Dietary self-regulation levels among adults in Shanghai: cross-sectional associations with e-health literacy, perceived stress, and rest intolerance
- 1Department of Critical Care Medicine, General Hospital of Ningxia Medical University
- 2Department of Dermatology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
- 3Cardiac Center, General Hospital of Ningxia Medical University
Abstract
Background: Dietary self-regulation supports healthy eating, but its cross-sectional associations with e-health literacy, perceived stress, and rest intolerance remain unclear. This study characterized dietary self-regulation levels among adults in Shanghai and estimated direct and indirect associations among these variables.
Methods: A cross-sectional survey of 1,011 permanent adult residents of Shanghai was conducted from July to September 2024. Validated questionnaires assessed e-health literacy, dietary self-regulation, perceived stress, and rest intolerance. Associations were examined using Spearman correlations, exploratory latent profile analysis, and a prespecified serial indirect-association model (PROCESS Model 6; 5,000 bootstrap resamples) adjusted for gender, age, education, employment, residence, and income.
Results: The selected three-class solution primarily distinguished low, moderate, and high overall dietary self-regulation, with largely parallel item-response patterns rather than qualitatively distinct subtypes. E-health literacy was positively associated with dietary self-regulation and rest intolerance and negatively associated with perceived stress; perceived stress was negatively associated with dietary self-regulation, whereas rest intolerance was positively associated with it. The total association between e-health literacy and dietary self-regulation was 0.615 (95% CI, 0.564–0.666); the association conditional on perceived stress and rest intolerance was 0.211 (95% CI, 0.147–0.274), and the total indirect association was 0.404 (95% CI, 0.344–0.466). The serial indirect association was small and negative (−0.015; 95% CI, −0.031 to −0.001), and the perceived stress-rest intolerance coefficient reversed direction after adjustment.
Conclusion: The variables were interrelated in the prespecified cross-sectional model, but the small serial estimate and directional instability do not support a clear sequential psychological mechanism. Because all variables were measured at one time point, temporal ordering and causal mediation cannot be established, and reverse causality remains possible. These findings are hypothesis-generating and require longitudinal or experimental confirmation.
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BibTeX
@article{tian2026dietary,
title = {{Dietary self-regulation levels among adults in Shanghai: cross-sectional associations with e-health literacy, perceived stress, and rest intolerance}},
author = {Fang Tian and Lin Du and Hao Yang and Yue Zhang},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1928922},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1928922/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Dietary self-regulation levels among adults in Shanghai: cross-sectional associations with e-health literacy, perceived stress, and rest intolerance
AU - Fang Tian
AU - Lin Du
AU - Hao Yang
AU - Yue Zhang
PY - 2026
DA - 2026/10/27
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1928922
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1928922/full
AB - Background: Dietary self-regulation supports healthy eating, but its cross-sectional associations with e-health literacy, perceived stress, and rest intolerance remain unclear. This study characterized dietary self-regulation levels among adults in Shanghai and estimated direct and indirect associations among these variables. Methods: A cross-sectional survey of 1,011 permanent adult residents of Shanghai was conducted from July to September 2024. Validated questionnaires assessed e-health literacy, dietary self-regulation, perceived stress, and rest intolerance. Associations were examined using Spearman correlations, exploratory latent profile analysis, and a prespecified serial indirect-association model (PROCESS Model 6; 5,000 bootstrap resamples) adjusted for gender, age, education, employment, residence, and income. Results: The selected three-class solution primarily distinguished low, moderate, and high overall dietary self-regulation, with largely parallel item-response patterns rather than qualitatively distinct subtypes. E-health literacy was positively associated with dietary self-regulation and rest intolerance and negatively associated with perceived stress; perceived stress was negatively associated with dietary self-regulation, whereas rest intolerance was positively associated with it. The total association between e-health literacy and dietary self-regulation was 0.615 (95% CI, 0.564–0.666); the association conditional on perceived stress and rest intolerance was 0.211 (95% CI, 0.147–0.274), and the total indirect association was 0.404 (95% CI, 0.344–0.466). The serial indirect association was small and negative (−0.015; 95% CI, −0.031 to −0.001), and the perceived stress-rest intolerance coefficient reversed direction after adjustment. Conclusion: The variables were interrelated in the prespecified cross-sectional model, but the small serial estimate and directional instability do not support a clear sequential psychological mechanism. Because all variables were measured at one time point, temporal ordering and causal mediation cannot be established, and reverse causality remains possible. These findings are hypothesis-generating and require longitudinal or experimental confirmation.
SN - 2296-2565
ER -