Amid the COVID-19 pandemic, TikTok, an emerging social media platform, has created an information hub to provide users with engaging and authoritative COVID-19 information. This study investigates the video format, type and content of the COVID-19 TikTok videos, and how those video attributes are related to quantitative indicators of user engagement, including numbers of views, likes, comments and shares. A content analysis examined 331 videos from official accounts featured in the COVID-19 information hub. As of 5 May 2020, the videos received 907 930 000 views, 29 640 000 likes, 168 880 comments and 781 862 shares. About one in three videos had subtitles, which were positively related to the number of shares. Almost every video included a hashtag, and a higher number of hashtags was related to more likes. Video types included acting, animated infographic, documentary, news, oral speech, pictorial slideshow and TikTok dance. Dance videos had the most shares. Video themes included anti-stigma/anti-rumor, disease knowledge, encouragement, personal precautions, recognition, societal crisis management and work report. Videos conveying alarm/concern emotions, COVID-19 susceptibility and severity, precaution response efficacy had higher user engagement. Public health agencies should be aware of the opportunity of TikTok in health communication and create audience-centered risk communication to engage and inform community members.

Parent-child sexual-health communication is critical. Religious involvement is important in many African-American families, but can be a barrier to sexual-health communication. We tested a theory-based, culturally tailored intervention to increase sexual-abstinence communication among church-attending African-American parent-child dyads. In a randomized controlled trial, 613 parent-child dyads were randomly assigned to one of three 3-session interventions: (i) faith-based abstinence-only; (ii) non-faith-based abstinence-only; or (iii) attention-matched health-promotion control. Data were collected pre- and post-intervention, and 3-, 6-, 12- and 18-months post-intervention. Generalized-estimating-equations Poisson-regression models revealed no differences in communication by intervention arm. However, three-way condition × sex-of-child × sex-of-parent interactions on children's reports of parent-child communication about puberty [IRR=0.065, 95% CI: (0.010, 0.414)], menstruation or wet dreams [IRR=0.103, 95% CI: (0.013, 0.825)] and dating [IRR=0.102, 95% CI: (0.016, 0.668)] indicated that the non-faith-based abstinence intervention's effect on increasing communication was greater with daughters than with sons, when the parent was the father. This study highlights the importance of considering parent and child gender in the efficacy of parent-child interventions and the need to tailor interventions to increase fathers' comfort with communication.

Menstruation is a natural process in girls, but sometimes it is accompanied by beliefs and behaviors with cultural roots that result in poor health consequences; this study aimed to consider perceptions of individual, families and community to current cultural beliefs, and to determine the effect of education based on the PEN-3 cultural model on students' menstrual health behaviors in Iran. Study had a mixed method design. In the qualitative phase, data were collected from students, their mothers and teachers through focused group discussion and in-depth interviews. In the quantitative phase, training was done in four 2-h sessions for intervention group. The data were collected immediately and 2 months after the training by a questionnaire and they were analyzed by Friedman and Wilcoxon non-parametric tests. Training was effective on all of the model structures and significantly increased mean score of the health behavior after training and 2 months later by 8.74 and 13.86, respectively, in intervention group (P<0.05). The perception and behavior of the others and access to sanitary services and products, especially cultural factors affect girls'' menstrual health behaviors, therefore, it is necessary to design the health plans regarding each of these factors, and the cultural context of each community.

Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.

Previous studies have found it challenging to recruit African-American (AA) participants into health education research studies. The goal of this article is to describe the recruitment methods used for the Nutritious Eating with Soul (NEW Soul) study, a 2-year randomized behavioral health education intervention, conducted in two cohorts, with emphasis on methods used for reaching men. Participants indicated how they learned about the study on an online screening questionnaire from a list of the recruitment strategies we employed. Due to limited recruitment of men in Cohort 1, recruitment strategies for Cohort 2 focused on reaching men. Across the two cohorts, a total of 568 (23% men) participants completed the online screener and 159 (21% men) completed all baseline assessments and enrolled in the study. The most effective methods for completing screening questionnaires were radio ads, referrals from friends and family, TV interviews, social media posts and community events. Men were primarily recruited via radio ads, whereas women were more often recruited through TV and social media. Radio was an effective way to recruit AA adults into nutrition interventions, particularly men. In addition, low-cost methods, such as personal referrals, social media posts and community events were also effective strategies.

In 2020, COVID-19, a new emerging infectious disease (EID), was spread throughout the world, including Europe. Spain, in particular, witnessed a significant outbreak of the pandemic. In consequence, all classes were cancelled and the Government declared a state of emergency, ordering the lockdown of the entire population from March to May. The aim of this research is to explore the impact of the COVID-19 outbreak on the representations of young university students from the University of the Basque Country and their emotional response when the crisis started. A free-association exercise was completed by 503 students from the University of the Basque Country (UPV/EHU) (Northern Spain). To analyze the content, the Reinert method was used with the Iramuteq software for lexical analysis. The results showed that students placed COVID-19 at a distance from the self, pointing out issues related to social response and disinformation, while showing concerns for self-related issues that are linked to negative emotions, academic consequences, and potentially close victims. The students' concerns were categorized at four main levels: the communicative-informative level, health-emotional level, community-social level, and academic level. All of this has created overwhelming feelings of nervousness, along with anger and emotional fatigue. These results indicate the necessity for universities to work from a holistic standpoint, not only in terms of responding to academic needs but also from psychological, communicative, social, health, and well-being perspectives.

Belonging to a school Gender and Sexuality Alliance (GSA) is associated with lower substance use among LGBTQ+ youth. However, it is unknown whether GSA participation facilitates access to resources for substance use concerns. Using longitudinal data from 38 Massachusetts high schools, we compared sources of support for substance use concerns listed by GSA members (n = 361) and nonmembers (n = 1539). Subsequently, we tested whether GSA membership was associated with comfort, confidence and awareness regarding substance use resources in school and the community. Finally, we assessed whether specific GSA activities and discussions (e.g. social support) were associated with these outcomes. Among students with recent substance use, GSA membership was associated with greater comfort, confidence and awareness regarding school-based substance use resources in the spring semester, adjusted for fall semester levels and non-GSA club involvement. Furthermore, students in GSAs where members reported more advocacy and social support activities reported higher levels of comfort, confidence and awareness regarding community-based substance use resources. These results indicate that among students using alcohol or nicotine products, GSA members may be more receptive to school-based substance use prevention efforts. Furthermore, GSA-based social support and activism experiences may promote access to community-based substance use resources.

The existing research routinely measures the influence of health information-seeking behavior (HISB) as a whole, which does not capture the complexity and diversity of media channel usage in HISB. The influence of HISB on patient's lifestyle behaviors and the mediation process through patient-centered communication (PCC) in medical encounters has been understudied in previous literature. Drawing from Street's three-stage model, this study conducted a secondary analysis of the Health Information National Trends Survey in China to investigate the influences of HISB across five different media outlets (e.g. information-oriented media, entertainment-oriented media, search engines, social media and mobile health applications) on two types of healthy lifestyles (e.g. physical activity, fruit and vegetable consumption), by the mediation of PCC. PROCESS path-analysis with bootstrapping estimation was used to test the hypothesized relationships. The results revealed that HISB is positively related to PCC, and PCC positively predicts frequent engagement in healthy lifestyles. Moreover, PCC partially mediates the effect of information-oriented media HISB on healthy lifestyles and fully mediates the effect of HISB through the other four media sources. This study highlights the essential stage of PCC transferring HISB to engagement in healthy lifestyles and draws attention to the varying influences of media channels carrying different characteristics.

While rates of sexually transmitted infections (STIs) in Iran are alarming, little is known about preventive sexual behaviors. The purpose of this article was to assess the effect of a mobile-based educational program to promote preventive behaviors regarding STIs in Iranian women. Using Roger's protection motivation theory, the following measures were developed as the study's conceptual framework: STI knowledge, STI vulnerability, STI prevention self-efficacy and STI prevention intentions. These variables were measured by the Persian version of a valid Korean four-scale tool. Data from 76 women were analyzed: 37 women in the smartphone application (Experimental) group and 39 in the control group. Health Education Sexually Transmitted Infections Application was developed as a smartphone application training program. Participants were tested at three-time points: pre-test (baseline), post-test 1 (immediately after the program's completion) and post-test 2 (16 weeks after the program's completion). Significant group differences were found at different times in STI knowledge, vulnerability, prevention self-efficacy and prevention intentions. The smartphone application was effective in sustaining the effects of the educational program in the experimental group. The development of appropriate teaching materials on sensitive public health issues, such as STIs to promote individual self-learning skills is suggested.

In the United States, elite and media communications about the risks of, and mitigation strategies for, COVID-19 have been characterized by lack of consensus. In this study, we draw from a nationally representative sample of American adults to examine the associations between exposure to different media and platforms (mainstream, conservative, liberal or social media) and adherence to COVID-19 mitigation measures such as physical distancing and mask use. We also examine the individual and social factors associated with adherence to mitigation measures. We find that exposure to conservative outlets, being republican, having low confidence in scientists and high perception of information overload are associated with low adherence. In contrast, exposure to liberal and mainstream news outlets, being democrat, having high confidence in scientists, and low perception of information overload are associated with high adherence. The findings suggest the need for consistent and unified public health messaging that cuts across partisan splits and the growing skepticism in science.

Corporal punishment (CP) leads to detrimental mental and physical consequences for a child. One way to prevent CP is to encourage parents to apply alternative discipline strategies that do not involve violence. Based on the knowledge-behavior gap framework in public health education, this study analyzed the focus group data of 75 low-income Black, Latino and White parents to uncover commonalties and differences in their knowledge, self-efficacy and response efficacy of alternative discipline strategies. Findings revealed that parents knew several alternative discipline strategies and had confidence in their ability to conduct these strategies. However, parents reported that some strategies were hard to implement because they lacked the relevant resources. Moreover, parents did not perceive that alternative discipline strategies were effective without using some forms of CP. Knowledge, self-efficacy and response efficacy of alternative discipline strategies are risk factors for child physical abuse and addressing them will help prevent injury and health impacts on children, while providing safe, stable, nurturing relationships and environments for child development.

Iceland has witnessed a dramatic decline in adolescent substance use that may be partly the result of efforts related to the Icelandic prevention model (IPM). We sought to test risk and protective factor assumptions of the IPM using a prospective cohort study with 12 months separating baseline from follow-up. Participants were students in grades 8 and 9 in the national Icelandic school system enrolled in the spring of 2018 and 2019 (N=2165). Participants self-reported their experiences of cigarette smoking, alcohol consumption, and cannabis use and seven risk and protective factors. Analyses were conducted with generalized linear modeling with extension to general estimating equations with correlated outcomes data. Both individual main-effects models and collective models including all main-effects were tested. Out of 28 individual main-effects models, 23 produced findings consistent with study premises (P<0.05). Multiple main-effects models largely sustained the findings of the individual main-effects models. Findings support the assumption that the risk and protective factors commonly emphasized in the IPM are associated with the four different substance use outcomes in the hypothesized direction. Communities that plan to implement the IPM among adolescents might consider these factors in their work.

The aim of the current study was to determine the extent to which Italian people intend to receive a vaccine against SARS-CoV-2 and to investigate its associations with worry, institutional trust and beliefs about the non-natural origin of the virus. A sample of 624 people living in Italy was recruited in April 2020 using an online platform. The survey included questions about intention to receive a vaccine against SARS-CoV-2, trust, worry and beliefs about the origin of the virus. Most respondents (75.8%) intended to receive a vaccine, while 32 (5.1%) and 63 (10.1%) participants responded 'No' and 'I do not know', respectively. The remaining participants (9.0%) chose not to respond to this question. Controlling for socio-demographic factors, a multinomial logistic regression model revealed that no intention to receive a vaccine was associated with lower levels of worry and institutional trust, while increased odds for responding 'do not know' were found among participants holding beliefs about the non-natural origin of the virus. Vaccine acceptance may not be sufficient to establish a high level of herd immunity and a successful implementation of new pandemic vaccination programs should take into account trust, conspiracy beliefs and worry.

Less than 1% of children in the United States concurrently meet guidelines for fruit/vegetable intake, physical activity, screen time, and sugar-sweetened beverages. Prior evidence suggests that parents of this 1% potentially cope with stress differently. This qualitative study used a positive deviance-based approach to locate mothers whose children avoided negative feeding outcomes despite being 'high-risk' for obesity. Semi-structured interviews were conducted in Spanish for two groups: low-income, Hispanic mothers whose children were normal weight and met recommendations for fruits/vegetables and physical activity (n = 5); and a comparison group whose children had obesity and did not meet guidelines (n = 8). Topics included weight-related parenting practices, attitudes toward health, and stress management. Interviews were transcribed, translated, and coded using NVivo for theoretically driven thematic analysis. Results suggested that mothers viewed stress differently. Mothers of healthy weight children believed stress could be prevented, such as by paying children more attention or directing one's attention away from stressors; comparison group mothers tended to report stress about managing their child's eating and about financial worries. Future research is needed to understand the underlying sources of these differences (e.g. personality traits, coping practices) and test whether stress prevention interventions can promote healthy parental feeding practices.

School-based sexuality education makes teachers important gatekeepers of students' access to information about sexual and reproductive health and rights. The school setting has the potential to reach large numbers of students. However, teachers' professional identities may go beyond, differ from or even conflict with the qualities required of sexuality educators. To gain a better understanding of the role of professional identity in the delivery of school-based sexuality education, this study used cultural schema theory to study teachers' professional identities, and how these motivate them to provide sexuality education. In-depth interviews were conducted with 40 sexuality education teachers at secondary schools in Kampala, the capital of Uganda. Sexuality education lessons were observed to validate the findings from the interviews. Results identified five cultural schemas of professional identity: (i) upholder of ethics and regulations; (ii) authority figure; (iii) counsellor and guide; (iv) role model; and (v) guardian. The study concludes that teachers' cultural schemas of professional identity motivate them to adhere to moral discourses of abstinence and sexual innocence. To support teachers in taking more comprehensive approaches to sexuality education, it is important that they receive adequate teacher training and support from the Ugandan government, the school administration and the wider community.

teen Mental Health First Aid (teenMHFA) is a school-based mental health program that trains adolescents to support peers who are experiencing mental health problems or crises. The program has been evaluated for adolescents aged 15-18 years as part of a randomized controlled trial, however qualitative feedback from students on their perceptions of the program is yet to be explored. The current study describes the perspectives of students who took part in the trial. Feedback on the perceived strengths and weaknesses of the program was provided by 979 Year 10 students (M = 15.82 years, female = 43.94%, English as a first language = 72.77%) at four government funded public schools in Melbourne, Australia via online surveys. A content and thematic analysis was performed on the data using a six-step process. Students generally found the program relevant and they connected with the visual material, personal stories and interactive activities. Suggestions for improvements included encouraging active student participation in classroom discussion and providing opportunities to practice skills. School-based mental health education can benefit from input from stakeholder perspectives, particularly when designing mental health content for delivery by external trainers.

The objective of this review was to investigate process of pictograph development and the effectiveness of pictographs in patient education. We conducted searches in Medline/PubMed, CINAHL with full text, PsycInfo, ERIC and Cochrane Library with keywords: (pictograph or pictorial) AND (patient education) NOT (children or adolescent or youth or child or teenagers). After excluding manuscripts that did not meet inclusion criteria, 56 articles were included between the time of the last review on this topic (January 2008) and May 2019. There are 17 descriptive studies, 27 randomized control trial studies, 9 quasi-experimental studies and 2 unique literatures in the systematic review. Major goals of the studies are pictograph development or validation. The majority of manuscripts (n = 48) supported the approach. However, six studies did not find significant differences in the outcome. Differences in patient population, pictograph designs and author-developed outcome measurements made it difficult to compare the findings. There is a lack of evidence on validating information outcome measurements. This review demonstrated that implementing pictographs into patient education is a promising approach for better information understanding and health management. Pictographic interventions need to be carefully developed and validated with both the targeted patient population and the clinical experts.

This prospective study aimed to examine how parenting style relates to health behaviors and body mass index of Lebanese adolescents while checking for interactive effect of child characteristics (age and gender). About 341 students from private and public schools in Mount Lebanon and Beirut area, aged between 16 and 18 years, completed a self-administered survey assessing socio-demographics, parenting styles and health behaviors. Adolescents were surveyed at two time points, six months apart. Anthropometric measurements were also taken. Authoritative parenting was associated with better outcomes compared to the neglectful style. Adolescents raised with an authoritative style had higher adherence to the Mediterranean diet and lower consumption of alcohol intake. Parenting style was a significant predictor of eating behavior and alcohol intake of Lebanese adolescent. Interventions aiming at improving health behaviors should also encompass healthy parenting style strategies.

Health literacy is considered by some as a determinant of health. Research suggests that different levels of health literacy may be associated with human immunodeficiency virus (HIV) knowledge and behaviour, including willingness to test. This study assessed the health literacy demands of existing Australia HIV prevention resources available online using a health literacy assessment and content analysis. Two reviewers assessed 66 resources using the Health Literacy INDEX. Sixty-one (92%) scored below 50%, with an average score of 35.5%. A coding frame was developed to conduct a content analysis of the resources excluding videos, multiple webpages and booklets (n = 52). We coded for six categories of knowledge: HIV knowledge (100% of resources), transmission (96%), acquired immune deficiency syndrome (AIDS) knowledge (88%), testing (87%), consequence of infection (85%) and prevention (77%). We found that resources required a reading grade above grade 8, and very few resources considered audience appropriateness. There were missed opportunities to encourage HIV prevention or testing. Some resources used incorrect language to refer towards people living with HIV, and transmission and prevention messages were often inconsistent. Guidelines for developing HIV prevention resources are warranted to improve health literacy, accessibility and appropriateness of resources and ensure consistent messages and framing of HIV risk.

This study examined whether type of physician practice settings was associated with cultural competency training for newly hired physicians. We used data from the 2016 National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services for Office-based Physician Survey. The survey contains a sample of 397 office-based physician responses completed during the period from August to December 2016 (weighted n = 293306). The outcome variable was whether cultural competency training was required for newly hired physicians. The primary predictor variable was type of physician practice settings. We used logistic regression to analyze the association between physician practice settings and cultural competency training for newly hired physicians adjusting for covariates. About 71% physicians belonged to solo or group practice settings. Among these, only 10.4% required cultural competency training for newly hired physicians. Among other practice settings, 34.8% required the training. Results from logistic regression showed that newly hired physicians in solo or group practices (adjusted odds ratio: 0.22; 95% confidence interval: 0.11-0.44) were less likely to have cultural competency training compared to those in other settings. Practice settings are associated with cultural competency training. Cultural competency training across all practice settings may contribute toward improving patient-physician communication, reducing health disparities, and increasing patient satisfaction.

Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.

The study compared the effectiveness of three teaching methods on the oral health status of high school children. The study population of 791 school children selected from three different schools was randomly allocated to one of three intervention groups: (i) Webinar group (Online presentation)-260 subjects, (ii) Face to Face lecture using PowerPoint presentation (F2F PP group)-261 subjects and (iii) Control group (Only lecture)-270 subjects. Subjects from the Webinar group and F2F PP group received oral health education at an interval of 15 days starting from baseline. Subjects from the control group received oral health education only at baseline. Oral Hygiene Index (OHI) and Gingival Index (GI) were measured at baseline, at 1 month, 2 months' and 3 months' interval. OHI and GI showed a significant reduction (P = 0.001) in the Webinar group and F2F PP group; However, in the control group, OHI and GI reduced from baseline till second month and showed an increase at 3 months' interval. F2F PP group showed a maximum reduction in OHI and GI followed by the Webinar group. It can be concluded that F2F PowerPoint-based oral health education was most effective followed by the webinar method.

Despite well-established research on the applications of the theory of planned behavior (TPB) in the American culture, TPB has not been fully tested in the Kenyan culture. This study compared the applications of TPB in predicting smoking intentions (i.e., future and weekend smoking intentions) of Kenyan and American young adults. Data were collected from 252 Kenyans and 227 Americans. The Kenyan participants consisted of 41.7% females with a mean age of 25 years (SD = 4.81). The American participants (49.3% females) had an average age of 19 years (SD = 1.30). Multi-group path analysis was performed to test the equivalence of a TPB-based mediation model in Kenyans and Americans. Significant differences of TPB application were detected. In the American model, smoking consequence beliefs were indirectly associated with smoking intentions through attitudes whereas neither direct nor indirect effects of smoking consequence beliefs were detected in the Kenyan model. Instead, normative beliefs indirectly associated with future and weekend smoking intentions through attitudes and subjective norms in the Kenyan model. Despite some overlapping paths, there were cultural variations on specific associations among TPB constructs between Kenyans and Americans. Cultural adaptations may be needed when applying TPB in the Kenyan cultural context.

The current study examined the efficacy of health warnings on caffeinated energy drinks (CEDs). Participants aged 12-24 years (n = 2040) completed an online survey where they were asked to recall any existing warning statements on CED products and were randomized to one of 29 experimental warning conditions. Regression models were fitted to examine differences between conditions in product appeal, perceived safety and message recall. Overall, fewer than 30% of participants were able to accurately describe an existing CED product warning. Experimental findings indicated that exposure to CEDs with warning labels resulted in greater recall. Warnings on the back of CED cans featuring large font, a border, and a 'caution' heading resulted in significantly greater recall (P < 0.05 for all). Front-of-package 'High source of caffeine' labels resulted in greater recall than a quantitative description (P < 0.001); caffeine labels generally elicited lower product appeal (P < 0.001) and perceived safety (P = 0.002) ratings vs. no caffeine labels, and the qualitative caffeine statement elicited lower perceived safety ratings than the quantitative statement (P = 0.02). Existing warning statements in Canada have low levels of awareness. Warnings on CEDs could be enhanced to increase the salience of messages, with greater impact from clear, descriptive, front-of-package 'High source of caffeine' labels.

Low-income, rural children are at a greater risk for poor dietary intake. Schools offer a venue to deliver appropriate interventions. Our aim was to evaluate the implementation and effectiveness of Healthy Schools, Healthy Students (HSHS). We conducted a mixed-methods evaluation using a cluster-randomized trial design with 20 schools in a rural, Midwestern state. HSHS included education sessions, cafeteria coaching and taste testing. We interviewed implementers (n = 13) and nutrition educators (n = 8), conducted six focus groups with cafeteria coaches, and surveyed fourth graders (n = 1057) about their nutrition knowledge, attitudes toward and preferences for fruits and vegetables (F&V), F&V consumption and MyPlate awareness. We used multi-level linear models to estimate the intervention effect and qualitative data were coded. There were very few challenges to implementation. HSHS participation was positively associated with knowledge, attitudes toward F&V, preferences for vegetables from the taste tests, MyPlate awareness and vegetable consumption. HSHS was viewed as beneficial and easy to deliver, suggesting this type of intervention could be widely implemented. Improving knowledge and attitudes through nutrition education and preferences through taste testing have the potential to improve dietary intake among rural students. Low-cost nutrition interventions can be successfully implemented in rural elementary schools with positive outcomes.

Preventive lifestyle interventions are needed to address challenges in engaging men in conventional health programmes. This process evaluation examined the feasibility and acceptability of HAT TRICK, a gender-sensitized programme targeting physical activity, healthy eating and social connectedness. A mixed-methods approach was utilized to examine the effectiveness of recruitment and selection processes, facilitators' experiences and challenges and participant experiences with the programme. Evaluation measures included participant flow data and baseline assessments, facilitator debriefs, a post-intervention process evaluation questionnaire and telephone interviews with a subsample of participants. Participants (n = 62) were overweight (body mass index [BMI] > 25 kg m-2) and inactive (<150 min of moderate to vigorous physical activity [MVPA] per week) men with a mean age 51 ± 10.1 years. Participants reported high levels of satisfaction, acceptability and engagement with the intervention programme, content and resources. Facilitators noted the importance of creating a friendly, non-judgemental environment and observed that intervention content was best received when delivered in an interactive and engaging manner. Future programme refinements should consider strategies for strengthening social support, as well as opportunities for leveraging participants' interest in other health-related issues (e.g. mental health). Findings yield valuable information about the implementation of gender-sensitized interventions for men and demonstrate the importance of male-specific engagement strategies for reaching and engaging overweight, inactive men.

Awareness and knowledge have been identified as essential requirements to successfully combat the global threat which COVID-19 currently poses. Rural communities are particularly at risk because of their low socio-economic status and high illiteracy level. There is currently uncertainty regarding how to effectively raise awareness about the pandemic and educate rural communities about it. In this study, we tested the effectiveness of interpersonal communication in awareness creation and knowledge about COVID-19 among rural communities in a developing country. We tested three hypotheses at 0.05 level of significance. The sample size was made up 470 participants. The questionnaire served as the instrument for data collection. In the analysis of data, both descriptive and inferential statistics were used. The results demonstrate that interpersonal communication is effective in creating awareness about COVID-19 among rural communities. It was also found that interpersonal communication was effective in improving knowledge about the pandemic among rural communications. We explored the implications of these findings on healthcare delivery.

Hand washing is effective for the prevention and transmission of pathogens but washing with water only is not effective at reducing contamination. The study focussed on the evaluation of hand washing behaviour in Basic schools (Primary and Junior High Schools) in Ghana. Results of the study revealed that 75% of responding schools have hand washing stands to promote hand washing with soap. Sixty percent of the hand washing facilities were functional at the time of the study in the schools. Hand washing facilities were found to be inadequate as most of the schools lacked running water and soap for hand washing. The school children (72%) were found to have knowledge on hand hygiene. The school children were aware that they can get cholera, typhoid fever, dysentery, diarrhoea, stomach cramps and pains when they do not wash their hands with soap. Majority (68.2%) of school children reported that washing hands after defecation is important but only 17.5% reported actually follow this practice. The school children (51%) reported washing their hands before eating. Many of the schools did not have toilet facilities for the school children. The school children (35%) learnt hand washing from their parents and 60% from the teachers.

This study examined media coverage of COVID-19 in Nigeria with attention to the frequency and depth of coverage, story format, news sources, media tone and themes. Four widely read newspapers were content analysed between February 2020 and April 2020. Focus was on Daily Sun, Vanguard, Daily Trust and Leadership. Results indicated that the Nigerian media performed well in terms of covering the pandemic, which in turn created awareness. However, the coverage was not in-depth as most of the reported stories were short and were predominantly straight news. It was also observed that the media cited more of the Nigeria Centre for Disease Control (NCDC) and government officials. Further findings disclosed that most of the stories were alarming and induced panic. Most common topics were coverage of cases in Nigeria, death rates and concerns about Nigeria's preparedness. Public sensitization and education were sparingly covered. Ethics healthcare workers could adhere to received minimal attention. The media should focus more on sensitizing and educating the public on the necessary steps to take in curbing the virus. They should refrain from over usage of alarming and panic tone in presenting the stories of COVID-19 pandemic in Nigeria.

We proposed a conceptual model combining three theories: uses and gratification theory, social networking sites (SNS) dependency theory and social impact theory to understand the factors that predict fake news sharing related to COVID-19. We also tested the moderating role of fake news knowledge in reducing the tendency to share fake news. Data were drawn from social media users (n = 650) in Nigeria, and partial least squares was used to analyse the data. Our results suggest that tie strength was the strongest predictor of fake news sharing related to COVID-19 pandemic. We also found perceived herd, SNS dependency, information-seeking and parasocial interaction to be significant predictors of fake news sharing. The effect of status-seeking on fake news sharing, however, was not significant. Our results also established that fake news knowledge significantly moderated the effect of perceived herd, SNS dependency, information-seeking, parasocial interaction on fake news sharing related to COVID-19. However, tie strength and status-seeking effects were not moderated.