Dih-Ling Luh

Community-based multiple screening model†‡§¶

Multiple disease screening may have several advantages over single disease screening because of the economics of scale, with the high yield of detecting asymptomatic diseases, the identification of multiple diseases or risk factors simultaneously, the enhancement of the attendance rate, and the efficiency of follow‐up.

Community-based multiple screening model: design, implementation, and analysis of 42,387 participants.

Multiple disease screening may have several advantages over single disease screening because of the economics of scale, with the high yield of detecting asymptomatic diseases, the identification of multiple diseases or risk factors simultaneously, the enhancement of the attendance rate, and the efficiency of follow‐up.

The Trajectory and the Related Physical and Social Determinants of Body Mass Index in Elementary School Children: Results from the Child and Adolescent Behaviors in Long-Term Evolution Study

This study explored developmental trajectory patterns of BMI and associated factors. Participants included 1,609 students who were followed from age 7 to 12 years. Data collection involved annual self-administered questionnaires and records of height and weight. An ecological model was used to identify the factors associated with BMI trajectories. Group-based trajectory models and multinomial logit models were used in the statistical analysis. There were gender differences in BMI trajectories. Among boys, four BMI trajectories were normal or slightly underweight, persistently normal weight, overweight becoming obese, and persistently obese. Among girls, four BMI trajectories were persistently slightly underweight, persistently normal weight, persistently overweight, and persistently obese. The mean BMI in each trajectory group demonstrated an upward trend over time. In boys, BMI trajectories were significantly associated with after-school exercise, academic performance, family interactions, overweight parents, and fathers education level. In girls, BMI trajectories were significantly associated with television viewing or computer use, family interactions, peer interactions, and overweight parents. Children under age 7 years who are already overweight or obese are an important target for interventions. The different factors associated with BMI trajectories can be used for targeting high risk groups.

Joint trajectories of multiple health-related behaviors among the elderly

ObjectivesThe main goal of this study was to identify the multiple trajectories of the following four health behaviors among the elderly by gender: smoking, drinking alcohol, getting regular exercise, and having a health checkupMethodsData were from a longitudinal survey conducted among the elderly from 1996 to 2007 in Taiwan. In total, 5,880 respondents were included in the analysisResultsThe trajectories of health-related behaviors differed between males and females. Five groups of male elderly were identified: smoking, inactive, healthy lifestyle, smoking and drinking, and quitting. Three groups of female elderly were identified: smoking and drinking, inactive, and healthy lifestyle. Age, education, self-rated health, depressive symptoms, and economic satisfaction at baseline were associated with the health behavior trajectoriesConclusionThe nature of healthy behaviors and risky behaviors may differ. Thus, multiple trajectories can exhibit patterns that differ from those of single behavior trajectories. Strategies designed to promote health need to consider both gender and behavior patterns which may change over time.

Constructing area-level indicators of successful ageing in Taiwan

We constructed area-level indicators of successful ageing in Taiwan. Area-level successful ageing was defined as follows: the living environment in a community/city is beneficial for physical, psychological and social health, and the people living in the area are well informed about the issues that pertain to maintaining health and behave in ways that promote their health. A modified Delphi method and analytical hierarchy process were used, with eight experts completing three successive rounds of questionnaires to determine the appropriate dimensions and indicators. In total, 65 indicators of area-level successful ageing were suggested. The weights of the six dimensions of the area indicators were determined as follows: health status (0.273), health lifestyle (0.182), social participation (0.166), health-care resources and utilisation (0.164), social environment (0.113) and natural environment (0.102). Nationwide survey data and government statistics were used to describe the profiles of 23 cities and counties in Taiwan with respect to successful ageing. Degree of ageing and geographic location were not related significantly to the total successful ageing scores of the cities/counties. However, urbanisation was correlated negatively to the total score (Spearmans rho = -0.43), the dimensions health status (rho = -0.54), health lifestyle (rho = -0.52), and natural environment (rho = -0.43), and degree of ageing was related moderately and negatively to health lifestyle (rho = -0.39). There were significant differences in health lifestyle and natural environment according to geographic location. These area indicators will be helpful to local governments for monitoring and improving successful ageing within their communities.

Do parents play different roles in drinking behaviours of male and female adolescents? A longitudinal follow-up study

Objective Gender differences in the associations between adolescent drinking behaviour, and perceived parental drinking behaviours and attitudes towards underage drinking, were investigated. Methods Data were drawn from two cohorts in the Child and Adolescent Behaviours in Long-term Evolution project. We used data from 2009 to 2006, when cohorts 1 and 2, respectively, were in grade 9. No cohort effect was found, so the two cohorts were pooled; 3972 students (1999 boys and 1973 girls) participated in the study. The major variables included adolescent drinking behaviours over the last month, and perceived parental drinking behaviours and parental attitudes towards underage drinking. The effects of the combination of parental drinking behaviours, and attitudes on the drinking behaviours of male and female adolescents, were analysed by logistic regression. Results The drinking behaviour of boys was correlated with the drinking behaviours and attitudes of their fathers but not with those of their mothers. Among boys, having a non-drinking father who was against underage drinking (OR=0.27, 95% CI 0.16 to 0.46), a non-drinking father who was favourable towards underage drinking (OR=0.61, 95% CI 0.39 to 0.94), or a drinking father who was against underage drinking (OR=0.44, 95% CI 0.23 to 0.85) significantly decreased the likelihood of alcohol consumption, whereas maternal behaviour and attitude were not significant influences. Among girls, having a non-drinking father who was against underage drinking (OR=0.52, 95% CI 0.30 to 0.91) or a non-drinking father who was favourable towards underage drinking (OR=0.51, 95% CI 0.32 to 0.83) significantly decreased the likelihood of alcohol consumption, as did having a non-drinking mother who was against underage drinking (OR=0.23, 95% CI 0.09 to 0.60). Conclusions The influences of fathers and mothers on the drinking behaviour of their adolescent children differed by offspring gender.

Defending behaviors, bullying roles, and their associations with mental health in junior high school students: a population-based study

BackgroundStudents should be encouraged to help prevent or stop bullying. However, defending victims of bullying can impact on mental health. It is not only bystanders who may defend victims, but bullies, victims and bully-victims can also have defending behaviors. Nevertheless, most studies of defending behaviors have been limited to an examination of the reactions of bystanders or those not involved in bullying and have ignored the other players. The aim of this study is to investigate the associations between defending behaviors and mental health among bullies, victims, bully-victims and bystanders.MethodsAssociations among defending behaviors, mental health (including depressive symptoms and social anxiety), and bullying experiences were cross-sectionally examined in 3441 students (13–15 years old.) from 20 randomly selected junior high schools in Taiwan using a self-report questionnaire. SAS 9.3 Survey Analysis procedures were used to conduct descriptive analysis and multiple regression models.ResultsDefending behaviors were associated with bullying roles and were higher in victims than in bullies or bystanders. Defending behaviors were positively associated with social anxiety and depressive symptoms. After stratifying by bullying roles, defending behaviors were positively associated with social anxiety in bystanders, and were positively associated with depressive symptoms in victims and bystanders. However, defending behaviors were not significantly associated with mental health indicators in bullies.ConclusionsThe associations between defending behaviors and mental health varied according to bullying roles. The results suggest that bystanders and victims experience more mental health effects than bullies. Intervention programs aimed at preventing bullying should focus on strategies that minimize social anxiety and depression in victims and bystanders, and urge students to help vulnerable peers during bullying events.

Comparison of the social contact patterns among school-age children in specific seasons, locations, and times

Social contact patterns among school-age children play an important role in the epidemiology of infectious disease. This study explored how people interact in specific seasons (flu season and non-flu season), environmental settings (city and county), and times (weekend and weekday). We conducted a survey of junior high school students (grades 7-8) using an established questionnaire during May-June 2013 and December 2013. The sample size with pair-wise comparisons for the times (weekday/weekend) and stratification by location and seasons were 75, 87, 105 and 106, respectively. The sample size with pair-wise comparisons for the seasons (flu/non-flu) and stratification by location were 54 and 83, respectively. Conversation and skin-to-skin contact behaviors were surveyed through diary-based questionnaires, of which 665 valid questionnaires were returned. There was no difference in the number of contacts during the flu and non-flu seasons, with averages of 16.3 (S.D.=12.9) and 14.6 (S.D.=9.5) people, respectively. However, statistical analysis showed that the average number of contacts in Taichung City and Yilan County were significantly different (p<0.001). Weekdays were associated with 23-28% more contacts than weekend days during both the non-flu and flu seasons (p<0.001) (Wilcoxon signed-rank test). Our work has important implications for the dynamic modeling of infectious diseases and performance analysis of human contact numbers and contact characteristics for schoolchildren in specific seasons, places, and times.

Health, healthy lifestyles and health examinations among the older people in Taiwan

This aim of this study was to examine the relationship between the utilisation of general health examinations and health and a healthy lifestyle.

Will personal values predict the development of smoking and drinking behaviors? A prospective cohort study of children and adolescents in Taiwan

This study examined how personal values predict the development of smoking and drinking behaviors in adolescence. The longitudinal data of 1545 adolescents over a 6-year period were analyzed. The results showed that adolescents who valued health and academics had similarly lower odds of reporting cigarette and alcohol use and those who valued friends had significantly higher odds. While the odds increased over time, the trend on alcohol use lessened for adolescents who valued academics, while the trend accelerated for those who valued friends. The finding suggests the important role that personal values play in adolescent risk behavioral development.