BACKGROUND: The Weight Stigma Exposure Inventory (WeSEI) is a newly developed instrument designed to assess weight stigma exposure across both interpersonal and non-interpersonal contexts. While prior studies have supported its use in individual regions, its cross-cultural applicability has not been comprehensively evaluated.

OBJECTIVE: The present study examined the psychometric properties and cross-cultural measurement equivalence of the WeSEI across six culturally diverse jurisdictional regions in Asia (i.e., Taiwan, China, Hong Kong, Indonesia, Türkiye, and Malaysia).

METHODS: A total of 7,787 participants completed the 35-item WeSEI via various online platforms. The WeSEI assesses weight stigma exposure across seven domains: social media, traditional media, television/movies, parents/siblings, friends/peers, significant others, and strangers. Rasch analysis was conducted to evaluate item fit, rating scale functioning, person separation reliability, and unidimensionality for each domain. Differential item functioning (DIF) was assessed across sex, weight status, and jurisdictional region.

RESULTS: The WeSEI demonstrated strong internal consistency, acceptable item fit, and unidimensionality across all domains, with only two items showing misfit (i.e., Friends/Peers_2 and Significant Other_2). Person separation indices exceeded 2.0 for each domain, confirming the scale's ability to distinguish individuals with varying levels of stigma exposure. Minimal DIF was observed by sex and weight status, supporting measurement equivalence across these groups. However, 19 out of 35 items showed significant jurisdictional region-level DIF, particularly those related to slim-normative attractiveness and family-based stigma. Malaysian participants consistently endorsed these items more than Chinese participants, suggesting cultural variation in the exposure of weight stigma.

CONCLUSION: The WeSEI is a psychometrically sound and culturally responsive tool for assessing weight stigma exposure across diverse populations in Asia. Cultural adaptation is recommended for cross-national comparisons.

BACKGROUND: Sexual and gender minority youth aged 12-18, whose sexual orientation, gender identity, or gender expression diverges from societal norms, encounter higher rates of bullying, violence, and depressive symptoms than their peers.

METHODS: Guided by the Minority Stress Model and Keyes' definition of well-being, this cross-sectional study investigates differences between sexual and gender minority youth and their peers in well-being (emotional, psychological, social), perceived school environment, and exposure to bullying and violence (sexual, physical, psychological). Furthermore, it explores the relationship between these factors and psychological distress and school attendance among sexual and gender minority youth. Secondary data analysis was conducted using the Youth Public Health Survey in Jönköping County, Sweden. Pooled multivariable linear and logistic regression analyses were performed to assess group differences (n = 5020) and identify predictors of psychological distress and school attendance among sexual and gender minority youth (n = 456).

RESULTS: Sexual and gender minority youth reported significantly lower levels of well-being, peace at school, alongside higher rates of bullying, violence, school stress, psychological distress, and increased odds of missed school compared to their peers. Among sexual and gender minority youth emotional and psychological wellbeing and teacher support were significant protective factors, while increased disability frequency, school stress, and exposure to sexual violence were significant risk factors across psychological distress and school attendance outcomes.

CONCLUSION: Swedish sexual and gender minority youth experience mental health and school-related disparities, underscoring the need for targeted, school-based interventions.

IMPLICATIONS TO PRACTICE: Pediatric and school-based nurses play a crucial role in these efforts.

The primary objectives of the present cross-sectional study were to translate and culturally adapt the YouTube Addiction Scale (YAS)into Malay and to evaluate its reliability, factorial validity, concurrent validity, and measurement invariance across gender and ethnicity among Malaysian university students. A total of 690 students participated (mean age = 21.29 years [SD ± 2.42]; 74% female). Confirmatory factor analysis supported a unidimensional YAS structure with good fit (CFI = 0.98, TLI = 0.97, SRMR = 0.06, RMSEA =0.07). The scale exhibited strong reliability (α = 0.83, ω = 0.84) and measurement invariance across gender and ethnicity. YAS scores showed correlation with Smartphone Application-Based Addiction Scale score (r = 0.17, p < 0.001) and Bergen Social Media Addiction Scale score (r = 0.23, p < 0.001), a weak correlation with time spent on social media (r = 0.09, p = 0.02), and no significant relationship with time spent on online gaming (r = 0.03, p = 0.47). The Malay YAS is a reliable and valid instrument for assessing YouTube addiction among Malaysian university students. Its unidimensional structure, strong reliability, robust measurement invariance across gender and ethnicity, and satisfactory concurrent validity support its application in research, screening, and intervention programs.

Aim: This repeated cross-sectional study examined trends and behavioral correlates of excessive screen time among Swedish adolescents across 2017, 2020 and 2023. Specifically, this study examined 1) temporal trends of variables used, 2) correlates of pooled screen time, and 3) correlates of specific screen modalities (gaming, social media, and film/TV viewing).

Methods: Data were collected from n=8,300 upper secondary school students in Jönköping County (n=2,319 in2017; n=3,056 in 2020; n=2,925 in 2023). Measures used included risk behaviors (e.g., alcohol, smoking), physical activity, psychosocial trust, exposure to violence and victimization, sleep duration, psychosomatic symptoms, absenteeism and living arrangement. General linear models (GLM; UNIANOVA) were conducted, adjusting for relevant covariates.

Results: Alcohol use, smoking, shorter sleep duration, higher psychosomatic symptoms, and school absenteeism were associated with higher pooled screen time, whereas physical activity, female gender, and living with both parents were associated with lower pooled screen time. Across modality-specific analyses, shorter sleep duration, lower physical activity, living without both parents, and school absenteeism were consistently associated with higher screen use across gaming, social media, and film/TV viewing, while substance-use and gender associations varied by modality.

Conclusion: Sleep, physical activity, family structure, and school absenteeism appear to be robust correlates across screen modalities, supporting the importance of targeting these factors in adolescent health promotion and digital media guidance. These findings highlight the need for parents, researchers, and health professionals to pay closer attention to adolescents’ digital media use.

Food addiction (FA) is linked to eating disorders and obesity. The Yale Food Addiction Scale (YFAS), which has various versions in different languages, is widely used to assess FA worldwide. This meta-analysis aimed to assess the YFAS through reliability generalization meta-analysis (REGEMA). From their inception until April 2024, a comprehensive systematic review across more than 30 databases was conducted to identify studies reporting reliability measures (e.g., Cronbach's alpha and McDonald's omega) of the YFAS. Sixty-five studies were included in this meta-analysis, with a median sample size of 451 participants. The results of the random-effects meta-analysis showed a high pooled reliability coefficient (α = 0.85, 95% CI: 0.83 to 0.86 p < 0.001). Test-retest reliability was also estimated using a random-effects meta-analysis of 10 studies, resulting in a pooled test-retest correlation coefficient of intraclass coefficients of (ICC = 0.77, 95% CI: 0.70 to 0.84, p < 0.001). These findings highlight the consistency and robustness of the YFAS in detecting FA across studies, suggesting its reliability for screening for FA-related disordered eating.

The present study aimed to use a novel method (i.e., network analysis) to examine if the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) has its unidimensional structure supported across different subgroups, including gender groups, continent groups, and age groups. Participants from five continents (n = 545 in Africa; n = 27,910 in Americas; n = 4640 in Asia; n = 88,835 in Europe; and n = 1633 in Oceania) completed the IGDS9-SF. The IGDS9-SF items showed a positively correlated network with moderate-to-high predictability (mean of R2 = 0.338, SD = 0.068). Moreover, the network analysis results suggested that the IGDS9-SF is very likely to have a one-factor model. This one-factor model was further found to be invariant across gender groups (men vs. women), continent groups (Africa, Americas, Asian, Europe, and Oceania), and age groups (minor aged under 18 years, young adults aged between 18 and 30 years, and adults aged 30 years or above).

BACKGROUND: Traditional moral disengagement is observed in daily life. However, with the increase in time spent in virtual environments, the need to also investigate online moral disengagement (OMD) is evident. In this study, we aimed to adapt the OMD Scale (OMDS) to the Turkish population and examine the relationship among OMD, empathic tendency, and cyberbullying.

METHODS: A total of 694 volunteering Turkish adolescents, 404 (58.2%) females and 290 (41.8%) males and with a mean age of 15.19 years (range: 14-17 years; standard deviation = 1.09), were included. Data were collected using the OMDS, Cyberbullying Scale, and Adolescent KA-Sİ Empathic Tendency Scale. The study was conducted in several stages: confirmatory factor analysis (CFA), item factor loading, item-total correlation, concurrent analysis, mediating analysis, and reliability analysis.

RESULTS: The CFA confirmed the validity of the eight-item structure OMDS. The findings also revealed a significant relationship between OMD, empathic tendency, and cyberbullying. Precisely, OMD mediated the relationship between empathic tendency and cyberbullying.

CONCLUSION: The reliability values of the OMDS were good. Likewise, the Turkish version of the scale was also valid and reliable. OMD mediated the relationship between empathic tendency and cyberbullying.

Objectives: Pain is a common symptom in prehospital emergency care and pain treatment in this context can be challenging. While previous research has assessed the use of morphine and other synthetic opioids for pain management in this setting, the evaluation of alfentanil is limited. The objective of this study was to evaluate the safety and effect of intravenous alfentanil when administered by ambulance nurses in prehospital emergency care.

Methods: This retrospective observational study consecutively included patients suffering from pain, treated with alfentanil in a Swedish EMS service from September 2011 to 31 September 2022. Data regarding occurrence of adverse events (AE), serious adverse events (SAE)–were used for safety evaluation and pain scores with a visual analogue scale (VAS) before and after treatment were used for evaluation of pain treatment. These data were extracted from the electronic patients’ medical records database for analysis. Univariate logistic regression analysis was used to identify significant predictors of AE following injection of alfentanil by nurses in prehospital emergency care.

Results: During the evaluation period 17,796 patients received pain relief with alfentanil. Adverse events affected 2.5% of the patients, while serious adverse events were identified in 25 cases (0.01%). Out of the 5970 patients with a complete VAS score for pain, the median VAS score was 8 (IQR 3) before treatment and 4 (IQR 3) after treatment. The mean reduction in pain measured by VAS was −4.1 ± 2.6 from the time before, to the evaluation after alfentanil administration. The administration frequency increased during the first year up to a steady level during the later part of the evaluation period.

Conclusions: This study proposes that alfentanil represents a safe and efficacious alternative for addressing urgent pain relief within the prehospital emergency context. Alfentanil demonstrates efficacy in alleviating pain across various conditions, with a relatively low risk of adverse events or serious adverse events when administered cautiously.

Biphasic sleep, characterized by nighttime sleep plus daytime napping, has demonstrated some cognitive, health and performance impacts when compared with consolidated monophasic sleep. This motivated the development and validation of the Biphasic Sleep Scale, reported in this paper. Scale development involved a literature review, expert input and individual interviews. The 16-item Biphasic Sleep Scale was then administered to an international online sample (n = 6965) alongside well-established validated sleep scales. To ensure a robust evaluation of the Biphasic Sleep Scale, the sample was divided into two parts: with 15% (n = 1000) of the participants allocated to the exploratory analytic phase; and the remaining 85% (n = 5965) reserved for confirmatory analyses. Psychometric evaluation included both exploratory and confirmatory factor analysis, reliability analysis, correlations, network analysis, and item response theory. Exploratory factor analysis indicated a three-factor structure assessing daytime napping as to likelihood, consequences and effect on nighttime sleep. Confirmatory factor analysis largely confirmed this model with no sex invariance. The three-factor structure showed adequate fit. The Biphasic Sleep Scale demonstrated good internal consistency (alpha = 0.88, Omega = 0.89). Network analysis revealed varying centrality and connectivity of items. Item response theory found items covering a range of biphasic sleep levels. Significant positive correlations with sleep criteria provided evidence for convergent validity. Further testing is warranted to confirm the factor structure, refine model parsimony, and establish clinical utility. With additional validation, it is hoped that the Biphasic Sleep Scale will become a widely utilized tool.

IMPORTANCE: Cannabis use disorders (CUD) are associated with adverse health effects, including mental disorders and motor vehicle collision-related injuries. However, little is known about whether CUDs are associated with increased mortality risk.

OBJECTIVE: To examine whether individuals receiving incident hospital-based care (an emergency department visit or hospitalization) for a CUD is associated with increased risk of death.

DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study included all individuals aged 15 to 105 years living in Ontario, Canada, between 2006 and 2021 (n = 11 622 571 individuals). Overall and cause-specific mortality were compared between individuals with incident hospital-based CUD care and age- and sex-matched members of the general population or individuals with hospital-based care for other substance use disorders using cause-specific hazard models adjusted for comorbid mental health, substance use, and chronic health conditions. Statistical analysis was performed from September to December 2024.

EXPOSURE: Incident hospital-based CUD care.

MAIN OUTCOMES AND MEASURES: Overall and cause-specific mortality identified using vital statistics.

RESULTS: The matched analysis included 527 972 individuals (mean [SD] age, 29.9 [13.6] years; 330 034 [62.5%] female) with a median (IQR) follow-up of 5 (3-9) years; 106 994 had incident CUD. Within 5 years of incident hospital-based CUD care, 3770 individuals (3.5%) died compared with 3770 (0.6%) of matched general population members. After adjusting for comorbid conditions, individuals with incident hospital-based CUD care were at increased risk of death relative to the general population (adjusted hazard ratio [aHR], 2.79 [95% CI, 2.62-2.97]). Individuals with hospital-based CUD care were at increased risk of all investigated types of death and particularly elevated risk of death by suicide (aHR, 9.70 [95% CI, 6.04-15.57]), trauma (aHR, 4.55 [95% CI, 3.55-5.82]), opioid poisoning (aHR, 5.03 [95% CI, 2.86-8.84]), other drug poisonings (aHR, 4.56 [95% CI, 3.11-6.68]), and lung cancer (aHR, 3.81 [95% CI, 2.39-6.07]) relative to the general population. Compared with an individual with hospital-based care for CUD, individuals with hospital-based care for alcohol (aHR, 1.30 [95% CI, 1.26-1.34]), stimulants (aHR, 1.69 [95% CI, 1.62-1.75]), and opioids (aHR, 2.19 [95% CI, 2.10-2.27]) were at relatively increased risk of death within 5 years.

CONCLUSIONS AND RELEVANCE: In this cohort study of all residents of Ontario, Canada, individuals with incident hospital-based CUD care were at markedly increased risk of death compared with the general population. These findings suggest important clinical and policy implications, given global trends toward cannabis legalization and market commercialization accompanied by increasing cannabis use and CUDs.