Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Excessive dietary salt intake is a key controllable risk factor for hypertension. Despite the clear clinical benefits of reducing salt intake, overcoming the "knowledge-action" gap among patients with hypertension poses a significant public health challenge. The Theory of Planned Behavior (TPB) is a powerful framework for understanding the psychological factors that influence behavioral intentions. However, studies based on TPB that explore dietary intentions to reduce salt intake in middle-aged and older hypertension patients have not been well described nor well studied in previous literature. Using the Theory of Planned Behavior (TPB) as the theoretical framework and Structural Equation Modeling (SEM) as the methodological basis, we aimed to examine the status of salt reduction dietary intention and its influencing factors in middle-aged and older hypertensive patients. From March to November 2023, a total of 558 middle-aged and older hypertensive patients across 38 districts and counties in Chongqing Municipality, China, were interviewed using a face-to-face questionnaire with a Likert scale. SEM was used to explore the relationship between the salt reduction intention (INT) of middle-aged and older hypertensive patients aged 45 years and above and their attitude toward salt reduction (ATT), subjective norms of salt reduction (SN), and perceived behavioral control of salt reduction (PBC), as well as the bidirectional correlation between ATT, SN, and PBC. Among the 558 participants, 55.2% were female, 61.3% were older, and 38.7% were middle-aged; 44.1% were the primary home cook, and 48% had a junior high school education or above. Overall 70.8% reported an intention to reduce salt in their diets. Attitudes toward a salt-reducing diet (β = 0.22, p < 0.05) and perceived behavioral control (β = 0.70, p < 0.05) positively affected salt-reducing diet intentions, with perceived behavioral control showing the strongest effect. Subjective norm (β = 0.14, p > 0.05) did not significantly affect intentions to reduce dietary salt. This study highlights the central influence of salt-reducing dietary attitudes and perceived behavioral control in salt-reducing dietary intentions among middle-aged and older hypertensive patients. Future nutritional health education should prioritize strategies to strengthen intention and perceived behavioral control.
Dietary behaviors among young adults in Japan have become increasingly polarized, highlighting the limitations of traditional knowledge-based health education. Behavioral science-based approaches such as nudging and gamification may offer alternative strategies. This study aimed to develop and examine a Theory of Planned Behavior (TPB)-based path model of healthy dietary choice behavior among young Japanese adults and to examine patterns associated with a star-rating gamification feature embedded in a nutrition management mobile application. A total of 188 participants aged 18-39 years completed an online survey assessing TPB constructs and normative factors. Participants used either a star-rating or non-rating version of the FoodLog Athl application. Composite-score-based path analysis and conditional process analyses were conducted to examine relational patterns among constructs. Intention and self-efficacy jointly explained 48% of the variance in dietary behavior, with self-efficacy emerging as the strongest predictor. Several moderation patterns were observed, including those of gender, university year, diet app use, awareness of consequences, and ascription of responsibility. Compared with users of the non-rating version, star-rating users were observed to show higher nutrient scores but lower self-efficacy and dietary behavior scores, along with greater awareness of dietary consequences. These post-intervention findings are exploratory. Self-efficacy plays a central role in healthy dietary choice behavior among young adults, and its association with behavior appears to be shaped by perceived consequences and responsibility. By applying a composite-score-based path analysis within an SEM framework, this study clarifies the structural relationships among TPB components in everyday dietary choice behavior among Japanese young adults. Star-rating feedback may enhance reflective awareness and shows potential as a gamified nudging tool but further research is needed to clarify its effects.
Nutrition is a key determinant of cognitive functioning and academic achievement, yet students' dietary behaviors are strongly shaped by social and economic contexts. Limited evidence exists on how social determinants, nutrition, and academic performance interact as multidimensional patterns in university populations. A cross-sectional study was conducted among 325 undergraduate students at the Universidad Estatal de Milagro (Ecuador). Data were collected using a validated questionnaire covering sociodemographic factors, social determinants, nutritional behaviors, and academic outcomes. All variables were categorized and analyzed using Multiple Correspondence Analysis (MCA) to identify latent dimensions, followed by hierarchical and k-means cluster analysis to derive homogeneous student profiles. The first two MCA dimensions explained 25.1% of the total variance and revealed a clear socioeconomic-nutritional gradient and a psychosocial-academic orientation. Cluster analysis identified four distinct student profiles differing in food access, dietary habits, and academic satisfaction. Profiles characterized by favorable socioeconomic conditions and regular healthy practices (e.g., consistent breakfast consumption) were associated with higher academic satisfaction and performance. Conversely, clusters reporting financial constraints, food access difficulties, and less structured dietary behaviors showed lower academic satisfaction. Social determinants critically shape nutritional behaviors, which are closely linked to academic outcomes in university students. The combined use of MCA and clustering reveals heterogeneous profiles that highlight the need for targeted, multidimensional interventions. Integrating nutrition support, food security policies, and psychosocial services into higher education strategies may contribute to improving both student health and academic success.
This study examined health literacy and identified factors associated with health literacy among adult women. This correlational study was based on a secondary analysis of data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES). The study sample included 3,333 women aged 19 years or older. Data were analyzed using complex sample design procedures in SPSS ver. 20.1. The mean health literacy score was 30.25 out of 40, indicating moderate health literacy. Scores were relatively low for items assessing the ability to evaluate the reliability of health information obtained from the internet or media and to use such information for health-related decision-making. Overall, 32.2% of adult women demonstrated an excellent level of health literacy. Lower education levels (≤elementary school: B=-4.31, p<.001; middle school: B=-2.17, p<.001; high school: B=-0.84, p<.001), longer weekday sleep duration (≥9 hours: B=-1.54, p=.003), poorer perceived health (bad: B=-1.49, p<.001; ordinary: B=-0.82, p<.001), older age (≥65 years: B=-1.43, p=.001; 45-64 years: B=-0.64, p=.048), shorter weekend sleep duration (≤6 hours: B=-0.83, p=.003), and not engaging in muscle-strengthening activities (B=-0.67, p=.004) were associated with lower health literacy among adult women. Interventions are needed to improve health literacy among adult Korean women, particularly among older women, those with lower education levels, and those with poorer perceived health. These interventions should also consider health behaviors such as muscle-strengthening activity and sleep duration. Further research is needed to examine the relationship between women's health literacy and health behaviors, including exercise and sleep duration. This study examined health literacy and identified factors associated with health literacy among adult women. This correlational study was based on a secondary analysis of data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES). The study sample included 3,333 women aged 19 years or older. Data were analyzed using complex sample design procedures in SPSS ver. 20.1. The mean health literacy score was 30.25 out of 40, indicating moderate health literacy. Scores were relatively low for items assessing the ability to evaluate the reliability of health information obtained from the internet or media and to use such information for health-related decision-making. Overall, 32.2% of adult women demonstrated an excellent level of health literacy. Lower education levels (≤elementary school: B=−4.31, p<.001; middle school: B=−2.17, p<.001; high school: B=−0.84, p<.001), longer weekday sleep duration (≥9 hours: B=−1.54, p=.003), poorer perceived health (bad: B=−1.49, p<.001; ordinary: B=−0.82, p<.001), older age (≥65 years: B=−1.43, p=.001; 45–64 years: B=−0.64, p=.048), shorter weekend sleep duration (≤6 hours: B=−0.83, p=.003), and not engaging in muscle-strengthening activities (B=−0.67, p=.004) were associated with lower health literacy among adult women. Interventions are needed to improve health literacy among adult Korean women, particularly among older women, those with lower education levels, and those with poorer perceived health. These interventions should also consider health behaviors such as muscle-strengthening activity and sleep duration. Further research is needed to examine the relationship between women’s health literacy and health behaviors, including exercise and sleep duration.
Valid, reliable, and comprehensive instruments enable early care and education (ECE) sites to self-assess nutrition and physical activity practices and policies, but availability is limited. Therefore, we developed and assessed the test-retest reliability and convergent validity of the Site-Level Assessment Questionnaire (SLAQ). Reliability testing compared questionnaires completed by ECE personnel at 2 time points (reliability pairs). Convergent validity testing compared questionnaires completed by ECE personnel with questionnaires completed by researchers (validity pairs). Semistructured interviews with personnel who completed the SLAQ informed revisions. California Supplemental Nutrition Assistance Program Education-eligible ECE sites. Convenience sample of 32 ECE sites (18 school districts; 14 Head Starts). Seventy-six items assessing wellness policies, federal food program participation, meals, snacks, beverages, food environment, feeding practices, nutrition education, gardens, physical activity, screen time, family involvement, and breastfeeding support. Weighted κ test statistics and percent agreement were calculated for each item to assess agreement between reliability pairs and validity pairs. Eighty-eight percent of items showed moderate or higher reliability; 52% had moderate or higher validity. On the basis of these results and interview findings, the SLAQ was revised to address issues identified. Findings suggest acceptable validity and reliability of the SLAQ for assessing policies and practices at SNAP-Ed-eligible ECE sites in California. Further testing with larger, randomly selected, and geographically and socioeconomically diverse populations could broaden its application. As is, the comprehensive assessment data the SLAQ provides can be used to identify opportunities for improving ECE practices and policies that support children's health.
To assess the Food Support Program (Programa de Apoyo Alimentario) implemented by the government of Montevideo to address childhood undernutrition. A mixed-methods design. Quantitative data were collected through telephone surveys and medical records and analyzed using a prepost design. Qualitative data were collected through interviews with mothers of beneficiary children. Montevideo, Uruguay. A total of 120 children participants of the Food Support Program and their mothers. Household food insecurity, children's food consumption frequency of 17 categories in the week before the survey, anthropometric data (weight-for-age, length-for-age, and weight-for-length z-scores), and mothers' perceptions about the program. Mixed linear models and content analysis of interviews. Average household food insecurity score decreased by 1.5 points (P < 0.001) after 12 months. Average frequency of milk and cheese consumption increased by 1.3 days (P < 0.001), frequency of adding oil to meals by 1.0 days (P = 0.002), and consumption frequency of sugary foods by 1.4 days (P < 0.001). Average z-scores for weight-for-age and weight-for-length increased 0.37 (P < 0.001) and 0.31 (P = 0.001), respectively. However, length-for-age showed no significant change (P = 0.90). Mothers of beneficiary children valued economic support but highlighted gaps in program communication and education, and counseling activities. The program showed potential to alleviate immediate nutritional deficiencies, but additional and sustained integrated efforts are needed to address chronic undernutrition, food insecurity, and diet quality. In particular, the persistence of food insecurity in half of the households after 12 months underscores the need to reassess the adequacy of the cash transfer amount relative to the affordability of a healthy food basket in the country.
To explore adolescents' perceptions of disordered eating behaviors, influencing factors, and perceived effects on health and well-being. Focus group discussions. Porto, Portugal. 80 adolescents aged 15-19 years. Disordered eating behaviors. Thematic content analysis. Factors influencing disordered eating behaviors include individual (including response to emotional status, body image, and self-perception), interpersonal (encompassing interactions with school peers and family, and health professionals), and social factors (namely social norms regarding beauty and their influences, such as social media). In terms of the impact of disordered eating, health implications such as malnutrition, obesity, and some cardiometabolic disorders were mentioned. Disordered eating behaviors, according to the adolescents' perspective, can also lead to guilt and depression and serve as a pathway to eating disorders. In addition, concerns about weight and body image were identified as contributing to social isolation. Findings highlight the complex interplay of factors shaping disordered eating behaviors in adolescents. Comparison with others, body image concerns, beauty standards, and social media emerged as key influencing factors, along with appearance-related comments. Future research could assess longitudinal social media effects, media literacy interventions, and explore gender-specific experiences across clinical and nonclinical settings.
To examine the spatial distribution of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized vendors across the US, focusing on their placement within socioeconomically disadvantaged neighborhoods (SDNs) and differences by urban-rural context. Using 2022 WIC vendor data, Area Deprivation Index measures, and population data from the American Community Survey, we conducted spatial analyses of the proportions and densities of WIC vendors in SDNs. Vendors were classified as located in SDNs if they fell within census block groups in Area Deprivation Index deciles 6-10. Descriptive and spatial analytic maps were used to visualize the variation in vendor proportions and density (per 10,000 people) across states and regions. Disparities were observed across states and by rurality. Several states, primarily in the Southeast and Northeast, had < 50% of vendors and < 2 vendors per 10,000 people in their SDNs. Many Midwestern and Plains states had > 65% of vendors and > 2 vendors per 10,000 people in their SDNs. Urban-rural analyses suggest rural SDNs may have better vendor access than urban SDNs, and spatial clustering revealed potentially high-access clusters concentrated in the Midwest and Plains. Geographic access to WIC vendors varies substantially by state, region, and rurality, revealing inequities that may contribute to disparities in WIC participation and benefit redemption. Ensuring vendor placement within areas of higher socioeconomic disadvantage could enhance program access and effectiveness.
To explore the perspectives of African American mothers of low income regarding children's food and identify their culturally specific nutrition education needs to inform the design of nutrition education within a community-led, culturally responsive health promotion campaign countering the marketing of ultraprocessed foods to African American children. A basic descriptive qualitative design with focus groups of African American mothers of low income (n = 33) with preschool-aged children enrolled in a Newark, NJ, Head Start. Zoom-based discussions were recorded, transcribed, and analyzed using reflexive thematic analysis. Three themes emerged: (1) mothers know that food and health are connected, (2) cultural foodways matter, and (3) mediators at every level of the Social Ecological Framework influence children's food choices. Differences by nativity revealed a distinct subset of food-related beliefs and practices between US-born mothers and their foreign-born counterparts. Personal, cultural, and environmental influences shape the early childhood feeding practices of African American mothers of low income. Differences within this population underscore the need for a culturally responsive campaign-grounded in sociocultural context and inclusive of both US and foreign-born families-to effectively support healthier eating in early childhood.
To assess whether a nutrition and body image program improved healthy food consumption, physical activity, eating pathology, and psychosocial factors for women in recovery from substance use. Secondary data, pretest-posttest. In-person intervention conducted in 6 substance use recovery centers. Six hundred and seven adult women. Ten-week, 90-minute weekly intervention led by trained instructors. Self-report demographics, drug-use history, general nutrition and health behaviors, thin-ideal internalization, body dissatisfaction, eating pathology, binge eating, and intuitive eating. Researchers collected anthropometric/physiological measures. Paired t tests using Cohen's d tested the differences between pretest and posttest total scores on all outcome measures; univariate analysis of variance tests were used for pretest participant comparison. Participants demonstrated statistically significant (P < 0.05) improvements in general nutrition, physical activity, thin-ideal internalization, body dissatisfaction, eating pathology, binge eating, and intuitive eating behaviors compared with pretest, with effect sizes ranging from small to large (d = 0.11-0.83). Participants also reported decreases in weight-related concerns. Healthy eating and physical activity significantly increased, whereas thin-ideal internalization, body dissatisfaction, and disordered eating symptoms significantly decreased. Results support this program to augment existing substance use treatment to address nutrition, physical activity, body image, eating pathology, and weight-related issues in women.
In African societies, cultural food practices often restrict or prohibit the consumption of certain foods during pregnancy. While some of these practices persist after migration, how healthcare professionals (HCPs) perceive the influence of these practices on African migrant women's food practices in Australia remains unexplored. Understanding HCPs' perceptions of African migrant women's food practices will provide insights into how these practices are understood and addressed in clinical settings. This study examines HCPs' perceptions of the cultural food practices and nutrition behaviours of African migrant women during pregnancy and the postpartum period in Australia. Participants were recruited through convenience and snowball sampling. In-depth semi-structured interviews were conducted with 15 HCPs who had experience providing antenatal care to African migrant women in Australia. Thematic analysis was used to analyse the data. Three themes were identified: (1) HCPs' perceptions of women's cultural food practices, (2) challenges in delivering general healthy eating information, and (3) strategies for providing effective nutrition advice. Few HCPs were aware of the specific restrictive food practices among the African migrant women they support. HCPs perceived that the healthy eating information provided to these women was not always effective and culturally appropriate due to the constraints on consultation time and a lack of culturally appropriate resources. Participants expressed a need for in-service education, tailored resources on African foods to enhance culturally appropriate care, and support for continuity of care. This study highlights the challenges HCPs face in providing culturally appropriate nutrition support to African migrant women during pregnancy and postpartum. Addressing these gaps through supportive training for HCPs and culturally tailored resources for women is needed.
To pilot test whether a multicomponent school garden and nutrition education intervention was associated with increased school lunch consumption. Students in grades 1-5 from matched pairs of public schools (1 high- and 1 low-poverty intervention school, each paired with a comparison school) were observed using the System of Observational Cafeteria Assessment of Foods Eaten. Consumption was defined as the percentage of each entrée and side salad eaten. Mixed-effects models analyzed data collected through direct observation over 13 days across 28 lunch periods. Students in intervention schools consumed 47.5% of the entrée and 44.1% of the entrée plus side salad, compared with 34.5% and 31.2% in comparison schools. Adjusted analyses showed students consumed 0.13 (P = 0.006) and 0.11 (P = 0.01) more portion units, with no significant treatment-by-pair interactions. The intervention was associated with greater meal consumption, supporting the need for a cluster-randomized trial.
To develop a machine learning model to identify adult Expanded Food and Nutrition Education Program (EFNEP) participants at high risk of attrition using preprogram data. Secondary data analysis. A total of 339,335 adults participating in EFNEP nationwide from 2013-2022. Adult EFNEP attrition, defined as a participant dropping out of EFNEP before the end of the program. Three machine learning models (logistic regression, random forest, and eXtreme Gradient Boosting) were developed and evaluated to predict attrition based on participants' preprogram food behaviors, dietary intake, demographics, and program characteristics. The eXtreme Gradient Boosting model demonstrated the best predictive performance, achieving the highest F1 score of 0.68 (a measure of the balance between correctly identifying true dropouts and avoiding false positives), and a recall of 70% (correctly identifying dropouts). Key predictors of attrition included Cooperative Extension region, EFNEP funding tier, enrollment year, household income, age, race, residence, number of children, and preprogram dietary intake and physical activity. Application of machine learning models in nutrition education program settings can uncover previously unknown patterns contributing to attrition, informing targeted interventions and resource allocation to improve retention and maximize program impact.
Hypertension and diabetes are very common, interrelated chronic conditions. Awareness, diagnosis, treatment, and control rates of these conditions remain low, and access to quality care-particularly in rural areas-is a persistent challenge in many low- and middle-income countries. Strengthening primary health care, including the use of digital tools, is important to improve management of these chronic conditions. This study aims to assess the implementation and effectiveness of a multicomponent, decentralized primary care model in comparison with a digital health-only intervention and usual care in rural Bangladesh. The study applies a type 2 hybrid effectiveness-implementation design, using a 3-arm quasi-experimental approach, comprising 2 intervention arms and 1 usual care comparison arm. The study is being conducted across 3 subdistricts in the Dinajpur district, Rangpur division, northern Bangladesh. Primary outcomes include blood pressure and blood glucose control rates, assessed by population-based repeated cross-sectional surveys with independent samples, supplemented by facility-based prospective cohort data. Additionally, a mixed methods process evaluation is being conducted to capture the quantity, fidelity, adaptations, reach, and context of the interventions. The baseline community survey was conducted between January and March 2024, enrolling 6849 participants distributed across 3 arms: 2262 in usual care, 2287 in the digital-only arm, and 2300 in the multicomponent intervention arm. Participants had a mean age of 55.9 (SD 10.6) years with equal sex distribution (female: 3432/6849, 50.1%). Educational attainment was low, with 39.5% (2704/6849) of participants having no formal schooling and only 12.1% (917/6849) attaining secondary or higher education. The majority (6316/6849, 92.2%) reported being either self-employed or homemakers. The age-standardized baseline blood pressure control rate among all participants with hypertension was 10.2% overall, while the glycemic control rate among those with diabetes was 14.9%. Awareness and treatment rates for hypertension were 35.3% and 23.0%, respectively, compared to 60.7% and 34.5% for diabetes. The study findings will provide critical evidence on scalable models for decentralized noncommunicable disease care and will have important implications for improving the management of hypertension and diabetes in Bangladesh and similar low-resource settings globally.
Examine young adults' use of social media for nutrition-related information (SMNI), and its association with diet quality, restrained eating, and explore potential mediators. We conducted a cross-sectional survey of Australians (aged 22-29 years) in 2023. The predictor variable was SMNI, mediators were nutrition knowledge, confusion, backlash, and social comparison, and outcomes were diet quality and dietary restraint. Mediation analysis was conducted using path analysis. From 200 participants, 46.5% used SMNI, and this was positively associated with nutrition knowledge (β = 0.19, P = 0.005), which was positively associated with diet quality (β = 0.25, P < 0.001). The mediating pathway between SMNI and diet quality, via nutrition knowledge, had a positive indirect effect (0.05 [95% confidence interval, 0.01-0.09]). There was no association between SMNI and restrained eating. Almost half the participants used SMNI, which was associated with diet quality and mediated by nutrition knowledge. Social media may be useful for nutrition promotion for young adults.
To evaluate the feasibility and effects of the What Can I Eat? (CIE) Healthy Choices for American Indians and Alaska Native (AI/AN) Adults with Type 2 Diabetes (T2D) curriculum augmented by a food security resource. A 3-arm pilot randomized controlled trial (n = 67) was conducted at an urban AI/AN clinic with adults with T2D. The groups were as follows: (1) WCIE and food security resource, (2) WCIE alone, or (3) food security resource alone. Feasibility outcomes were collected throughout the study. Baseline and 3-month assessments included sociodemographic, clinical, dietary (24-hour recall), food security, and nutrition behavior measures. Data were analyzed using linear mixed models. Feasibility outcomes were strong: 90% class attendance, 93% retention, > 99% data completeness, and high satisfaction. Randomization and recruitment were successful. Trends suggest improved self-efficacy for healthy eating (Δ = 0.3-0.6, P < 0.05) and use of the American Diabetes Association Diabetes Plate (Δ = 0.7-1.0, P < 0.05). What Can I Eat? Healthy Choices for American Indians and Alaska Natives With Type 2 Diabetes is feasible and may enhance healthy eating and self-efficacy among AI/AN adults with T2D.
Prediabetes (PD) does not always progress to type 2 diabetes; however, lifestyle modification and weight loss are recommended to prevent disease progression. This study aimed to determine whether a text message-based intervention for older adults with PD in South Korea could reduce glycated hemoglobin (HbA1c) levels and promote healthy habits. A randomized controlled trial with two parallel groups was conducted and approved by the Institutional Review Board of Wonju Severance Christian Hospital (IRB No: CR321379). A text message intervention was provided only to the intervention group for six months, while the control group was advised to maintain their usual daily routines. The text messages covered the following categories: nutrition, exercise, medical knowledge, lifestyle, and self-reflective thoughts. A total of 96 participants aged 50 years and older underwent clinical measurements, completed the Korean Health Habits Questionnaire, and were assessed for quality of life at baseline and after the intervention. HbA1c, waist circumference, and fasting blood glucose decreased significantly in both groups (p < 0.05). The intervention group demonstrated significant improvements in body mass index, low-density lipoprotein cholesterol, total cholesterol, and milk consumption. In contrast, instant food consumption increased significantly in the control group, resulting in significant between-group differences (p < 0.05). In addition, the frequency of late-night eating increased significantly within the control group (p < 0.05). Text message-based interventions may serve as an effective adjunctive self-management strategy to improve HbA1c levels and promote healthy habits in older adults with prediabetes.
This study examined the association between various tobacco product use behaviors and metabolic syndrome (MetS) among Korean adults. Data from 15 359 adults aged ≥19 years who participated in the 2020-2022 Korea National Health and Nutrition Examination Survey were analyzed. Participants were classified as dual users, e-cigarettes (EC; nicotine-containing liquid-type)/ heated tobacco products (HTP) users, cigarette-only users, ex-smokers, or non-smokers. MetS was defined according to the NCEP ATP III criteria. Subgroup analyses were conducted by survey year and age group. Complex-sample cross-tabulation and logistic regression analyses were performed. All types of tobacco product use were associated with an increased likelihood of MetS compared with non-smokers. This association was particularly evident among dual users (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.12 to 1.94) and cigarette-only users (OR, 1.19; 95% CI, 1.01 to 1.41). The highest risk was observed among adults aged 19-39 years and among dual users in 2020. Dual use and cigarette smoking were associated with a higher likelihood of MetS, particularly among younger adults. Efforts are needed to reduce the misconception that EC/HTP products are less harmful alternatives and to strengthen education and prevention in order to prevent changes in tobacco use behavior from leading to new health risks.
The rationale for this current study was to assess the factors associated with anxiety and depressive symptoms in a cohort of students from seven universities across the European education system. Furthermore, the research sought to assess the barriers and facilitators for seeking support when students perceive any mental health issues. A cross-sectional multicenter study was conducted, which included 4830 higher education students from seven European countries. A sociodemographic questionnaire, the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7) were used to assess depressive and anxiety symptoms, respectively. The Mental Health Inventory (MHI-5) assessed general psychological well-being. A questionnaire was used to assess preferences regarding support-seeking behavior and perceived barriers in the event of mental distress. Linear mixed models (LMMs) were used in the statistical analysis. Swedish students reported lower levels of moderate to severe depressive symptoms (34.1%) and moderate to severe anxiety (27.9%) when compared, for example, with Irish students (63.1% and 52.9%, respectively). Younger students, females, students with a history of mental disorder and lower levels of academic performance, or from a poorer socioeconomic background reported increased rates of depressive and anxiety symptoms. The most valued support-seeking strategies were speaking to friends or engaging in psychotherapy; in contrast, the most cited barrier to seeking support was the expense related to professional therapy and long waiting times for an appointment with professional therapists. There is a need to develop and/or review mental health promotion strategies for higher education students across Europe. These strategies need to consider the individual and culturally specific needs of higher education students so that they are effective in removing perceived barriers when seeking support in the event of mental distress.