Background: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. Objective: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. Methods: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. Results: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=−0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=−0.45, P<.001) via vaccine hesitancy (SSC=−0.32, P<.001). Conclusions: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function.

Social and physical environments are not only hypothesized to influence physical activity (PA), they are also interrelated and influence each other. However, few studies have examined the relationships of PA with social and physical environments simultaneously. Accordingly, the current study aims to examine the association between physical and social attributes of neighborhood with leisure-time physical activity (LTPA) among the Chinese elders. By employing a two-stage stratified random sampling procedure, 2783 elders were identified from 47 neighborhoods in Shanghai during July and September in 2014. Social and physical attributes of neighborhood were assessed using a validated and psychometrically tested measures, and the Chinese version of the International Physical Activity Questionnaire—Long Form was used to assess LTPA. Control variables included sex, age, marital status, education level, self-rated health and chronic conditions. Multilevel logistic regression analysis was conducted to explore whether individual- and neighborhood-level social and physical attributes were associated with LTPA. The overall prevalence of leisure-time active (LTA) was 46.6 %. After controlling for individual covariates, 1) compared to participants with the first quartile of social participation, the odds ratios of LTA for participants with the second, third and fourth quartile of social participation were 1.86 (95 % CI: 1.44–2.41), 2.37 (95 % CI: 1.82–3.08) and 4.27 (95 % CI: 3.27–5.58); 2) compared to participants with the first quartile of social cohesion, the odds ratios of LTA for participants with the second, third and fourth quartile of social cohesion were 1.09 (95 % CI: 1.07–1.20), 1.14 (95 % CI: 1.08–3.50) and 1.31 (95 % CI: 1.11–1.58); 3) compared to participants living in neighborhoods with the first quartile of walkability, the odds ratios of LTA for participants living in neighborhoods with the second, third and fourth quartile of walkability were 1.13 (95 % CI: 1.03–2.02), 1.73 (95 % CI: 1.12–3.21) and 1.85 (95 % CI: 1.19–3.35). Both social and physical attribute of neighborhood associate with LTPA among Chinese older adults. It may promote LTPA among Chinese older adults to encourage them to participate in social activities, meanwhile, building walkable and cohesive neighborhoods.

Our aim is to examine the associations between long working hours and depression and mental well-being among the working population in Shanghai, as well as to identify the impact of having hobbies on these relationships. A cross-sectional study was conducted in Shanghai, with depression assessed by the Patient Health Questionnaire-9 (PHQ-9) scale and mental well-being assessed by the World Health Organization five-item Well-Being Index (WHO-5) scale. The phenomenon of long working hours (69.3%) was quite common among employees in Shanghai, and the rate of working over 60 h was 19.3%. Those who worked over 60 h had the highest prevalence of poorer mental health compared with individuals working ≤40 h per week. After adjustment in the logistic regression model, those who reported weekly working time over 60 h were 1.40 (95%CI: 1.03–1.90) and 1.66 (95%CI: 1.26–2.18) times more likely to have depression and poor mental well-being (PMWB), respectively. Adjusted ORs for having hobbies were 0.78 (95%CI: 0.62–0.97) and 0.62 (95%CI: 0.51–0.75), respectively. Meanwhile, having hobbies could significantly lower the mean score on the PHQ-9 and elevate the mean score on the WHO-5 in each working time group, with no interaction effect. Long working hours could have a significantly negative impact on workers’ psychological health. Importantly, having hobbies in their daily lives might help to mitigate the adverse effects of long working hours on workers’ depression and mental well-being.

Background: COVID-19 lockdowns may lead to physical inactivity, a major risk factor for non-communicable diseases. This study aims to determine: 1) the trajectory in daily step counts before, during and after the lockdown in China, and 2) the characteristics associated with the trajectories.Methods: From December 2019 to July 2020, smartphone-based step counts were continuously collected in 815 Chinese adults residing in Shanghai over 202 days across three phases: before, during, and after the lockdown. Participant characteristics were reported, and height, weight and body composition measured before the lockdown. A ‘sharp’ regression discontinuity design with cluster robust standard errors was used to test the effect of the lockdown and reopening on daily steps and a linear mixed model was used to examine the characteristics associated with trajectories during the observed period.Results: Based on 164,630 person-days of data, we found a sharp decline in daily step counts upon the lockdown (24/01/2020) by an average of 3796 (SE = 88) steps, followed by a significant trend of increase by 34 steps/day (SE = 2.5;p < .001) until the end of the lockdown (22/03/2020). This increasing trend continued into the reopening phase at a slower rate of 5 steps per day (SE = 2.3;p = 0.029). Those who were older, married, university educated, insufficiently active, had an ‘at risk’ body composition, and those in the control group, were slower at recovering step counts during the lockdown, and those who were older, married, without university education and with an ‘at risk’ body composition recovered step counts at a slower pace after the reopening.Conclusions: Despite later increases in step counts, COVID-19 lockdown led to a sustained period of reduced physical activity, which may have adverse health implications. Governments and health professionals around the world should continue to encourage and facilitate physical activity during the pandemic.

Background: The study aimed to investigate the association between content-based problematic smartphone use and obesity in school-age children and adolescents, including variations in the association by educational stage and sex. Methods: Two-stage non-probability sampling was used to recruit 8419 participants from nineteen primary schools, five middle schools, and thirteen high schools in Shanghai in December 2017. Obesity was identified by body mass index (BMI), which was obtained from the school physical examination record, while problematic smartphone use was measured by the Revised Problematic Smartphone Use Classification Scale as the independent variable. Results: The rates of obesity varied with educational stages, while problematic smartphone use increased with educational stages. Male students reported higher obesity rates (37.1%vs19.4%, P < 0.001) and greater problematic smartphone use scores (25.65 ± 10.37 vs 22.88 ± 8.94, P < 0.001) than female students. Problematic smartphone use for entertainment (smartphone users addicted to entertainment games, music, videos, novels and other applications) was positively associated to obesity status for primary school [odds ratio (OR), 1.030; 95% confidence interval (95% CI), 1.005–1.057] and high school students (OR, 1.031; 95% CI, 1.004–1.059). For female students, problematic smartphone use for entertainment was positively associated with obesity status (OR, 1.046; 95% CI, 1.018–1.075). Conclusions: Problematic smartphone use may be associated with obesity in children and adolescents. The association differed based on the educational stage and sex, and the difference possessed dimensional specificity.

Objective: This study aimed to assess smartphone use time and total screen time among students aged 10–19 in Shanghai, China, and examine their effects on academic stress.Methods: Baseline and follow-up surveys were conducted in December 2017 and December 2018, respectively, using a cohort study design with 1,771 participants. Questionnaire surveys and physical examinations of participants were conducted by trained investigators and professional school physicians, respectively. The self-administered questionnaire mainly covered demographic information, academic stress, smartphone use time, total screen time, and other lifestyle behaviors.Results: The average smartphone use time of primary, middle, and high school students was 0.76 ± 0.90, 1.34 ± 1.29, and 2.39 ± 1.66 h/day, respectively; total screen time was 2.60 ± 2.63, 2.65 ± 3.39, and 3.52 ± 2.7 h/day, respectively (P < 0.001). The academic stress scores of primary, middle, and high school students were 9.25 ± 3.96, 11.97 ± 4.58, and 15.06 ± 5.10 (out of 30), respectively. The smartphone use time and total screen time were positively associated with academic stress score, with β values of 0.307 (95% CI: 0.164–0.450) and 0.171 (95% CI: 0.088–0.255), respectively. The longer the smartphone use time and total screen time, the higher the risk of abnormal academic stress, with OR values of 1.199 (95% CI: 1.103–1.303) and 1.104 (95% CI: 1.056–1.154), respectively. After stratifying by grade group, positive associations between smartphone use time or total screen time and abnormal academic stress were observed in primary and middle school students; for high school students; however, only smartphone use time had a positive association.Conclusions: This study confirmed that the academic stress is widespread among students aged 10–19 in Shanghai, China. From a public health perspective, smartphone use time and total screen time should therefore be restricted for reducing academic stress and preventing related problems among adolescents in Shanghai, China, in school, family, and other environments.