PurposeThe study aims to have adults discuss experiences, practices needs and feelings related to health management, diet and food security.Design/methodology/approachA total of 22 immigrants were recruited from the Open School of Immigrants in Piraeus, Attica, Greece, to participate in focus group discussions. The discussions were audio recorded and thematically analyzed. Three major themes were developed: pathways to health care, nutrition management and experiences related to food shortages.FindingsMost of the participants identified internet as the most commonly used way to obtain health advice; they also stated that unexpected ill-health is usually accompanied by feelings of fear, anxiety and loneliness. Immigrants, who had visited a public hospital in Greece, identified the language barrier as the most challenging issue, followed by the long waiting lists. Fear and anxiety of hospital visits was an important factor in their decision to vaccinate against COVID-19. Lack of time, high cost of healthy food and lack of knowledge were the most common obstacles to a healthy diet. One in two immigrants reported that they have faced food insecurity issues in the past. Stress, psychological distress and irritation were reported, due to food shortages, especially during the first few years of arriving in Greece. The exclusion of some foods, reduced portion sizes and buying cheaper foods were among the coping strategies to address food shortages.Originality/valueThe study offers an insight into immigrant's experiences, practices and feelings about managing health issues and could be useful for health-care practitioners, researchers and policymakers.

Achieving high COVID-19 vaccination rates globally is a key public health challenge. The study aims to investigate factors determining COVID-19 vaccine hesitancy and adherence to prevention measures, in Greek adults. This cross-sectional study was conducted in Greece, from the 21st of February to the 3rd of April 2021, during the strict lockdown period of the 3rd COVID-19 wave. A total of 2029 adults (75.3% women, median age 38 years) participated in an online survey. Participants completed a questionnaire assessing sociodemographic and anthropometric characteristics, adherence to COVID-19 prevention measures and willingness to vaccinate. Health Literacy (HL), perceived stress, life satisfaction and adherence to Mediterranean Diet (MD) were also assessed. Multiple linear and logistic regression analyses were employed. The median score of COVID-19 adherence to the prevention measures tool was 23.08 (interquartile range: 3.83; range: 1 to 35). A total of 57.5% of the participants were willing to vaccinate, 12.1% were unwilling and 30.4% were undecided. Linear regression revealed that women, obese participants, those with a chronic disease and those willing to vaccinate reported higher adherence to prevention measures. Older age, higher levels of HL, life satisfaction and adherence to MD were also positively associated with higher adherence. Logistic regression revealed that being a woman decreases the odds of having the willingness to vaccinate, whereas older age, higher education and adherence to measures increase the odds of willingness to vaccinate. The results could be used by practitioners, researchers and policy makers working in the field of prevention and management of COVID-19.

BACKGROUND: Suboptimal control of blood pressure (BP) is a public health challenge in Greece. This educational intervention attempts to improve health literacy (HL) and nutrition literacy (NL) in primary healthcare (PHC) patients with hypertension (HTN). MATERIALS AND METHODS: This was a proof-of-concept (PoC) educational intervention. Twenty-four patients with HTN and low or medium levels of HL agreed to participate in this 6-week educational intervention. The program was delivered by a general practitioner (GP) in group A and by a qualified nurse in group B. Group C was the control group. The levels of HL of NL, adherence to the Mediterranean diet, and perceived stress were assessed using the European Health Literacy Survey Questionnaire 16 (HLS_EU_Q16) and part B (reading a medication label) of the High Blood Pressure–Health Literacy Scale (HBP–HLS), the Nutrition Literacy Scale-Greek (NLS-Gr), the Mediterranean Diet Adherence Screener (MEDAS), and the Perceived Stress Scale (PSS-14), respectively, together with certain socioeconomic, dietary, and lifestyle characteristics. The Kruskal–Wallis and Wilcoxon nonparametric, the Chi-square, and the McNemar–Bowker tests were used. The analysis was done with the STATA software, version 14 (MP & Associates, Sparta, Greece). RESULTS: No statistically significant differences were found in the total score of HL and NL before and after the intervention; however, the results indicate a slight improvement in HL and NL levels in the two intervention groups, together with small improvements in knowledge and behaviors related to HTN and dietary salt. A trend of improvement in the MEDAS levels in the GP's group and the HBP–HLS levels in the nurse's group was also reported. CONCLUSION: A slight improvement in HL and NL levels in the two intervention groups has been reported, and the changes, however, were not statistically significant.

BACKGROUND: It is widely known that excessive or prolonged stress in humans, can negatively affect eating behavior. OBJECTIVE: The aim of the study was to validate the Salzburg Stress Eating Scale (SSES) in the Greek language and to examine its psychometric properties, in a sample of adults, in Greece. METHODS: An online survey was conducted. The Perceived Stress Scale (PSS), the three-factor eating questionnaire (TFEQ) R-18 and two subscales of the Dutch Eating Behavior questionnaire (DEBQ) were used, together with the SSES. Certain sociodemographic and lifestyle characteristics were also assessed. Exploratory Factor analysis (EFA), Cronbach’s α and Spearman’s rho were used. RESULTS: The sample consisted of 368 participants (51.1% women) and the mean age of the participants was 35 years. EFA indicated one factor in SSES with Eigenvalues > 1, which explained the 54.6% of total variance. The Cronbach’s Alpha was 0.920. SSES was significantly positively correlated with the subscales of the DEBQ (for the Restrained Eating subscale r = 0.147 and for the Emotional Eating subscale r = 0.615, p < 0.001) and was significantly negatively correlated with two subscales of the TEFQ (for the TFEQ1 r = – 0.233 and for the TFEQ2 r = – 0.562, p < 0.001). CONCLUSIONS: The Greek version of SSES is a reliable tool for assessing changes in eating behavior, in relation to stress.

The study was set out to investigate the factors affecting consumers’ purchasing attitudes and their intention to buy PDO/PGI food products. A total of 615 consumers took part in the study from the municipality of Attica, Greece. The majority of the respondents consider PDO/PGI products of better quality and higher safety than the conventional ones, and they are also able to identify them. However, respondents are unsure whether these products are superior in terms of health benefits, less expensive and tastier than the conventional ones. Furthermore, consumers, who pay attention to the origin, the health claims, the label of a product, and have a high level of consumer awareness, are more likely to buy PDOs/ PGIs. Understanding the main factors that influence consumers to purchase PDO/PGI products, is a vital step towards the promotion of special labeled agri-foodstuffs, which could contribute to the local sustainable development.

The aetiology of autism spectrum disorder (ASD) is heterogeneous and is attributed to the concurrent interaction of a number of genetic and environmental factors. The steady increase in ASD rates in recent years makes the detection and study of environmental risk factors increasingly important. This systematic review identifies potential environmental factors associated with ASD focusing specifically on recent studies conducted in selected Southern European countries. Nine relevant studies were selected for this systematic review. Results indicate that ASD in Southern Europe is associated with a variety of prenatal, perinatal and postnatal environmental factors, including stressful early life events, maternal infection during pregnancy, delivery mode and perinatal complications or breastfeeding problems in the offspring. Specially designed, large population-based birth cohort studies are needed in Southern Europe, to allow precise assessment of potential environmental confounders and elucidate their association with ASD.

Purpose The pandemic of COVID-19 led to considerable challenges with respect to people's health, dietary behavior and satisfaction with life. This study aims to investigate perceived stress levels, in relation to diet quality and life satisfaction in Greek adults, during the COVID-19 lockdown. Design/methodology/approach This is a cross-sectional study which took place in Greece in the course of the strict lockdown period, in the third COVID-19 wave. A sample of 2,029 adults aged 18 years and above participated in an online survey. The questionnaire consisted of questions on sociodemographic and anthropometric characteristics. The Perceived Stress Scale, the Satisfaction with Life Scale and the Mediterranean Diet Assessment Tool were also used. Findings Linear regression has shown that women ( p < 0.0001), younger individuals ( p < 0.0001), obese individuals ( p = 0.047), those with lower levels of satisfaction with life ( p < 0.0001) and lower adherence to Mediterranean diet ( p = 0.0001) were positively associated with higher levels of stress. Originality/value To the best of the authors’ knowledge, this is the first study conducted in Greece aiming at investigating concurrently, levels of perceived stress, with respect to levels of satisfaction with life and diet quality in adults, during the lockdown period of the COVID-19 pandemic.

BACKGROUND: Having comprehensive and validated tools to effectively measure levels of Health Literacy (HL) in the general population is of great importance, since HL levels appear to be a crucial determinant of the population’s overall health. OBJECTIVE: The aim of the study was to validate the Greek version of the HLS_EU_Q16 questionnaire. METHODS: A total of 496 participants (81.8% women) participated in a self-administrated online, cross-sectional survey. The participants had to concurrently complete the Greek Version of HLS_EU_Q16 and the New Vital Sign (NVS). Certain socioeconomic and anthropometric characteristics were also assessed. For test-retest reliability, 149 of the participants completed the questionnaire twice within a 15-day period. Principal Component Analysis, Cronbach’s a Spearman’s rho were used. RESULTS: All 3 factors assessed by the tool: “Health Care”, “Disease Prevention” and “Health Promotion”, had eigenvalues greater than 1. The Cronbach’s a was 0.884, for the total score of the HLS_EU_Q16 and 0.790, 0.710 and 0.800, for the above 3 subscales, respectively. Finally, test–retest reliability, after 15 days for the HLS_EU_Q16, resulted in Spearman’s correlation coefficient of r = 0.628 (p < 0.0001) which show a high correlation. CONCLUSIONS: Results indicate that the HLS_EU_Q16 is a reliable and valid tool for assessing HL in the Greek population.

Background: Health literacy (HL) and nutrition literacy (NL) are important issues to consider, in the provision of health care to children and the establishment of healthy eating behaviors. Aim: The study investigates the possible role of HL and NL levels of Greek parents, in parental Feeding Practices (PFP). Methods: This is a cross-sectional study which was conducted in the urban area of the Attica region, Greece. The sample consisted of 402 parents (68.4% mothers). Parents completed the Greek version of Comprehensive Parental Feeding Questionnaire, the European Health Literacy Questionnaire 47 and the Greek version of the Nutrition Literacy Scale. Sociodemographic and anthropometric characteristics were also assessed. The non-parametric tests Mann-Whitney and Kruskal Wallis, the chi-square test and linear regression models were applied. Results: The median for HL and NL were 33.69 and 24.00, respectively. Mothers applied the “child control” practice more frequently than fathers (p = 0.015). Linear regression analysis revealed that HL was associated positively with “healthy eating guidance” and “monitoring” (p = 0.009 and p < 0.0001, respectively) and negatively with “emotion regulation/food as reward” and “child control” (p = 0.037 and p = 0.015, respectively). NL was associated positively only with “healthy eating guidance” (p = 0.009), positively but marginally with “monitoring” (p = 0.051) and negatively with “emotion regulation/food as reward” (p = 0.020). Conclusions: Higher parental levels of HL and NL are significantly positively associated with better parental feeding practices in Greece.

The article aims at presenting scientific evidence on the possible role of Health Literacy (HL) on hypertension health outcomes. Original-research studies published in English from January 1st 1990 to February 28th 2021, were selected through a computer-assisted literature search, using specific key words relating to hypertension and HL. Studies in full text, on adult hypertensive patients, were included. Out of the 56 articles reviewed, 29 publications met the criteria for inclusion. Twenty-four studies were cross-sectional, 2 studies were interventions and there was 1 study from each of the following categories: randomised control trial (RCT), retrospective study and a non-randomised prospective cohort trial. The findings differ according to the design of the study, however, there seems to be good evidence that higher HL is usually associated with better blood pressure control, better hypertension knowledge, better medication adherence and higher levels of health-related quality of life of the participants. There is evidence that health literacy levels positively affect hypertension health outcomes.

Purpose The purpose of this paper is to develop and validate the Greek version of the Mediterranean Diet Adherence Screener (MEDAS). Design/methodology/approach The MEDAS was translated to the Greek language forward and backward, twice and subsequently was administered to 50 healthy adult participants living in Attica, Greece. The participants had to complete the tool twice, within a period of 15 days. Participants also completed the well-recognized Mediterranean Diet Score (MedDietScore), for comparison purposes with the tested tool. Socioeconomic and anthropometric characteristics were also assessed. Findings There was a moderate association between the Greek MEDAS (MEDAS-Gr) and the MedDietScore [(Pearson r = 0.50, p < 0.001; Intraclass Correlation Coefficient (ICC)=0.46, p = 0.015)]. The concordance between these two questionnaires varied between the items (Intraclass correlation coefficient of 0.62 for fruit at the highest and −0.09 for alcohol consumption). The Cronbach’s a coefficient of reliability for the Greek MEDAS was good (a = 0.62). The two administrations of the MEDAS-Gr produced similar mean total scores (7.6 vs 7.9, p = 0.090), which were correlated (r = 0.71, p < 0.001; ICC = 0.85, p < 0.001) and agreed substantially [k statistic (k)=0.72, 95% CI 0.54–0.89, p < 0.001)]. Originality/value The MEDAS-Gr seems to be a valid tool for assessing adherence to the Mediterranean diet in the Greek population.

Objectives: Healthy and sustainable eating should be encouraged in children. This study aimed to create, apply and evaluate the effectiveness of a specially designed, school-based educational programme to promote healthy and sustainable eating in children. Design: Pilot, school-based educational intervention, aimed at promoting health and sustainable eating patterns in children. Setting: Four schools (two primary schools and two kindergartens) in Attica, Greece. Method: The 3-month, pilot intervention consisted of a teacher training session, an educational package (11 teaching sessions, 1 session/per week), 3 separate parents and teachers’ educational sessions, and 2 teacher feedback meetings. In total, 290 children (intervention group n = 230, control group n = 60) aged 5–11 years old from four schools in Attica, Greece, participated in the study. Parents completed a specially designed questionnaire before and after the intervention, assessing children’s anthropometric characteristics, children’s adherence to a Mediterranean Diet (MD) and physical activity levels, together with usual eating and food waste behaviours in the household. Results: Children’s adherence to a MD was not significantly affected by the educational intervention. However, there was a significant increase in children’s fruit consumption, with 48% of the children eating at least two portions of fruit per day after the intervention. With respect to the food sustainability behaviours of the household, the intervention group threw away less food and, in particular, fewer fresh fruit and less bread, following the intervention. Conclusion: There is evidence that the educational programme can positively affect certain healthy eating behaviours in participating children.

Mental stress, poor life satisfaction and an unhealthy diet are significantly associated with serious negative health outcomes and behaviors (McNaughton et al., 2015; Palmore & Luikart, 1972; PerezAraluce et al., 2021). The COVID-19 outbreak has posed considerable challenges for people’s health and life satisfaction. The current study aims to investigate perceived stress levels, in relation to life satisfaction and diet quality in Greece adults, during the lock down period of the COVID-19 pandemic. This cross-sectional, population-based study was conducted in Greece, from the 21st of February to the 3rd of April 2021, during the strict lockdown period of the 3rd COVID-19 wave. A total of 2029 adults (75.3% women and median age 38 years) participated in an online survey. Participants completed a specially designed questionnaire assessing sociodemographic, anthropometric characteristics, perceived stress levels using the Perceived Stress Scale 14 (PSS-14), life satisfaction levels with the Satisfaction with Life Scale (SWLS) and adherence to Mediterranean Diet (MD) using Mediterranean Diet Assessment Tool (MEDAS). Multiple linear regression analysis was employed. Twenty six percent of the participants reported very low and low life satisfaction levels and only 11% reported high and very high levels of life satisfaction. With respect to the adherence to the MD, 17.6% had low adherence, 68.1% moderate adherence and only 14.2% had high adherence to the MD. Women reported higher levels of MD adherence (p = 0.037) and perceived stress levels (p <0.0001) than men. Multiple linear regression has shown that women (b = 3.052, 95% CI: 2.381–3.722, p < 0.0001), younger individuals (b = −0.109, 95% CI: −0.136 −0.082, p < 0.0001), obese individuals (b = 0.827, 95% CI: 0.009 −1.644, p = 0.047) compared to normal weight, those with lower levels of life satisfaction (b = −0.667, 95% CI: −0.711 – −0.622, p < 0.0001) and lower adherence to MD (b = −0.234, 95% CI: −0.377 – −0.091, p = 0.0001) were positively associated with higher levels of perceived stress. In conclusion, perceived stress seems to be significantly associated with lower life satisfaction and poorer diet, during the lock down period of the pandemic, in Greece.

Purpose The paper aims to investigate food security research in Southern Europe and selected Eastern Mediterranean countries. Design/methodology/approach An electronic literature search was conducted using Medline/PubMed and Scopus, to identify articles and reviews that were published in the English language, between January 2014 and December 2019. Thirty-three publications met the criteria for review. Findings Depending on the population sample and the measurement tool, reported food insecurity differed significantly between and within countries. In Portugal, food insecurity ranged from 11 to 70%; in France, from 6.3 to 77.7%; and in Greece, from 17.3 to 82%. Research limitations/implications Research investigating food insecurity issues and its true prevalence across southern European and Eastern Mediterranean countries are relatively limited. Originality/value Food insecurity levels in the above countries vary significantly, and the different methodologies often used render the results difficult to compare.

BACKGROUND: Food insecurity seems to be positively correlated with increased risk of malnutrition and poor health. OBJECTIVE: The purpose of the study was to develop and validate the Greek version of Adult Food Security Survey Module (AFSSM). METHODS: The AFSSM was translated to the Greek language forward and backward twice and subsequently was administered to 94 healthy adult individuals living in Greece. The participants had to complete the tool twice, within a period of 15 days. Fifty of the above participants also took part in a specifically designed structured interview, designed to assess food insecurity, for comparison purposes with the tested tool. Socioeconomic and anthropometric characteristics were also assessed. RESULTS: There was a significant positive correlation between the Greek AFSSM (AFSSM-Gr) and the results of the specifically designed structured interview, assessing food insecurity ( r = 0.376, p < 0.01). The Cronbach’s alpha coefficient of reliability for the Greek AFSSM was good (α= 0.763). There was also a significant negative correlation between the age of the participants and the score of the AFSSM-Gr ( r = –0.307, p < 0.01). CONCLUSIONS: The AFSSM-Gr can be considered as a useful tool for assessing Food Insecurity.

OBJECTIVES:Mental stress, low health literacy (HL) and nutrition literacy (NL) are associated with serious negative health outcomes. The aim of this study was to investigate HL and NL levels, in relation to levels of perceived stress, in adults.METHODS:This cross-sectional study was conducted in the urban area of the Attica region, Greece. The sample consisted of 1,281 individuals, aged ≥ 18 years. The European Health Literacy Questionnaire 47, the Greek version of the Nutrition Literacy Scale and the Perceived Stress Scale 14 were used. Socio-demographic characteristics were also assessed. Nonparametric Mann-Whitney U and Kruskal-Wallis tests, Pearson chi-square and multiple linear regression models were used.RESULTS:The sample's perceived stress mean value (SD) was 26.47 (7.27) with women scoring statistically significantly higher than men. The mean HL and NL scores were 32.28 (8.28) and 22.11 (5.67), respectively. Linear regression analysis has shown that perceived stress was significantly negatively associated with HL (p < 0.001) but not with NL levels (p = 0.675) after adjusting for a series of confounding variables.CONCLUSIONS:Low health literacy seems to be very significantly associated with high levels of perceived stress. The reasons behind this association require further investigation.

Purpose The paper aims to investigate food security research in Southern Europe and selected Eastern Mediterranean countries. Design/methodology/approach An electronic literature search was conducted using Medline/PubMed and Scopus, to identify articles and reviews that were published in the English language, between January 2014 and December 2019. Thirty-three publications met the criteria for review. Findings Depending on the population sample and the measurement tool, reported food insecurity differed significantly between and within countries. In Portugal, food insecurity ranged from 11 to 70%; in France, from 6.3 to 77.7%; and in Greece, from 17.3 to 82%. Research limitations/implications Research investigating food insecurity issues and its true prevalence across southern European and Eastern Mediterranean countries are relatively limited. Originality/value Food insecurity levels in the above countries vary significantly, and the different methodologies often used render the results difficult to compare.

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children's weight status. It's a cross-sectional study of 402 parents (68.4% mothers), with children aged 2-12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children's adherence to the MD. Logistic regression showed that in children aged 2-<6 years, "emotion regulation/food as reward" and "pressure" decrease MD adherence (OR = 0.186,p < 0.0001 and OR = 0.496,p = 0.004), and "monitoring" decrease excess body weight (OR = 0.284,p = 0.009). In older children (6-12 years), "healthy eating guidance" and "monitoring" increase MD adherence (OR = 3.262,p = 0.001 and OR = 3.147,p < 0.0001), "child control" decreases MD adherence (OR = 0.587,p = 0.049), "pressure" decrease excess body weight (OR = 0.495,p < 0.0001) and "restriction" increase excess body weight (OR = 1.784,p = 0.015). "Healthy eating guidance" and "monitoring" seem to be the best PFP employed, in terms of children's MD adherence and weight status.

BACKGROUND: Low Health Literacy (HL) and Nutrition Literacy (NL) are associated with serious negative health outcomes. OBJECTIVES: The aim of this study was to investigate certain lifestyle factors and obesity, in relation to HL and NL. METHODS: This cross-sectional study was conducted in the urban area of the Attica region, in Greece. The sample consisted of 1281 individuals, aged ≥18 years. HL, NL sociodemographic characteristics and lifestyle factors (physical activity, smoking status, alcohol consumption,) were assessed. Mann-Whitney U, the Kruskall Wallis, Pearson chi-square tests and multiple linear regression models were used. RESULTS: Linear regression analysis has shown that smoking, alcohol consumption and physical activity, were associated with HL levels (–1.573 points for ex-smokers in comparison to smokers, p = 0.035, –1.349 points for alcohol consumers in comparison to non-consumers, p = 0.006 and 1.544 points for physically active individuals to non-active, p = 0.001). With respect to NL levels, it was also not associated with any of these factors. Obesity was not associated with HL and NL levels. CONCLUSIONS: Certain lifestyle factors, including physical activity, are predicting factors of HL levels, in Greek adults. The results contribute to the understanding of the relationship between lifestyle factors and HL and should be taken into account when HL policies are designed.

Poor health literacy (HL) is associated with poor health behaviours and outcomes. The aim of the study was to investigate the effect of socioeconomic status on HL and nutrition literacy (NL) in Greece. This is a cross-sectional study which took place in Attica, Greece. 1281 individuals, aged ?18?years of both sexes, participated. The European Health Literacy Questionnaire and the Greek version of the Nutrition Literacy Scale were used. Linear regression analysis revealed that education was significantly positively associated with HL (p?=?0.002) and medium annual income was significantly associated with higher HL (p?=?0.024), in contrast to low annual income. Education (p?<?0.001) was significantly positively associated with NL. Unskilled particpants had lower NL compared to skilled paricipants (p?=?0.021) and participants with medium annual income had significantly higher NL (p?=?0.003) in comparison to participants with low annual income. Socioeconomic inequalities seem to negatively associate with HL and NL in Greece.