Hyeonkyeong Lee

Background: Unhealthy weight management behaviors (UWMBs) have become increasingly common among emerging adult women, yet prior research has largely focused on psychological or perceptual correlates in isolation. In appearance-oriented contexts, structural influences, including social norms, may co-occur with individual characteristics to shape these behaviors. The social determinants of health (SDOH) framework offers a useful lens for examining UWMBs by jointly considering structural and intermediary determinants. Objective: This study aimed to identify key SDOH associated with engagement in UWMBs among emerging adult women in South Korea by examining structural and intermediary determinants within a single adjusted model. Methods: A nationwide cross-sectional survey was conducted among women aged 19 to 25 years using stratified sampling with quota allocation based on residential area and employment status. The final analytic sample included 1594 participants. UWMBs were assessed using a 9-item checklist; reporting at least 1 behavior in the past year was classified as UWMB engagement. Structural determinants included social norms, social influence, and socioeconomic position. Intermediary determinants included perceived body shape, body weight misperception, weight disparity, weight self-stigma, media health literacy, social network support, and BMI. Multivariable logistic regression analyses were performed to identify factors associated with UWMBs. Results: Overall, 88% (1404/1594) of participants reported at least 1 UWMB in the past year, and 71.4% (n=1002) engaged in 2 or more UWMBs. Compared with women without UWMBs, those engaging in UWMBs reported stronger weight-related social norms, greater social influence, more distorted perceptions of body image, higher weight self-stigma, and greater media health literacy and social network support. In the multivariable model, UWMB engagement was significantly associated with perceived body shape (average vs thin: OR 2.41, 95% CI 1.52-3.83; P <.001; obese vs thin: OR 2.33, 95% CI 1.13-4.79; P =.02), descriptive norms (OR 1.38, 95% CI 1.19-1.61; P <.001), thin-ideal internalization (OR 1.32, 95% CI 1.01-1.71; P =.04), BMI (OR 1.10, 95% CI 1.01-1.19; P =.04), and educational attainment (in college vs high school or less; OR 1.69, 95% CI 1.09-2.62; P =.02; college or higher vs high school or less; OR 1.81, 95% CI 1.13-2.91; P =.01), with perceived body shape showing the largest odds ratios. Conclusions: UWMBs are widely practiced among emerging adult women and are associated with both intermediary body image–related factors and broader sociocultural norms when considered simultaneously. These findings underscore the need for interventions that address appearance-related norms, particularly those disseminated through social media environments, rather than approaches focused solely on individual determinants. Future research should clarify the mechanisms linking structural and individual determinants to inform culturally relevant prevention strategies.

Background: Unhealthy Weight Management Behavior (UWMB) refers to harmful weight-control practices that can lead to physical and mental health issues, requiring intervention. This study examines how social media affects UWMB in emerging adult women (18–25 years). Methods: A systematic review was conducted following PRISMA guidelines. Five databases (PubMed, CINAHL, EMBASE, Web of Science, and Cochrane Library) were searched for studies published between 1 January 2014 and 31 December 2023. Study quality was assessed using JBI critical appraisal tools, and the protocol was registered with PROSPERO (CRD42024542028). Results: Nine studies were included. Social networking sites (SNS) (n = 6, 66.7%) promoted self-objectification, body comparison, and appearance-focused feedback, contributing to UWMB. Appearance comparisons on SNS triggered body dissatisfaction, exacerbating UWMB. Content communities (n = 4, 44.5%), such as diet/fitness apps, fostered competition and obsession with numbers, further aggravating UWMB. Definitions of UWMB varied across studies, encompassing behaviors like heavy exercise, substance use, surgical methods, calorie-counting obsession, and binge eating, highlighting inconsistencies. Conclusions: Social media's diverse negative influences on UWMB in emerging adult women are highlighted with the need for clearer definitions and measurements of UWMB. Tailored interventions that address the specific impacts of different social media platforms are essential.

Background: High consumption of sugar-sweetened beverages (SSBs) is associated with numerous adverse health outcomes, as they are a major source of added sugars. Parents play a critical role in shaping children's dietary behaviors, and their nutritional literacy is particularly important in influencing SSB intake. Aim: This study examined the factors influencing SSB consumption among parents of elementary school children in Nigeria. Methods: A cross-sectional study was conducted using a convenience sample of 188 parents of children aged 10 to 13 years. Data were collected through a self-administered survey that measured the frequency of SSB intake, categorized as low (0–1 serving per week), moderate (2–6 servings per week), or high (≥7 servings per week). The survey also assessed nutritional literacy, SSB knowledge, and awareness of the recommended daily intake of added sugar. A generalized linear model with ordinal logistic regression was used. Results: Approximately 66.5% of parents reported moderate SSB consumption. Chi-squared analysis showed significant differences across nutrition literacy variables: parents who frequently read nutritional labels, utilized nutritional information, and referred to nutrition facts consumed fewer SSBs ( p < 0.001). In the regression models, SSB knowledge remained a significant predictor of lower SSB intake (adjusted OR = 1.34, 95% CI [1.18, 1.51], p < 0.001). Conclusion: Although parental nutrition literacy is important, targeted knowledge about SSBs is a stronger factor in reducing SSB intake. These findings emphasize the need for culturally relevant interventions and school-parent nutrition programs that equip Nigerian parents with specific knowledge to reduce SSB consumption and support healthier family diets.

Aims: Income influences individuals’ engagement in health behaviours, which may mediate the relationship between income and cardiovascular event incidence. However, research on the association between cardiovascular event and cumulative low-income status remains limited, as most previous studies have assessed income at a single time point. This study aimed to investigate the association between cumulative low-income status and cardiovascular event incidence and to explore the mediating role of engagement in health behaviour. Methods and results: In this retrospective cohort study, we analysed national representative data from the Korea Health Panel Survey (2008–2018), including 9284 Korean adults. Cumulative low-income status was defined based on total number of years classified as low-income status during the 3 year baseline. Cardiovascular event incidence was defined as the first diagnosis of myocardial infarction, stroke, or cardiovascular disease-related death. Engagement in health behaviour was measured through smoking, alcohol consumption, and physical activity. After adjusting for covariates, Cox proportional hazard models showed an association between increased risk of cardiovascular event incidence and prolonged cumulative low-income status [1 or 2 years: hazard ratio (HR) = 1.27, 95% confidence interval (CI) = 0.97–1.67; 3 years: HR = 1.33, 95% CI = 1.01–1.77; P for trend = 0.045]. A generalized structural equation model revealed that engagement in negative health behaviour mediated the longitudinal relationship between 1 and 2 years of cumulative low-income status and cardiovascular event incidence (indirect effect estimate = 0.179, P-value = 0.004). Conclusion: These findings suggest that interventions targeting engagement in health behaviour among population with cumulative low-income status may help prevent cardiovascular events and promote cardiovascular health equity.

Background: Sugar intake through sugar-sweetened beverages (SSBs) remains a major public health concern among adolescents. Tailored dietary interventions have garnered interest for promoting sustainable behavior change, yet traditional pre-post designs often overlook the temporal complexity of individual adaptation. This study applied a trajectory-based approach to assess how adolescents’ sugar intake trajectories evolved in response to an intake-based tailored intervention. Methods: A secondary analysis was conducted on data from a 14-day chatbot intervention (CRIS, KCT0008114) aimed at reducing sugar intake among adolescents. Group-based trajectory modeling (GBTM) was used to identify distinct intake trajectories. A linear mixed-effects model examined the impact of tailored intervention type, time, and trajectory group membership on sugar consumption, including their interactions. Subgroup analysis compared intervention responses between native Korean and racial and ethnic adolescents. Results: Three trajectory groups were identified: reduction (38%), maintenance (57%), and no-intake (5%). Adolescents with higher baseline intake exhibited rapid declines in consumption, whereas those with lower intake showed gradual reductions. By the second week, reduction and maintenance groups converged. A significant three-way interaction among intervention type, time, and trajectory group was observed, indicating heterogeneous responses. No group exhibited increased consumption, suggesting sustained effects. Racial and ethnic adolescents demonstrated greater responsiveness to the tailored intervention. Conclusion: Intake-based tailored interventions effectively accommodate individual variability in dietary behavior change, with particularly pronounced benefits among participants with higher baseline intake. These findings underscore the importance of adaptive intervention strategies and the need to consider individual and structural factors when designing public health interventions targeting adolescent diet.

Digital health interventions are increasingly used to promote behaviour change in adolescents. The Living Lab approach, fostering collaboration with users and stakeholders to identify real-life problems and co-create sustainable solutions, is gaining traction in health interventions. This study aimed to evaluate the usability of a novel Digital-based Living Lab (D-LLab) designed to promote healthy dietary behaviour in adolescents. The D-LLab was developed in four phases: topic derivation, strategy selection, digital tool selection, and usability assessment. It was implemented over a 4-week period, structured into four participatory phases: identifying problems, exploring solutions, solving problems, and sharing outcomes. Twenty-one adolescents aged 14–16 from one middle school enrolled, with a balanced sample of racial and ethnic adolescents, and native Koreans. Usability was evaluated using a mixed methods approach, incorporating quantitative indicators—appropriateness (system usability scale, SUS), acceptability (satisfaction), and feasibility (completion rate)—alongside qualitative data on participant experiences. The mean SUS score was 70.75, exceeding the benchmark for acceptable usability. Participants rated high satisfaction (mean score: 8.45/10), and 95.2% completed all sessions. High usability appeared to be driven by real-time information sharing and collaborative digital interaction, which supported spontaneous problem solving around dietary issues. The D-LLab demonstrated acceptable usability and strong participant engagement. These findings highlight the feasibility of applying digital-based Living Lab approaches in school settings, warranting further trials to evaluate long-term behavioural impact across diverse populations. This intervention was registered at cris.nih.go.kr as KCT0007004.

Objective: Implementation outcomes are important in intervention research as a necessary precursor to achieving desired health outcomes. Considering the critical role of implementation outcomes, this study involved a comprehensive review of implementation outcome measures used in digital health interventions specifically targeting young adults. Methods: This scoping review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, and the search incorporated the elements of population, concept, and content framework in three electronic databases (PubMed, Embase, and CINAHL). A matrix was used for data extraction and integrative thematic synthesis for analysis. Implementation outcomes were reported based on the indicators in each study, totaling eight outcomes: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Results: The search yielded 2441 articles, and 17 were finally identified. The intervention implementation techniques that were adopted were telephone calls ( n = 1); social media ( n = 2); web-based programs ( n = 4); short message service ( n = 5); wearable devices ( n = 1); mobile applications ( n = 3); and a combination of phone calls, emails, and text messaging ( n = 1). The highest number of implementation outcomes that were assessed in all the studies were acceptability ( n = 10), feasibility ( n = 10), and fidelity ( n = 8). Short message service ( n = 14), web-based programs ( n = 11), and mobile applications ( n = 7) had the highest number of implementation outcomes. Conclusions: Researchers have largely assessed the acceptability and feasibility outcomes. The need to integrate the implementation outcomes framework in intervention research design is underscored.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Adolescents in child welfare institutions often experience challenges in adopting health-promoting behaviors (HPB), which leads to significant health vulnerabilities. Objective: This study aimed to identify the HPB of adolescents in child welfare institutions and the determinants influencing them, using the Health Promotion Model. Methods: A cross-sectional design was employed. A total of 276 adolescents from 17 child welfare institutions in East Java Province, Indonesia, participated in this study. Structural equation modeling was utilized to examine the relationships among the determinants. Results: HPB had a positive correlation with health literacy (r=0.13, P<.05), self-esteem (r=0.31, P<.001), perceived self-efficacy (r=0.66, P<.01) and social support (r=0.53, P<.01), and a negative correlation with perceived barriers to action (r=-0.15, P<.05). In the final model, both perceived self-efficacy and social support accounted for 47.9% of HPB. In addition, perceived barriers to action were influenced by health literacy (β=-0.234, P<.001), self-esteem (β=-0.194, P<.01), and perceived self-efficacy (β=-0.185, P<.01). Self-esteem indirectly affected HPB through perceived self-efficacy (β= 0.099, P<.01) and social support (β= 0.078, P<.001). Conclusions: To improve the HPB of adolescents in these institutions, their self-esteem needs to be increased in order to further enhance their self-efficacy and social support. Careful attention and monitoring of HPB among these adolescents may lead to better health outcomes and support their transition from child welfare institutions to the broader community.

BACKGROUND Adolescents in child welfare institutions often experience challenges in adopting health-promoting behaviors (HPB), which leads to significant health vulnerabilities. OBJECTIVE This study aimed to identify the HPB of adolescents in child welfare institutions and the determinants influencing them, using the Health Promotion Model. METHODS A cross-sectional design was employed. A total of 276 adolescents from 17 child welfare institutions in East Java Province, Indonesia, participated in this study. Structural equation modeling was utilized to examine the relationships among the determinants. RESULTS HPB had a positive correlation with health literacy (r=0.13, P<.05), self-esteem (r=0.31, P<.001), perceived self-efficacy (r=0.66, P<.01) and social support (r=0.53, P<.01), and a negative correlation with perceived barriers to action (r=-0.15, P<.05). In the final model, both perceived self-efficacy and social support accounted for 47.9% of HPB. In addition, perceived barriers to action were influenced by health literacy (β=-0.234, P<.001), self-esteem (β=-0.194, P<.01), and perceived self-efficacy (β=-0.185, P<.01). Self-esteem indirectly affected HPB through perceived self-efficacy (β= 0.099, P<.01) and social support (β= 0.078, P<.001). CONCLUSIONS To improve the HPB of adolescents in these institutions, their self-esteem needs to be increased in order to further enhance their self-efficacy and social support. Careful attention and monitoring of HPB among these adolescents may lead to better health outcomes and support their transition from child welfare institutions to the broader community.