Background The Belt and Road Initiative is promoting the growth of the cross-border population, and there is still a lack of study on modifiable factors associated with health-related preventive behaviors among resident aliens in China. Public health events may highlight the relevant factors. Objective To conduct a pilot study to preliminarily identify potential modifiable factors associated with preventive behaviors among resident aliens in China, and to explore possible mediating effects of positivity and self-efficacy on the relationship between satisfaction of health services and preventive behaviors, aiming to provide ideas for further research in this direction. Methods A cross-sectional survey was conducted among foreigners in a city of East China by using snowball sampling in July 2023. Based on the protection motivation theory, the Self-Efficacy Scale, Positivity Scale, Preventive Behaviors Scale, and Satisfaction of Health Services Scale were adopted in the survey. Cronbach's α coefficient was used to evaluate scale reliability. A structural equation model was constructed for validity test and path analysis. Maximum likelihood method was used for parameter estimation, and bias-corrected percentile Bootstrap method was used to verify mediating effect. Results A total of 187 resident aliens were approached and 180 of them returned valid questionnaires. The Cronbach's α coefficients of the Self-Efficacy Scale, Positivity Scale, and Preventive Behaviors Scale were 0.904, 0.784, and 0.821, respectively. The M (P₂₅, P₇₅) scores of self-efficacy, positivity, preventive behaviors, and satisfaction of health services were 32 (27, 35), 29 (25, 30), 17 (14, 20), and 4 (3, 5), respectively. Statistically significant differences in the scores of preventive behaviors were identified among the participants by religious belief, geographical location, and economy (P<0.05). The results of path analysis showed that satisfaction of health services, positivity, and self-efficacy had direct positive effects on preventive behaviors (P<0.05), and positivity and self-efficacy played multiple mediation roles in the relationship between satisfaction of health services and preventive behaviors. The results of mediating effect test showed that the indirect effects of the three identified paths mediated by positivity and self-efficacy were statistically significant, and the total size of indirect effect was 0.316 (95%CI: 0.180, 0.466) that accounted for 61.2% of the total effect size. The strongest mediating path was satisfaction of health services→positivity→preventive behaviors, with an indirect effect size of 0.167 (95%CI: 0.046, 0.335) that accounted for 32.4% of the total effect size. Conclusion Future studies and policy formulation on preventive behaviors of foreigners in China should focus on the social demographic factors such as geographical location of home country, religious belief, and cultural customs. At the same time, the study of path relationship of preventive behaviors should embrace environmental factors, emotional factors, and cognitive factors.

Background Occupational stress is an important factor affecting the health of working population, wellness is a topic that has received much attention in recent years, and sleep quality and wellness have a certain impact on occupational stress. Objective To understand the current situation of occupational stress among locomotive engineers in in the Yangtze River Delta, explore the influence of well-being and sleep quality on occupational stress, and provide a theoretical basis for occupational stress intervention among locomotive engineers. Methods Sampling was conducted from October to December 2022 using stratified random sampling. The Chinese version of the Brief Occupational Tension Questionnaire based on the Job Demand-Control Model (JDC model), the World Health Organization 5-item Well-Being Index (WHO-5), and the Pittsburgh Sleep Quality Index (PSQI) scale were used to investigate the occupational stress, well-being, and sleep quality of locomotive engineers. Logistic regression was used to analyze the effects of sleep quality and well-being on occupational stress, and additive and multiplicative interaction models were applied to evaluate the interactive effects of well-being and sleep quality on occupational stress. Results A total of 8243 questionnaires were collected from five locomotive companies, and after excluding unqualified questionnaires, a total of 7976 questionnaires were included in the analysis. The number of locomotive engineers in the Yangtze River Delta reporting positive occupational stress was 4633 (58.09%), the number of low-level well-being was 4949 (62.05%), and the number of poor sleep quality was 4129 (51.77%). The distribution of occupational stress varied by age, length of service, region, technical level, nature of vehicle, education, per capita monthly family income, marital status, smoking, drinking, number of exercise sessions per week, quality of sleep, work shifts, and length of commute (P<0.01). The results of logistic regression showed that a lower level of occupational stress was associated with >11000 yuan per capita monthly household income (OR=0.795, 95%CI: 0.656, 0.964), high level of well-being (OR=0.477, 95%CI: 0.430, 0.528), and good sleep quality (OR=0.588, 95%CI: 0.531, 0.651); a higher level of occupational stress was associated with night shifts: 1 or fewer night shifts (OR=1.707, 95%CI: 1.312, 2.221), 2 to 3 night shifts (OR=2.649, 95%CI: 2.111, 3.325), and 4 or more night shifts (OR=2.804, 95%CI: 2.202, 3.571); a higher level of occupational stress was associated with 60 min or more commuting time (OR=1.353, 95%CI: 1.111, 1.646). Regarding interaction between poor sleep quality and low well-being on occupational stress, the relative excess risk ratio (RERI), attributable risk index (API), and synergy index (SI) were 1.451 (1.059, 1.844), 0.417 (0.327, 0.507), and 2.407 (1.787, 3.241), respectively, and the result of the multiplicative interaction was an OR of 1.546 (95%CI: 1.262, 1.893). Conclusion The prevalence of occupational stress among locomotive engineers in the Yangtze River Delta region is generally at a medium level compared with other industries. Good sleep quality reduces the risk of occupational stress to a greater extent than high well-being, and poor sleep quality and low well-being can interact and further increase the risk of occupational stress.