An Agent-based Model to Evaluate Positive Externality of Smoking Cessations 采用个体为本模型评估戒烟服务的正外部性

Introduction: Cigarette smoking can be viewed as a contagious disease whereby an active smoker will turn nonsmokers into passive smokers. Agent-based models (ABM) have been shown to have the advantage of exploring heterogeneity and inter-agent interaction, as compared with more aggregate models. In this study, we use an ABM framework and simulate a hypothetical tobacco control program in a multiunit dwelling, to examine the program’s “return on investment” in terms of passive smoking reduction. Method: We assume that in a multiunit building of 121 people there are 30 active smokers, with their neighbors as passive smokers. We simulate different spatial distributions of these 30 active smokers. Results: Helping the last active smoker quit smoking gave us a net reduction of four passive smoking cases, revealing a pattern of marginal increase in return to smoking cessation efforts. For population segments where active smokers are more likely to be clustered together (in households, work sites, residential units, etc.) this pattern of “increasing returns to health investments” will be even stronger. Discussion: This hypothetical intervention experiment provides an insight for the potential impact of reducing active smoking prevalence on reducing passive smoking prevalence. A model-based discussion can help public health stakeholders strategize their approaches to design tobacco control programs

Refocusing China’s Family Planning Commission in the 21st Century

China’s entry into an aging society calls for a transition of its population policy. The State Family Planning Commission (SFPC) could concentrate more on many essential health and human services for the next few decades. Prevention of birth defects and reduction of unnecessary cesarean births are cost-effective interventions that would enhance the health of the upcoming generations. Research and evaluation of modern contraceptive technologies are needed to promote reproductive health and help both the SFPC and users make well-informed decisions. Human Immunodeficiency Virus (HIV) and Sexually Transmitted Diseases (STD) testing and counseling deserve the joint efforts of the government, health services, and the society at large. Further, the SFPC’s collaboration with the Ministry of Health, Ministry of Agriculture and the National Women’s Federation can help to reinforce its role in the treatment of infertility and maternal diseases, the provision of public services for low-income families, and the prevention of domestic violence. The SFPC can also play a role in China’s increasing foreign aid, particularly in those countries where artificial contraception and HIV/STD prevention are needed

The Association Between Nutrition, Physical Activity, and Weight Status Among Adults in Georgia

Background: Obesity is classified as having a body mass index (BMI) greater than 30 and is associated with higher risks of type 2 diabetes, coronary heart diseases, hypertension, and other adverse health outcomes. In 2015, the prevalence of self-reported obesity among adults in Georgia was 30.7. The present study focused on how, in 2015, lifestyle factors, specifically nutrition and physical activity levels, related with weight status in Georgia. Methods: The dataset used for this analysis was from the 2015 Behavioral Risk Factor Surveillance System. The association between weight status (as measured by BMI) and nutrition and physical activity levels was examined by use of linear regressions, controlling for socio-demographic variables. Results: The sample consisted of 3,543 adult respondents in Georgia, of whom 2,285 (64.5%) were overweight or obese. Regarding the variables assessing nutrition, vegetable consumption had a significant association with weight status: one unit increase in consumption of vegetables decreased BMI by 0.009 (p=0.039). Conclusions: Vegetable consumption was negatively associated with BMI. Future research should examine, with more robust measures, the relationship between physical activity levels and weight status and determine how other lifestyle factors relate to weight status. This will become increasingly relevant, as the rates for obesity in Georgia and the United States continue to trend upward. Key words: obesity, lifestyle factors, nutrition, physical activity, weight status, BM

Impact of School Social Support and Bullying Victimization on Psychological Distress among California Adolescents

Background and Purpose: National reports showed that over 20% of high school students were victims of bullying, which could potentially lead to psychological problems. School social support may be protective against mental distress linked with victimization. This study examined the main and moderating effects of social support from adults in schools on non-specific serious psychological distress (SPD) related to victimization among California adolescents. Methods: Utilizing the 2011-2012 California Health Interview Survey (CHIS), we analyzed a representative sample of 2,799 adolescents aged 12-17 years old. Logistic regression analyses were conducted modeling the odds of SPD in relation to school social support and victimization. Results: Adolescents who were victimized were twice as likely to have SPD compared to non-victims. Higher level of social support from adults in schools was protective against SPD, but did not buffer the effect of bullying exposure. Discussion: Findings from the present study suggested that adult support from schools can help with students’ psychological problems but does not appear to prevent the psychological consequences of victimization. Additional intervention is needed, above and beyond social support, to prevent victimization and its psychological consequences

Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women.

INTRODUCTION:Asian women have a higher prevalence of gestational diabetes mellitus than women of other races/ethnicities. We aimed to compare the prevalence of gestational diabetes among Asian American women to other racial/ethnic groups and explore whether the higher occurrence of the disorder among Asian women can be explained by acculturation. METHODS:We conducted a population-based, cross-sectional study among 5,562 women who participated in the 2007 Los Angeles Mommy and Baby Study (LAMB) in Los Angeles County, California. All women included in this study had a live delivery in 2007 and did not have pre-pregnancy type I or II diabetes. We applied multivariate, weighted logistic regressions to compare gestational diabetes prevalence among racial/ethnic groups, adjusting for its known risk factors. We conducted mediation analysis to test whether the difference in prevalence across racial/ethnic groups could be explained by acculturation. RESULTS:Among the 5,562 women studied, the weighted prevalence of gestational diabetes was 15.5% among Asian American women, followed by 9.0% among non-Hispanic black women, 10.7% among Hispanic women, and 7.9% among non-Hispanic white women. Compared with non-Hispanic white women, Asian women had 2.44 (95% confidence interval [CI], 1.81-3.29; P < .001) times the odds of having gestational diabetes, independent of maternal age, education, marital status, income, prenatal care adequacy, prepregnancy BMI, and physical activity. Acculturation was negatively associated with having gestational diabetes (odds ratio [OR] = 0.93; 95% CI, 0.86-0.99) and explained 15.9% (95% CI, 11.38%-25.08%; P < .001) of the association between Asian race and the condition. CONCLUSION:We found that Asian race was an independent risk factor for gestational diabetes, and higher acculturation may play a protective role against it in Asian American women

Healthfulness of Fast-Food and Full-Service Restaurants in 16 Georgia Counties after Mandatory Menu Labeling

Background: Despite that the effect of menu labeling on consumer choices has been studied, there are gaps in the research on the healthfulness of the restaurant food environment post-mandatory menu labeling, specifically in the Southern United States. This study aims to assess the healthfulness of fast-food and full-service chain restaurant environments after compliance with mandatory menu labeling. Methods: The healthfulness of 46 representative fast-food and full-service chain restaurants in 16 Georgia counties was examined using the Nutritional Environment Measures in Restaurants (NEMS-R) survey. The scores were compared between full-service and fast-food restaurants using t-tests across several healthfulness measures such as facilitators and barriers to healthful eating. Results: Fast-food restaurants had more barriers to healthy eating than full-service restaurants. Specifically, fast-food restaurants, compared to full-service restaurants were more likely to encourage large portions (60.9% vs. 17.4%, p=0.006) and offer combination meals at a cheaper price than the sum price of individual items (56.5% vs. 21.7%, p=0.033). Conclusions: Findings on the post-menu labeling chain restaurant food environment in our study does not show improvements from the extant evidence on pre menu labeling food environment. Further, NEMS-R scores for both fast-food and full-service restaurants indicated the need for improvements in the healthfulness of chain fast-food and full-service restaurants’ food environments

Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Schizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China. Methods: This was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients' sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted. Results: A total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia. Conclusions: The direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.National Natural Science Foundation of China Natural Science Foundation of Guangdong Provinc

Daily time-use patterns and obesity and mental health among primary school students in shanghai: a population-based cross-sectional study

Physical activity, screen viewing, sleep, and homework among children have been independently linked to health outcomes. However, few studies have assessed the independent associations between time spent in daily activities and children’s physical and mental health. This study describes time spent in four activities among primary school students in Shanghai, and examines the relationship between daily time-use patterns and obesity and mental health. The representative sample consists of 17,318 children aged 6–11 years in Shanghai. Time spent in moderate to vigorous physical activities (MVPA), screen viewing, sleep, and homework was measured by validated questionnaires. Logistic regressions were performed. We also fitted generalized additive models (GAM) and performed two-objective optimization to minimize the probability of poor mental health and obesity. In 2014, 33.7% of children spent ˂1 hour/day on MVPA, 15.6% spent ≥ 2 hours/day on screen viewing, 12.4% spent ˂ 9 hours/day on sleep, and 27.2% spent ≥ 2 hours/day on homework. The optimization results suggest that considering the 24-hour time limit, children face trade-offs when allocating time. A priority should be given to the duration of sleep and MVPA. Screen exposure should be minimized to save more time for sleep and other beneficial activities

Predictors of patients’ loyalty toward doctors on web-based health communities: cross-sectional study

Background: Web-based health communities provide means for patients to not only seek care but also to promote their relationship with doctors. However, little is known about the predictors of patients’ loyalty toward doctors in Web-based health communities. Objective: This study aimed to investigate the predictors of patients’ loyalty toward doctors in Web-based health communities. Methods: On the basis of sociotechnical systems theory and attachment theory, we propose that social factors including emotional interaction, perceived expertise, and social norm influence patients’ loyalty through their emotional attachment, whereas technical factors including sociability, personalization, and perceived security affect patients’ loyalty through functional dependence. To validate our proposed research model, we used the survey method and collected 373 valid answers. Partial least square was used to analyze the data. Results: Our empirical analysis results showed that all the social factors including emotional interaction (beta=.257, t350=2.571; P=.01), perceived expertise (beta=.288, t350=3.412; P=.001), and social norm (beta=.210, t350=2.017; P=.04) affect patients’ emotional attachment toward doctors significantly, whereas except sociability (beta=.110, t350=1.152; P=.25), technical factors such as personalization (beta=.242, t350=2.228; P=.03) and perceived security (beta=.328, t350=3.438; P=.001) impact functional dependence significantly. Considering the effect of working mechanisms, both emotional attachment (beta=.443, t350=4.518; P<.001) and functional dependence (beta=.303, t350=2.672; P=.008) influence patients’ loyalty toward doctors in Web-based health communities significantly. Conclusions: Patients’ loyalty toward doctors in Web-based health communities is important for the effectiveness of doctors’ advice or service in Web-based health communities. The research results not only fill the gaps in the literature of the patient-doctor relationship and Web-based health communities but also has many implications for establishing patients’ loyalty on Web-based health communities and in physical context