Background: This study aimed to examine the relationship between residents’ health literacy (HL) and their use of and trust in information channels. Methods: A community-based cross-sectional health survey utilizing a cluster sampling design was conducted in January 2022. The sample consisted of 1067 residents in Shanghai, China. Those who correctly answered over 80% of the questions were regarded as qualified. The differences in residents’ HL and the dimensions of knowledge HL, lifestyle HL, and skills HL were analyzed based on their use of and trust in traditional media, the internet, and offline activities. Logistic regression was conducted to examine the effects of the usage of these channels on all four types of HL. Results: A total of 27.65% of participants were qualified for HL. The use of traditional media (OR = 1.405, p < 0.05) and engagement in offline activities (OR = 1.951, p < 0.05) were significantly related to HL. Disbelief in traditional media was related to being qualified in knowledge HL (OR = 1.262; p < 0.05), whereas disbelief in offline activities had an adverse effect on knowledge HL and skills HL (OR = 0.700, 0.807; p < 0.05). Conclusion: Effort should be made to improve the efficiency of offline health education, and ensure the reliability and quality of health-related information from mass media and the internet to improve residents’ HL.

Objectives: Family functioning (FF), physical activity (PA), and high-fat food consumption (HF) are associated with adolescents being overweight and obese; however, little is known about their interactions. Therefore, this study aimed to examine how they work jointly on adolescent obesity with BMI as the outcome variable. Methods: A cross-sectional survey utilizing a cluster sampling design was conducted. Multinomial logistic regressions, multiplication interaction (MI), and marginal effects (MEs) were tested. Results: Active PA (non-overweight vs. obesity: OR = 2.260, 95% CI [1.318, 3.874]; overweight vs. obesity: OR = 2.096, 95% CI [1.167, 3.766]), healthy HF (non-overweight vs. obesity: OR = 2.048, 95% CI [1.105, 3.796]) and healthy FF (overweight vs. obesity: OR = 2.084, 95% CI [1.099, 3.952]) reduced obesity risk. Overweight students with healthy FF were less likely to become obese regardless of PA (inactive: OR = 2.181, 95% CI [1.114, 4.272]; active: OR = 3.870, 95% CI [1.719, 8.713]) or HF (unhealthy: OR = 4.615, 95% CI [1.049, 20.306]; healthy: OR = 5.116, 95% CI [1.352, 19.362]). The MEs of inactive PA and unhealthy FF were −0.071, 0.035, and 0.036 for non-overweight, overweight, and obese individuals, respectively (p < 0.05); the MEs of HF and healthy FF individuals were −0.267 and 0.198 for non-overweight and obese individuals, respectively (p < 0.05). Conclusions: Unhealthy FF regulated the influence of inactive PA or unhealthy HF on adolescent obesity, altogether leading to a higher risk of obesity.

Background: University students often struggle to maintain healthy sleep, physical activity, and screen usage due to academic pressures and irregular schedules. Ecological momentary assessments (EMAs) and interventions (EMIs) offer real-time, context-aware opportunities to monitor and promote healthier behaviors. This pilot study aimed to evaluate the feasibility of a hybrid study design combining continuous monitoring with sequential randomized controlled trials (RCTs) evaluating EMIs targeting movement behaviors among university students. Methods: The MOVE@NUS pilot study (September 2024 - January 2025) embedded three sequential RCTs, each targeting one behavior: sleep, physical activity, or screen time. For each RCT, participants were randomized on a 1:1:1 schedule (control, intervention 1, intervention 2). Eligible participants were first-year undergraduates, aged 18–25 years, who regularly used an iPhone and an Apple Watch. Smartwatches (primary) and smartphones (supplementary) passively and continuously tracked behaviors. EMAs (eight 3-day bursts) and web-based surveys captured self-reported behaviors and participant experience. All assessments were self-administered, and no provider assistance was involved. Results: Of 229 students who met screening criteria, 65 enrolled (mean age 20.4 ± 1.5 years; 53.8% female). Questionnaire completion was high (baseline: 100.0%, midway: 89.2%, endpoint: 86.2%). EMA engagement decreased from 88.7% (first burst) to 49.2% (final burst). Passively monitored data were obtained from 62 participants (95.4%) with a mean tracking duration of 67.8 days (range: 11 to 114). Data completeness was highest for passively captured measures of physical activity, while more participant-dependent measures, such as manually uploading screen time screenshots, showed greater attrition. Overall satisfaction was 78.9% for sleep, 70.6% for physical activity, and 60.0% for screen time. Conclusions: This hybrid study design is feasible and acceptable among university students, with successful integration of self-reports and passive tracking. Variations in engagement and data completeness highlight areas for optimization in future large-scale digital cohort studies. Trial registration: ClinicalTrials.gov ID NCT06597890 First Posted: 2024-09-19.

Background: Digital media use is ubiquitous among university students, yet longitudinal evidence regarding its impact on mental health remains limited. This study examined longitudinal associations between device-, purpose-, and day-type-specific digital media use and mental well-being and psychological distress among students.Methods: This prospective cohort study followed first-year undergraduates across three timepoints from enrolment to graduation at National University of Singapore. Students who completed at least one timepoint were included. Self-reported sociodemographics, health behaviors, and mental health outcomes, alongside anthropometric measurements, were collected. Generalized linear mixed models were used to examine longitudinal associations with categorical digital media use. Sensitivity analyses were applied with continuous and person-mean centering exposure specifications.Findings: Among 997 enrolled students (mean age 20·2 years; 59·6% female), mean daily digital media use was 14·3 hours/day at enrolment and declined to 12·6 hours/day at final follow-up (p<0·0001). This decline was driven by study-related (from 7·6 to 5·6 hours/day) and computer use (7·0 to 5·7), while recreational and mobile use remained stable. Daily digital media use was associated with increased odds of poor mental well-being (Global p<0·0001) and psychological distress (Global p=0·041). Compared with low-use, strongest risks were observed for high daily use (well-being: OR 1·78 [95% CI 1·30–2·44]; distress: 1·81 [1·09–2·99]) and high study-related use (well-being: 1·85 [1·34–2·55], Global p<0.0001; distress: 2·49 [1·42–4·37], Global p=0.0052). High computer use remained associated with poor well-being (1·97 [1·42–2·75], Global p<0.0001). Findings were consistent across sensitivity analyses.Interpretation: Higher digital media use, particularly for study-related or computer use, is a longitudinal risk factor for poorer mental health during the transition to adulthood. The context of use matters more for mental health than total duration alone, highlighting a need for targeted digital wellness interventions.