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BACKGROUND: Body dissatisfaction is associated with poor psychological and physical health, particularly among young people. However, limited data exist on body size perceptions across countries and factors associated with dissatisfaction.
OBJECTIVE: This study examined dissatisfaction prevalence and associations with sociodemographics and social media use among youth in six countries.
METHODS: Repeat cross-sectional national online surveys were conducted as part of the 2019 and 2020 International Food Policy Study Youth Survey.
METHODS: The sample included 21,277 youth aged 10-17 from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Youth were recruited to complete the online survey through parents/guardians enrolled in the Nielsen Consumer Insights Global Panel and their partners\' panels.
METHODS: Figural drawing scales assessed self-perceived and ideal body images, with differences between scales representing body dissatisfaction.
METHODS: Multinomial logistic regression models examined differences in body dissatisfaction by country, and associations with sociodemographics and either social media \'screen time\' or platforms used, including 2-way interactions with country.
RESULTS: Overall, approximately 45% of youth reported the same perceived and ideal body sizes, while 35% were \'larger than ideal\' (from 33% in Canada and Australia to 42% in Chile) and 20% were \'thinner than ideal\' (from 15% in Chile to 22% in Mexico). Greater social media screen time was associated with a higher likelihood of moderate-severe dissatisfaction for being \'thinner than ideal\' and at least mild dissatisfaction for being \'larger than ideal\' (p<0.003 for all contrasts), with greater dissatisfaction among users of YouTube and Snapchat than non-users (p≤0.005 for both contrasts). Modest differences in body dissatisfaction between countries were observed for age, ethnicity, body mass index, and weight-based teasing.
CONCLUSIONS: Body dissatisfaction is prevalent among youth across diverse countries. These findings highlight the need to promote healthy body image in youth, particularly among social media users.

Social media use among young people has raised concerns about its potential impact on mental health. However, research is limited regarding whether certain subgroups may be differently affected. This study uses data from the 2022 National Youth Tobacco Survey, a nationally representative sample of middle and high school students aged approximately 11-18 years (n = 23,366). Mental health conditions were assessed using the Patient Health Questionnaire-4, and social media use was categorized by frequency levels. We employed multinomial logistic regression and a finite mixture Poisson model to explore the relationship between social media use, sexual identity, and mental health status. The study found a consistent association between social media use and mental health conditions, particularly among frequent users. The finite mixture model revealed two latent groups based on mental health status: a \'better\' group with minimal or no poor mental health indicators and a \'worse\' group with more indicators. For both groups, social media use was associated with mental health conditions, with a stronger association among frequent users. Notably, sexual minorities, especially bisexual students, were more likely to report poor mental health indicators. This study suggests that frequent social media use may adversely affect young people\'s mental health and that different youth subgroups may respond differently to social media use and mental health conditions.

BACKGROUND: Digital competencies are essential for nurses to actively participate in the digitisation of healthcare systems. Therefore, it is important to assess their skill levels to identify strengths and areas for improvement.
METHODS: This study aims to investigate nurses\' knowledge, attitudes, behaviours, subjective norms and behavioural control regarding digital health. A knowledge-attitude-practice model guided the development of a structured questionnaire divided into six sections. A sample of 480 registered nurses of Naples will be involved in the study. After conducting a pretest, an invitation will be publicised through the institutional communication channels of Nurses Provincial Order of Naples. Nurses will respond via a unique link or quick response code sent through a PEC email system (a legally valid email system, which guarantees delivery and receipt). They will have 30 days to complete the survey, scheduled between May and July 2024.
BACKGROUND: No ethics committee approval was required, as the study does not involve minors, direct or indirect physical or physiological harm to participants, or clinical trials. Anonymity will be guaranteed at all data collection and processing levels. The results will be broadly distributed through conference presentations and peer-reviewed publications. The effective use of digital technologies by healthcare professionals can bring significant improvements to healthcare services and help improve the health of individuals and community health. The study\'s findings will serve as a foundation for developing and implementing educational programmes related to eHealth and telemedicine, promoting the harmonisation of such programmes.

BACKGROUND: Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients.
METHODS: We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews.
RESULTS: Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients.
CONCLUSIONS: To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.

BACKGROUND: Large-scale crisis events such as COVID-19 often have secondary impacts on individuals\' mental well-being. University students are particularly vulnerable to such impacts. Traditional survey-based methods to identify those in need of support do not scale over large populations and they do not provide timely insights. We pursue an alternative approach through social media data and machine learning. Our models aim to complement surveys and provide early, precise, and objective predictions of students disrupted by COVID-19.
OBJECTIVE: This study aims to demonstrate the feasibility of language on private social media as an indicator of crisis-induced disruption to mental well-being.
METHODS: We modeled 4124 Facebook posts provided by 43 undergraduate students, spanning over 2 years. We extracted temporal trends in the psycholinguistic attributes of their posts and comments. These trends were used as features to predict how COVID-19 disrupted their mental well-being.
RESULTS: The social media-enabled model had an F1-score of 0.79, which was a 39% improvement over a model trained on the self-reported mental state of the participant. The features we used showed promise in predicting other mental states such as anxiety, depression, social, isolation, and suicidal behavior (F1-scores varied between 0.85 and 0.93). We also found that selecting the windows of time 7 months after the COVID-19-induced lockdown presented better results, therefore, paving the way for data minimization.
CONCLUSIONS: We predicted COVID-19-induced disruptions to mental well-being by developing a machine learning model that leveraged language on private social media. The language in these posts described psycholinguistic trends in students\' online behavior. These longitudinal trends helped predict mental well-being disruption better than models trained on correlated mental health questionnaires. Our work inspires further research into the potential applications of early, precise, and automatic warnings for individuals concerned about their mental health in times of crisis.

BACKGROUND: The ability of a nurse to make effective clinical decisions is the most important factor that can affect the treatment quality. However, several factors can affect the ability of nursing and midwifery students to make effective clinical decisions.
OBJECTIVE: This study aims to identify the confounding factors that may affect the clinical decision making of nurses and thus patient outcomes after the COVID-19 pandemic in Jordan.
METHODS: A descriptive cross-sectional design was employed in this study. An online self-administered questionnaire was distributed to 269 nursing and midwifery students selected through purposive sampling, 224 of whom completed the questionnaire. The valid and reliable nursing decision-making instrument, which consisted of 24 items, was employed to gather the data, and descriptive statistics and simple linear regression were employed for the data analysis. Data was collected from November to the end of December 2022.
RESULTS: Among the respondents, 72.8% were female, and the average age was 20.79 years (SD = 1.44). The vast majority of the respondents (94.6%) was unmarried, and 74.1% were pursuing a nursing degree. The simple linear regression analysis showed that clinical decision making had a negative and significant relationship with social media usage of an average of 6 h a day (β=-0.085). Moreover, the male nursing students obtained lower clinical decision-making scores (β= -0.408) compared with the female nursing students.
CONCLUSIONS: Social media usage and gender have a considerable effect on the clinical decision making of the nursing and midwifery students. Therefore, the confounding factors that can affect the clinical decision making of nurses should be discussed further, and strategies to address such factors should be implemented.

OBJECTIVE: This study explores the opportunities of social media advertisements as a recruitment strategy in women with stress urinary incontinence (SUI).
METHODS: This feasibility study was part of a larger clinical trial on the effects of a patient decision aid for SUI treatment. We started a 61-day social media advertisement campaign to recruit women for the trial. The primary outcome of our study was enrolment pace. Secondary outcomes involved cost per participant, baseline demographic comparison and ad campaign performance metrics. Additionally, we interviewed recruited participants to identify the facilitators and barriers of our approach.
RESULTS: Ten participants were recruited, of whom 8 completed the full study protocol (2 questionnaires 6 months apart). The enrolment pace, 4.0 study participants per month, was faster compared to the average of 2.7 participants per month through conventional methods. The campaign reached 87 clicks on the advertisement per day and 1 % of these women showed interest in our study by contacting us. The overall conversion rate from click to full participation was 0.2 %. The costs per participant were €112. Besides higher age, the demographics of the social media recruited participants were comparable to the conventional inclusions. Qualitative analysis identified more user-oriented enrolment procedures and potential participant benefit as facilitators of social media recruitment.
CONCLUSIONS: This study shows that social media recruitment can be feasible in trials for women with SUI. It can accelerate recruitment of eligible participants. Optimising the enrolment procedure to better meet participants\' needs and recruitment benefits may improve participation and cost-effectiveness. Trial registration ID 2017-3540.

BACKGROUND: Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment.
OBJECTIVE: This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic.
METHODS: Foreign-born Chinese women aged 18-45 years, with a gestational diabetes index pregnancy of 0.5-5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving.
RESULTS: Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants were mainly recruited from social media (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time.
CONCLUSIONS: We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by persistent concern with non-existent or minor defects in one\'s physical appearance. BDD can be difficult to identify as patients often have limited insight into the condition.
OBJECTIVE: We aimed to determine the prevalence of BDD in patients presenting to private aesthetic clinical settings in four Latin American countries.
METHODS: We conducted a cross-sectional study From August to October 2022 to evaluate the prevalence of BDD among 360 patients seeking nonsurgical cosmetic procedures in Chile, Mexico, Argentina, and Colombia using the Dysmorphic Concern Questionnaire (DCQ). We reported prevalence estimates for the lowest and highest previously proposed DCQ cutoff points.
RESULTS: The DCQ total scores in the study population ranged from 0 to 21, with a mean total score of 5.1 ± 3.4. The prevalence of positive screening results for BDD (total DCQ score ≥ 9) was 15.8%. The prevalence of a likely diagnosis of BDD (total DCQ score of ¥ 17) was 0.83%.
CONCLUSIONS: The convenience sample limited the generalizability of the findings to Latin America.
CONCLUSIONS: We encourage colleagues to be more mindful of this diagnosis and to facilitate earlier psychological evaluation in patients who are positive for BDD.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .