epidemiological research, since practitioners and health researchers now have a valid and reliable short scale.

Weight Management Efforts, But Not Weight Perceptions, Are Associated with Dietary Quality among Youth and Young Adults in Canada

BACKGROUND

Efforts to lose, gain, or maintain weight are prevalent among youth and young adults, but little is known about the relationship between weight management efforts and dietary quality. Attempts to manage weight are typically driven by weight perceptions, which may also uniquely affect overall diet.

OBJECTIVE

The objective was to explore sex-stratified associations between weight management efforts and perceptions with dietary quality among youth and young adults.

DESIGN

Cross-sectional online survey data were drawn from Wave 1 (2016) of the Canada Food Study.

PARTICIPANTS/SETTING

Youth and young adults (n = 3,000), aged 16 to 30 years, were recruited from community settings in five Canadian cities and completed the online survey. The analytic sample consisted of 2,040 participants.

MAIN OUTCOME MEASURES

The Healthy Eating Index-2015 (HEI-2015) was used to characterize dietary quality among participants who completed a 24-hour recall. Respondents reported their weight change efforts over the past year and their weight perception.

STATISTICAL ANALYSES PERFORMED

Sex-stratified multiple linear regression analyses were conducted to investigate relationships between each of weight management efforts and perceptions, separately, and dietary quality, controlling for known covariates.

RESULTS

The HEI-2015 mean score was 52 of 100 possible points. Nearly one quarter of male and female respondents reported not trying to do anything about their weight, whereas 16% reported trying to maintain, 28% and 5% trying to gain, and 33% and 55% trying to lose weight, respectively. Most respondents (63% of males and 66% of females) perceived their weight as just about right. Among males, trying to gain or maintain weight were each significantly associated with higher HEI-2015 mean scores compared with not trying to manage weight (P < .01 and <.001, respectively), whereas this relationship existed only for weight maintenance among female respondents (P < .01). Weight perceptions and HEI-2015 mean scores were not significantly related.

CONCLUSIONS

Efforts to manage weight, which are commonplace among youth and young adults, are associated with dietary quality. Future behavioral research may provide insights into strategies used by youth to manage weight, guiding interventions that recognize links among weight-related behaviors, dietary quality, and other determinants of health.

A gender framework for understanding health lifestyles

PURPOSE

A health lifestyles approach holds promise for understanding change in women's and men's health behaviors and reducing gendered health disparities. The emerging theoretical and empirical literature on health lifestyles (individuals' bundled health behaviors that are shaped by group-based identities and norms) helps elucidate complex disparities in health behaviors, but research is needed on how gender shapes the development of health lifestyles. This study proposed and assessed a dynamic multilevel framework for understanding health lifestyles that draws on insights from contemporary gender and life course scholarship.

DATA

Using the transition from adolescence into adulthood as an empirical case, we analyzed US data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 6605), which followed adolescents through young adulthood, collecting information on their health behaviors and social contexts.

FINDINGS

Latent class analyses showed that health lifestyles differed significantly by gender. Results supported the dynamic multilevel framework, finding more variation in health lifestyle behaviors within genders than between, high levels of change across ages, intersections of gender with age, and socioeconomic status as a structural pathway for gender's influence.

CONCLUSION

Taken together, these findings suggest that conceptualizing gender as a dynamic multilevel system intersecting with other social statuses is fruitful for understanding how health lifestyles form and change. These findings can inform more effective policies to change health behaviors.

Working memory moderates the predictive influence of distress intolerance on health-related goal attainment

High distress intolerance (DI: often assessed as anxiety sensitivity) and low working memory capacity (WMC) have each been identified as risk factors for negative health behaviors. To our knowledge, these risk factors have only been studied independently. The current study investigated both the independent and interactive effects of DI and WMC in predicting health-related goal attainment in 118 undergraduates who self-selected a health-related goal. Participants received one of three interventions: values clarification, action planning, or a combination of the two. Across these interventions, we found that DI was at the point of significance (and reflected a small effect size) for predicting goal attainment, whereas WMC was not. Further, we found that when entered into the stepwise regression model together, the interaction of WMC and DI significantly predicted goal success one week later. Specifically, for individuals scoring one standard deviation below the mean in WMC, having worse DI significantly predicted worse goal attainment one week later. We believe this study represents the first published finding of the moderation of the predictive influence of DI by WMC, and underscores the importance of evaluating how risk factors that are typically examined independently operate together.

The role of education and other transition milestones in the progression of social inequalities in cigarette smoking between the ages of 18 and 25: Evidence from the Canadian National Population Health Survey

Young adulthood is now considered a sensitive period in the progression of health inequalities over the life-course. This age group experiences highly dynamic and socially patterned life-course events that require nuanced modelling choices compared to those commonly used in public health sciences. To illustrate this, we estimate changes in the risk of smoking according to student status, employment status, living arrangements, and relationship status at different ages across education categories. We used longitudinal data in 1,243 young adults followed every two years between the ages of 18-19 and 24-25 in the Canadian National Population Health Survey (1994-95 to 2010-11). We examined the age-graded associations of occasional and daily smoking with educational attainment and transition statuses using random-effects multinomial logistic regression models with interaction terms. Post-secondary education, living with parents, studying, and being in a relationship were associated with a lower risk of daily smoking in main models, with some of these associations significantly varying in magnitude by age. The risk associated with living without parents at ages 18-19 disappeared by ages 24-25. Being single was both a protective factor at ages 18-19 and a risk factor at ages 24-25. Finally, the risk associated with being single was also stronger among those who did not pursue post-secondary education. These findings support the argument that the simple conceptualization of young adults' circumstances - independent from age and social context - provides a limited understanding of the progression of health inequalities over the life-course. Research needs to consider the dynamic and intersecting nature of transition milestones during this intensive life period.

A latent class analysis of health lifestyles and health outcomes among Chinese older adults

Prior analyses have repeatedly documented the association between individual health behaviours and health outcomes. Nonetheless, few studies have taken a health lifestyle theory approach to examine how health lifestyle behaviours have shaped Chinese older adults’ health status. Using the most recent 2011–2012 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among Chinese older adults aged 65–105. Four distinct classes representing health lifestyles emerged. Furthermore, the research found the way in which the four classes representing older adults’ health lifestyles can be predicted by the respondent's demographic and socio-economic characteristics. In addition, health lifestyles were found to be strongly associated with Chinese older adults’ health outcomes which were measured by self-rated health, functional independence, cognitive function and chronic diseases, even after controlling for demographic features as well as individual and parental socio-economic disadvantage. Findings supported the cumulative disadvantage theory in health. The research highlighted the importance of promoting health lifestyles to improve older adults’ health outcomes.

The health of college students on the autism spectrum as compared to their neurotypical peers

LAY ABSTRACT

Studies have shown that children and older adults on the autism spectrum experience more physical and mental health problems than their neurotypical peers. Less is known about the physical and mental health of college students on the spectrum. Studying college students is important because young adults on the spectrum are enrolling in college at increasing rates and because health problems can be a barrier to succeeding in college. We collected data from 2820 students at 14 colleges and universities using an online survey, some of whom had registered for accommodations based on autism and others of whom had not. We used the data to compare the physical and mental health of students on the spectrum to their neurotypical peers. Because students with autism often report other disabilities that also affect health, we accounted for whether they experienced a learning disability, attention deficit hyperactivity disorder, sensory impairment, mobility impairment, mental health disorder, or any other disabilities. We assessed health using self-reports of how healthy they were physically and mentally, and reports of depressive symptoms, symptoms of anxiety, sleep deprivation, and binge drinking. We found that students with autism reported poorer physical and mental health, more depressive symptoms, and more symptoms of anxiety even after taking into account other disabilities they may have experienced. They were also less likely to report sleep deprivation and binge drinking. Our results argue for developing specialized services to address the physical and mental health challenges of college students on the spectrum.