Mainstream cognitive behavioural theory stipulates that clinically significant health anxiety persists over time at least partially due to negatively reinforced health-related behaviours, but there exists no broad and psychometrically valid measure of such behaviours.

To draft and evaluate a new self-report scale – the Health Anxiety Behavior Inventory (HABI) – for the measurement of negatively reinforced health anxiety behaviours.

We drafted the HABI from a pool of 20 candidate items administered in a clinical trial at screening, and before and after cognitive behaviour therapy (n=204). A psychometric evaluation focused on factor structure, internal consistency, convergent and discriminant validity, test–retest reliability, and sensitivity to change.

Based on factor analysis, the HABI was completed as a 12-item instrument with a four-dimensional factor structure corresponding to the following scales: (i) bodily preoccupation and checking, (ii) information- and reassurance-seeking, (iii) prevention and planning, and (iv) overt avoidance. Factor inter-correlations were modest. The internal consistency (α=.73–.87) and 2-week test–retest reliability (r=.75–.90) of the scales was adequate. The bodily preoccupation and checking, and information- and reassurance-seeking scales were most strongly correlated with the cognitive and emotional components of health anxiety (r=0.41, 0.48), and to a lower extent correlated to depressive symptoms and disability. Change scores in all HABI scales correlated with improvement in the cognitive and emotional components of health anxiety during cognitive behaviour therapy.

The HABI appears to reliably measure negatively reinforced behaviours commonly seen in clinically significant health anxiety, and might be clinically useful in the treatment of health anxiety.

The physical and mental health of women prior to conception can have a significant impact on pregnancy and child outcomes. Given the rising burden of non-communicable diseases, the aim of this analysis was to explore the relationship between mental health, physical health and health behaviour in women planning a pregnancy.

To investigate the association between indices of physical and mental health in a large population of women in the UK planning a pregnancy.

Responses to a preconception health digital education tool provided data on the physical and mental health and health behaviour of 131,182 women planning pregnancy. Logistic regression was used to explore associations between mental health and physical health variables. Multiple imputation by chained equations was implemented to handle missing data.

There was evidence for an association between physical and mental health conditions (OR 2.22; 95% CI 2.14, 2.3). There was also an association between having a mental disorder and physical inactivity (OR 1.14; 95% CI 1.11, 1.18), substance misuse (OR 2.4; 95% CI 2.25, 2.55) and less folic acid use (OR 0.89; 95% CI 0.86,0.92).

There is a need for greater integration of physical and mental healthcare for women in the preconception period, which could support women, including those who wish to conceive, to optimise their health during this time.

No significant relationships.

Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic.

Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 – consistently low, 2 – become low during the quarantine, 3 – become high during the quarantine or 4 – consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine.

Brazil.

Brazilian adults (nationally representative).

Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption.

Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine.

To describe low-income parents’ and caregivers’ perceptions of the Cooking Matters Mobile Application (CM App) meal planning and preparation features.

Explanatory mixed-methods design where data were gathered via online surveys based on the Theory of Planned Behaviour and the Theory of Reasoned Action, followed by telephone interviews.

CM App, a mobile phone-based resource geared towards low-income parents and caregivers of young children (pregnancy/infant to age 5 years) for meal planning and preparation, with features based on skills taught in the Cooking Matters course: recipes, shopping list and meal planning.

Low-income parents and caregivers (survey participants, n 461; interview participants, n 20) who had downloaded the CM App to their smartphone and agreed to participate in the current evaluation.

Attitudes and self-efficacy related to CM App’s subject matter and functions (meal planning; recipe use; creating and using a shopping list) were measured via surveys and interviews. Mean (sd) responses were positive towards ‘meal planning’ and ‘shopping and cooking’ (4·17 (0·63) and 3·49 (0·86) on a 5-point Likert scale, respectively). Interviewees described meal planning and preparation behaviours as intrinsic, based on habit, and influenced by family preference and food costs. Early adopters of the CM App may already be engaged in and/or are motivated to engage in the targeted health behaviours.

Users may benefit most from incorporating into their routines new ways to prepare easy, cost-efficient, healthy meals at home that their families will enjoy.

The present research aimed to describe perceptions and behaviours around the consumption of water and sugar-sweetened beverages (SSB) by youths.

A formative, qualitative study which conducted four focus groups. Transcripts were analysed and themes related to reasons youths drink SSB and water, and conversely do not drink SSB and water, were analysed to reveal thematic clusters around sensory factors, environment and policy, access, marketing and role model influences, and health risks.

A rural, tri-ethnic community in New Mexico, USA.

Middle- and high-school students, parents and teachers.

Although youths and adults were aware of the health risks of soda, they did not translate this information to other SSB, including sports drinks and sweetened tea. Moreover, their perceptions of risks of dyes outweighed their concern with sugar. Youths and adults were aware of water’s health benefits, but they focused on short-term benefits. Youths and adults perceived water as unappealing. Adults were also concerned with water safety and access.

This formative research has implications for decreasing SSB consumption and simultaneously increasing water intake among youths in rural communities. Addressing unique access and safety concerns related to water in rural communities, as well as increasing awareness of the risks of all types of SSB, can work together in a positive feedback loop to change perceptions and behaviours with long-term health consequences. Specific policy suggestions include strengthening school policies to restrict all types of SSB and water promotion efforts that address access, safety and health benefits.

Severe mental illness (SMI) is thought to be associated with lower diet quality and adverse eating behaviours contributing towards physical health disparities. A rigorous review of the studies looking at dietary intake in psychotic disorders and bipolar disorder is lacking.

To conduct a systematic, comprehensive evaluation of the published research on dietary intake in psychotic disorders and bipolar disorder.

Six electronic databases were searched for studies reporting on dietary intakes in psychotic disorders and bipolar disorder. Dietary-assessment methods, and dietary intakes, were systematically reviewed. Where possible, data was pooled for meta-analysis and compared with healthy controls.

In total, 58 eligible studies were identified. People with SMI were found to have significantly higher dietary energy (mean difference 1332 kJ, 95% CI 487–2178 kJ/day, P = 0.002, g = 0.463) and sodium (mean difference 322 mg, 95% CI 174–490 mg, P < 0.001, g = 0.414) intake compared with controls. Qualitative synthesis suggested that higher energy and sodium intakes were associated with poorer diet quality and eating patterns.

These dietary components should be key targets for preventative interventions to improve weight and other physical health outcomes in people with SMI.

S.B.T. and E.T. have clinical dietitian appointments within the South Eastern Sydney Local Health District and do not receive any further funding.

To examine the associations of individual and food environmental factors with fruit and vegetable (F&V) intake in a city in a low-to-middle-income country (LMIC).

Cross-sectional.

Representative sample of the Brazilian Primary Care service known as the Health Academy Program (HAP) in Belo Horizonte, a Brazilian city.

Using a conceptual model as a guide, individual and food environment data were obtained through: (i) face-to-face interviews with participants aged 20 years or older; and (ii) F&V food store audits. A broad set of individual, household, and community and consumer nutrition environment variables was investigated. Multilevel linear regression was used to quantify area-level variations in F&V intake and to estimate associations with the factors.

Eighteen HAP centres were selected and 2944 participants and 336 food stores were included. F&V intake varied between contexts, being higher in areas with better socio-economic conditions and food store quality, such as specialised F&V markets. Individual-level factors, including age, income, food insecurity, stage of change, self-efficacy and decisional balance, were significantly associated with F&V intake. After controlling for individual-level characteristics, greater F&V intake was also associated with higher quality of food stores.

In one of the first studies to comprehensively assess the food environment in an LMIC, individual-level factors accounted for the largest variation in F&V intake; however, the food environment was also important, because area-level variables explained 10·5 % of the F&V intake variation. The consumer nutrition environment was more predictive of healthy eating than was the community nutrition environment. The findings suggest new possibilities for interventions.

To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women.

A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use.

The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009–2010.

Pregnant women (n 6822) enrolled into a nationally generalizable cohort.

Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks’ gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity.

In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.

Folic acid supplementation and folate-rich diets are recommended for women of childbearing age worldwide to prevent congenital anomalies. We aimed to determine the current status of folic acid supplementation among pregnant Japanese women and identify means to increase the intake of these supplements.

Cross-sectional study.

A total of 1862 pregnant women who consulted the perinatal centre from September 2014 to December 2015 completed a questionnaire concerning knowledge about folic acid, sources of information and the use of folic acid supplements.

Osaka Medical Center and Research Institute for Maternal and Child Health (Japan).

In our study population, only 20·5 % of pregnant women took folic acid supplements periconceptionally even though 70·4 % knew about the protective effect of folic acid. A multivariate analysis demonstrated that age ≥35 years (OR=2·80; 95 % CI 1·24, 6·29) and knowledge of the benefits of folic acid (OR=2·64; 95 % CI 1·92, 3·62) were associated with periconceptional folic acid use, and multiparity was negatively associated with such use. Compared with those who took folic acid supplements periconceptionally, women who did not take supplements received information through passive and less interactive media.

Although folic acid awareness was relatively high among pregnant Japanese women, folic acid supplementation before conception was insufficient. To increase the intake of folic acid supplements in countries in which foods are not fortified with folic acid, an effective public health approach promoting behavioural change is necessary for women of reproductive age.

Adequate fruit and vegetable intake is important in the prevention of chronic disease. Health literacy is associated with health outcomes but its role in dietary behaviour has received little attention. The present study investigated the association between a multidimensional measure of health literacy, sociodemographic characteristics, and fruit and vegetable intake in rural Australia.

A cross-sectional survey on intake of fruits and vegetables (servings/d), demographic characteristics and health literacy profile using a nine-scale Health Literacy Questionnaire (HLQ). Associations between health literacy and fruit and vegetable intake were assessed using logistic regression.

A large rural area of Victoria.

Adults residing in the Grampians region (n 1154; 61 % female, mean age 52 (sd 17) years).

The HLQ scale ‘Actively managing my health’ predicted (OR; 95 % CI) fruit (2·31; 1·87, 2·84) and vegetable (1·81; 1·45, 2·26) intake. The scales ‘Appraisal of health information’ (fruits: 1·73; 1·41, 2·13; vegetables: 1·49; 1·20, 1·86), ‘Social support for health’ (fruits: 1·31; 1·06, 1·63; vegetables: 1·40; 1·10, 1·76) and ‘Ability to find good health information’ (fruits: 1·25; 1·05, 1·48; vegetables: 1·36; CI 1·13, 1·63) also predicted fruit and vegetable intake. These associations remained significant after adjusting for age, gender, educational attainment and having private health insurance.

Health literacy, particularly being proactive, appraising information and having social support for health, is associated with greater fruit and vegetable intake. Future interventions should consider the health literacy needs of the community to improve fruit and vegetable intake.

Antenatal healthy lifestyle interventions are frequently implemented in overweight and obese pregnancy, yet there is inconsistent reporting of the behaviour-change methods and behavioural outcomes. This limits our understanding of how and why such interventions were successful or not.

The current paper discusses the application of behaviour-change theories and techniques within complex lifestyle interventions in overweight and obese pregnancy. The authors propose a decision tree to help guide researchers through intervention design, implementation and evaluation. The implications for adopting behaviour-change theories and techniques, and using appropriate guidance when constructing and evaluating interventions in research and clinical practice are also discussed.

To enhance the evidence base for successful behaviour-change interventions during pregnancy, adoption of behaviour-change theories and techniques, and use of published guidelines when designing lifestyle interventions are necessary. The proposed decision tree may be a useful guide for researchers working to develop effective behaviour-change interventions in clinical settings. This guide directs researchers towards key literature sources that will be important in each stage of study development.

To identify barriers to fruit and vegetable intake for Indigenous Australian children and quantify factors related to these barriers, to help understand why children do not meet recommendations for fruit and vegetable intake.

We examined factors related to carer-reported barriers using multilevel Poisson models (robust variance); a key informant focus group guided our interpretation of findings.

Eleven diverse sites across Australia.

Australian Indigenous children and their carers (N 1230) participating in the Longitudinal Study of Indigenous Children.

Almost half (45 %; n 555/1230) of carers reported barriers to their children’s fruit and vegetable intake. Dislike of fruit and vegetables was the most common barrier, reported by 32·9 % of carers; however, we identified few factors associated with dislike. Carers were more than ten times less likely to report barriers to accessing fruit and vegetables if they lived large cities v. very remote areas. Within urban and inner regional areas, child and carer well-being, financial security, suitable housing and community cohesion promoted access to fruit and vegetables.

In this national Indigenous Australian sample, almost half of carers faced barriers to providing their children with a healthy diet. Both remote/outer regional carers and disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables for their children. Where vegetables were accessible, children’s dislike was a substantial barrier. Nutrition promotion must address the broader family, community, environmental and cultural contexts that impact nutrition, and should draw on the strengths of Indigenous families and communities.