Hand hygiene, including handwashing by children, has been reported to contribute to the prevention of various infectious conditions. This study aims to explore the correlates of handwashing behavior among 1690 fourth to sixth grade primary school students in 19 Tibetan primary schools (Golog, Qinghai, China). The theory of reasoned action (TRA) was applied. Data was collected by questionnaire. Structural equation modeling (SEM) analysis showed that students’ attitude (β = 0.22, 95% CI 0.13–0.31) and subjective norms in terms of compliance to teachers’, parents’ and peers’ suggestions to wash hands (β = 0.09, 95% CI 0.01–0.18) were directly associated with students’ handwashing behavior. Students’ knowledge (β = 0.04, 95% CI 0.03–0.07) had an indirect association with handwashing behavior, mediated by students’ attitudes and subjective norms. Subjective norms (β = 0.12, 95% CI 0.07–0.17) were also indirectly correlated with handwashing through students’ attitudes. Therefore, our study supported the theory of reasoned action through our findings that students’ attitude and knowledge, and also attitudes from teachers, parents and peers were correlated with student handwashing behavior. Students reported higher level of compliance to teachers than to their parents and classmates. Based on this information, we recommend teacher-involved participatory hygiene education to promote students’ handwashing behaviors in areas at high risk for infectious diseases that can be prevented by handwashing.

The hepatic steatosis index (HSI) has been demonstrated to have a significant correlation with prediabetes and diabetes; however, its potential association with reversion to normal glucose regulation (NGR) from prediabetes remains insufficiently investigated. The primary objective of this study was to elucidate the relationship between HSI levels and the probability of reversion to NGR among Chinese adults with prediabetes. This retrospective cohort study utilized health examination data from 11,241 Chinese adults with prediabetes. Cox proportional hazard models were employed to calculate hazard ratios (HR) and 95% confidence intervals (CI) to assess the association between HSI levels and reversion to NGR. Additionally, a Cox proportional hazards regression model incorporating cubic spline functions and smooth curve fitting was utilized to determine any nonlinear relationships between HSI levels and reversion to NGR. The results of the multivariate analyses demonstrated a significant association between reduced HSI levels and an increased likelihood of reversion to NGR (HR = 0.92, 95%CI: 0.89–0.95, P < 0.0001). Furthermore, a nonlinear relationship was identified between HSI levels and the reversion to NGR, with a critical threshold at an HSI value of 43.08. Below this threshold, a strong negative association was observed, markedly enhancing the probability of returning to normoglycemic status (HR = 0.91, 95% CI: 0.88–0.94, P < 0.0001). This study reveals a negative, nonlinear correlation between HSI levels and the reversion to NGR in individuals with prediabetes. These findings highlight the essential role of effectively managing HSI as part of comprehensive prediabetes treatment strategies, which may significantly enhance the likelihood of achieving normoglycemic status.

• Understanding the ethnic gap in protective behavior adoption and its explanatory factors is a promising step for reducing pandemic-induced disparities. • Differences in socioeconomic status, fearfulness levels, degree of knowledge held about COVID-19, and self-efficacy levels appear to contribute to explaining the Han-minority protective behavioral gap in rural China. • Targeted, group-specific COVID-19 preventative messages may help to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for COVID-19.

Rural-urban difference in depressive symptoms is a manifestation of health inequality. This study aimed to analyze the association between offline and onli