bluuebunny/crossref_metadata_2025 huggingface dataset:
The indirect costs of motherhood and fatherhood: impacts on income, working hours, and perceived health across 32 European countries
Authors: Leão T , Perelman J , Amaro J , Mamelund S E , Pereira M , Severo M
Published: October 2024

Background

Parenthood may affect men’s and women’s personal lives, professional careers, and well-being differently. In the last decades, structural modifications in gender norms, the labor market, and family-supporting policies have occurred, but with cross-country variations, even within European borders. This study aimed to update the estimates on the impact of parenthood on men’s and women’s income, working hours, and perceived health status, and better comprehend their variation across 32 European countries, using a longitudinal approach.

Methods

Data from the European Survey on Income and Living Conditions (2004-2020) were used to estimate the income variation and the likelihood of transitioning into a non-income status, less than 40 weekly hours, and less than very good health status, from one year before to one year after parenthood. Estimates were done by sex and country. Pooled effects were estimated using random effects meta-analysis.

Results

We found a short-term 29% income penalty for women and a 12% income premium for men after parenthood. Seventy percent of women who transitioned their status after motherhood shifted to work less than 40 hours per week while no effect was found for men. Regarding perceived health, no shifts were overall observed. A large cross-country heterogeneity was found.

Conclusions

Motherhood-related income penalties concurred with losses of employment and reductions of weekly working hours, while among men the income premiums were not necessarily coupled with transitions to employed status or 40 weekly working hours. The cross-country heterogeneity is, probably, multifactorial, depending on countries’ policies, norms, labor market, and social structure.
The long-term impact of parenthood on women and men’s income in 26 European countries
Authors: Moreno J , Severo M , Mamelund S E , Perelman J , Leão T
Published: October 2024

Background

Historically, women’s roles were predominantly associated with motherhood, leading to significant career interruptions and lower incomes compared to men. As gender roles have evolved, as did labor policies protecting parents, it would be expected that income penalties in women and income premiums in men would attenuate, especially in the long term. This study aims to assess the association between the number of children and the income earned by women and men in older adulthood.

Methods

We used data from wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes 43,772 participants with 50 years old or over and their partners, living in 26 European countries. Multilevel analysis was employed to estimate the association between having children and the total, employment-related, and pensions-related incomes, adjusting for sociodemographic characteristics and clustering by country.

Results

The highest median annual total income was identified for individuals living in Bismarkian (€19,000) and Scandinavian countries (€17,708), more than twice the income earned in the European remaining countries. Having had children was associated with lower total income (OR = 0.870 for 1-2 children, OR = 0.773 for 3-5 children, OR = 0.666 for more than 5 children; p < 0.005), and women received lower total incomes (OR = 0.694; p < 0.001). These patterns were also found for employment- and pensions-related incomes.

Conclusions

There is a long-term negative effect of having had children, and of the number of children, on income, both employment and pension-related, but women continue to receive about 30% lower incomes than men. The adoption of comprehensive policies stimulating a more equal gender distribution of childrearing responsibilities, while protecting parenthood, along with recognizing caregiving responsibilities in pension calculations, could mitigate these disparities and promote gender equity and better living conditions at the older ages.
Developing a structured framework to address vaccination barriers for Newly Arrived Migrants in EU/EEA
Authors: Declich S , Scarso S , Marchetti G , Russo M L , Tosti M E , Papaevgeniou N , Karnaki P , Marceca M
Published: October 2024

Background

Access to vaccination is a critical aspect of public health, particularly for newly arrived migrants (NAMs) in European Union/European Economic Area (EU/EEA) countries. Despite this, significant barriers exist, necessitating urgent attention. This study addresses the pressing need to improve vaccination coverage for NAMs by developing a General Conceptual Framework (GCF) to understand and overcome system barriers and analyzing possible strategies.

Methods

starting from a theoretical conceptualization, the study employed a mixed-method approach, incorporating literature review and qualitative research. The GCF was formulated based on key components of the vaccination process. Barriers and solutions were identified through a non-systematic literature review and qualitative investigation. The GCF served as a guide for study activities, facilitating data integration.

Results

The study outlines a structured GCF comprising five interconnected steps in the vaccination process: entitlement, reachability, adherence, achievement, and evaluation of vaccination. Barriers and solutions identified through literature review and qualitative research are presented. Strategies to enhance professional knowledge, accessibility, adherence, coverage, and intervention evaluation are proposed. Recommendations include proximity strategies, provider training, migrant-sensitive approaches, and robust data collection.

Conclusions

Equitable access to vaccination is paramount for public health, particularly for vulnerable populations like NAMs in EU/EEA countries. The development of the GCF represents a crucial step towards understanding and addressing barriers to vaccination access. Implementation of recommended strategies can significantly improve vaccination outcomes for NAMs, ultimately contributing to the overall health and well-being of these communities.
Paving the way for equitable and guaranteed access to vaccination for Newly Arrived Migrants
Authors: Papaevgeniou N , Karnaki P , Radaios V , Declich S , Serre Delcor N , Ayala Cortes S N , Marceca M
Published: October 2024

Background

There is a gap in knowledge on the country-specific access to vaccination for Newly Arrived Migrants (NAM) in Europe, the obstacles encountered, and the resources available to surmount these barriers. The AcToVax4NAM project addresses gaps in the vaccination process of NAM in 8 European countries by developing country-specific, action-oriented flowcharts of the vaccination pathway that identify barriers and provide barrier-specific solutions. The flowcharts are linked to a comprehensive Repository of Tools aimed at providing tools to overcome system barriers and ensuring equitable immunization access for NAM in all consortium countries.

Methods

Country-specific action-oriented flowcharts group the vaccination pathway for NAM in the five hubs (entitlement, reachability, adherence, achievement, and evaluation) and offer solutions for identified barriers. Participatory research validated these flowcharts via focus group discussions with 84 total professionals FOR health (PFH) involved in NAM immunization. The tools were sourced from all consortium countries, encompass diverse formats and languages, and provide a holistic approach to vaccination promotion.

Results

The validated instrument was deemed useful, relevant, and easily understandable. Validated barriers included the lack of multi-stakeholder collaboration, culturally competent PFH, tailored educational materials, and language barriers. Meanwhile, the linked Repository includes 359 tools categorized according to the five hubs of the vaccination pathway. These can be filtered by language, country, type of tool, year of issuance, and/or intended target population.

Conclusions

The flowcharts and the Repository serve as the basis for a pilot intervention aiming to strengthen healthcare system responsiveness to promote NAM immunization. This participatory approach aims to equip PFH with a clear understanding of system-level vaccination barriers and solutions to enhance vaccination uptake among NAMs.
Empowering Professionals For Health to promote Newly Arrived Migrant vaccination uptake
Authors: Papaevgeniou N , Karnaki P , Radaios V , Russo M L , Marceca M , Declich S
Published: October 2024

Issue/Problem

The imperative task of making access to vaccinations equitable and guaranteed for Newly Arrived Migrants (NAM) in Europe not only highlights a public health challenge but also offers a chance to tackle barriers within health systems. NAMs frequently encounter hurdles in accessing healthcare services, with vaccinations often ranking lower on their list of health priorities. The AcToVax4NAM project developed and implemented tailored interventions for Professionals FOR Health (PFH) working with NAMs in 8 EU countries.

Description of the problem

NAM often overlook vaccinations due to more immediate concerns, and health systems lack a comprehensive approach to vaccinations. Thus, piloted interventions were developed in consortium countries, working with PFH to tackle vaccination barriers. Over 3 months, each country implemented context-specific interventions to enhance health systems’ responsiveness using culturally appropriate tools. Key objectives included developing procedures, improving PFH cultural sensitivity communication skills, and assessing NAM vaccination intentions.

Results

Initial findings vary depending on the country’s context but generally show notable enhancements in PFH cultural competencies and increased willingness among NAM to get vaccinated. The pilots underscored the importance of tailoring strategies to specific contexts and fostering collaboration among stakeholders for a successful intervention.

Lessons

The results highlight the pivotal role of tailored interventions in addressing vaccination disparities among NAM. As PFH working with diverse populations, their role in implementing similar training programs in other settings facing similar challenges is invaluable to achieving equitable vaccination processes. Recommendations encompassing the lessons learned and challenges encountered throughout the pilot implementation will further facilitate the dissemination of this knowledge amongst relevant stakeholders.
Preparing for outbreaks of vaccine preventable diseases: why are prisons invisible?
Authors: O’Moore E
Published: October 2024

From 1 March 2023 to 29 February 2024, 30 EU/EEA Member States reported a total of 5 770 cases of measles, 4 864 (84.3%) of which were laboratory-confirmed. Th7e highest number of cases were reported by Romania- at the time of writing, 11,397 confirmed cases, including 12 deaths from 1 January 2023 to 7 April 2024. Measles is a highly infectious disease. The best mitigation is vaccination which is highly effective. Outbreaks in many countries have been driven by decreases in vaccine coverage with a two-dose measles-containing vaccine (MCV), especially evident since the COVID-19 pandemic. In many countries, vulnerable migrant populations, ethnic groups and communities experiencing social deprivation have been over-represented in cases and under-covered by vaccine programmes. We know that prisons contain such populations. Historic seroprevalence studies of prison populations, which themselves are scant, show that prison populations are under-vaccinated. Prisons are a setting that can cause disease amplification. Given these facts, it is perhaps surprising that many countries in Europe cannot provide specific surveillance data on either cases in prisons or vaccine coverage specifically in prison populations. Further, that prisons are not often cited as specific settings for vaccine catch-up programmes in national or regional programmes. This is despite evidence of measles cases and outbreaks historically and currently in several European countries. In the presentation we will ask why this ‘blind spot’ in national and international disease surveillance continues and what Member States could and should do to prevent the risk of mass outbreaks of measles in prisons, causing pressures on justice and health systems and risking wider community outbreaks. Finally, we will reflect on how this experience should alert us to the risk of other infectious diseases going undetected, unprevented, and under-studies in prisons, threatening our collective health security.
Towards better prepared prisons: monitoring and response to the use of new substances inside prison
Authors: Montanari L
Published: October 2024

The use of new psychoactive substances (NPS) became an emerging issue in prisons in a number of European countries in 2014-2015. Synthetic cannabinoids were the new psychoactive substances most often reported, followed by synthetic cathinones, synthetic opioids and new benzodiazepines. Quantitative qualitative data on prison and drugs provided by 27 European Member States, Norway and Turkey to the EMCDDA (European Monitoring Centre for Drugs and Drug Addiction).

An exploratory study conducted in 2017 found signs of NPS use in prison in 22 countries. Based on 2021-2022 data from a few countries, the lifetime prevalence of NPS in prison ranges from <1 to 19%, with large variation by country. Anecdotal information from 2024 referred to the use of new strong synthetic opioids (nitazene) inside prison. A wide range of physical and mental health harms (e.g. psychosis, disorientation, suicidal ideation, aggressiveness to others or self-harm) has been associated with acute intoxication by, and chronic consumption of NPS inside prison. Recent overdoses associated with the use of nitazene were reported in some prisons in Ireland and the UK. Additionally, the use of NPS in prison can have a disturbing impact on prison management, internal violence and bullying. To date, interventions to tackle the problems related to the use of NPS in prison have tended to focus on supply reduction and controls. Health and social interventions have begun to emerge, but they remain limited. Despite signs of increasing challenges posed by the emergence of NPS since several years, prisons remain largely unprepared to monitor and respond to those challenges. A new key task of the revised EMCDDA mandate (EUDA - European Drug Agency from 2nd of July) is to be better prepared to monitor, forecast and respond to new challenges in the drug field. Prisons should be prepared to adequately address the new challenges posed by the NPS to benefit the health and security of people living and working in prison.
Framework for approaching federated causal inference based on real-world observational data sources
Authors: Meurisse M , Schutte N , Van Goethem N , Estupiñán-Romero F , Bernal-Delgado E
Published: October 2024

Context

Causal inference methods, generally requiring detailed individual information, allow us to evaluate public health interventions in real-world observational settings. When comparing interventions across borders and for this purpose leveraging distributed sensitive individual-level data, a federated approach can be aided. However, reusing such distributed data while maintaining privacy and interoperability, is a challenging endeavor.

Methodological framework

In the context of the BY-COVID project, a methodological framework to approach federated causal inference was published in October 2023. It is presented as a set of guidelines in the form several consecutive steps, starting with defining a research question, to building a causal model, translating the causal model into data requirements captured within a Common Data Model (CDM), generating synthetic data complying with the requirements captured in the CDM, and developing interoperable analysis scripts which can be distributed for deployment in different federated nodes. The proposed framework was built through implementing and combining existing methodologies and taking into account the principles of legal, organizational, semantic and technical interoperability.

Objectives

This presentation will provide an overview of the proposed framework, and its demonstration by performing an international comparison of the real-world effectiveness of SARS-CoV-2 primary vaccination campaigns in preventing infections at different federated sites. Challenges encountered (e.g. difficulties in complying with data requirements by linking heterogeneous local data sources) and lessons learned in the course of the demonstrator will be highlighted.

Implications

We aim to contribute to a public health research field where the rapid assessment of emerging population-health research questions (potentially feeding into evidence-based policy-making) is achievable, in that way contributing to European pandemic preparedness.
Unraveling Social Health Inequalities during COVID-19 in Belgium: The Vital Role of Data Linkages
Authors: Van den Borre L , Cavillot L , De Pauw Robby , Devleesschauwer B
Published: October 2024

Background

During the COVID-19 crisis, data linkages were set up to efficiently monitor the outbreak and identify vulnerable population groups. Yet, considerable technical, administrative and data security issues have hindered the effectiveness of data linkages as a critical instrument during public health emergencies. This workshop aims to provide a practical demonstration of the challenges encountered in a Belgian data linkage during the COVID-19 crisis, along with the strategies implemented to overcome these challenges. This case study offers insights into the development of a highly sensitive linkage between COVID-19 hospital data and information related to social and health use in Belgium.

Methods

The HELICON data linkage is developed at the individual level to investigate the risk of COVID-19 hospitalization and the influence of various social and biomedical factors during and after the crisis. Data are drawn from data collections on hospitalization from the COVID-19 health surveillance (Sciensano), on the socioeconomic and sociodemographic context (Statistics Belgium), and on healthcare use and reimbursement (InterMutualistic Agency).

Results

A representative case-cohort study is established comprising 1,149,264 million randomly selected Belgians and 44,508 hospitalized patients. Annual follow-up is scheduled over a four-year span, allowing the investigation of pre- and post-pandemic health data from July 2020 to January 2026.

Conclusions

The HELICON data linkage took 3.5 years to complete. Among the many challenges, we were faced with complicated approval procedures, ambiguous data security guidelines, unclear cost estimates, and technical issues related to the analysis environment. Building on these experiences, we explore the strengths and weaknesses of data linkages as a research instrument during the COVID-19 pandemic and discuss which lessons should be drawn to for the post-pandemic era.
Artificial intelligence to predict estimates of physical activity in small geographic areas
Authors: Carvalho Malta D , Faria T R , de Almeida Célio F , Bottoni de Souza J , Saar Gomes C , Tomie Ivata Bernal R , Velásquez Meléndez J G , Cardoso L , Gonçalves M A , Almeida J M
Published: October 2024

Background

Artificial intelligence (AI) predictive models have been used to estimate the risk of a certain outcome occurring, using all available variables.

Methods

Using AI methods we have developed a small area estimation (SAE) technique to estimate the prevalence of leisure-time physical activity (LTPA), or who practices 150 minutes of LTPA per week, in small areas, in Belo Horizonte, Brazil, between 2009 and 2018, by the usage of k-means clustering. The VIGITEL, national telephone survey of Risk Factors for non-communicable diseases, was the main source. We applied available data to estimate prevalence of LTPA in 3300 census tracts, aggregated in 150 Primary Health Care (PHC) areas. The prevalence of PA was analyzed between two time periods, due to the low number of census tract interviews. With the available data, we estimate vulnerability clusters, derived from a Health Vulnerability Index (IVS), for the city of Belo Horizonte, according to socioeconomic, sanitation and health indicators, which measure the percentage of the population living in areas of vulnerability in the city. The index main purpose is to support public policy implementation.

Results

Nine clusters were identified according to the Silhouette coefficient analysis, i.e.: low (LO-0, LO-1), medium (ME-0, ME-1), high (HI-0, HI-1, HI-2) and very high) vulnerability (VH-0, VH-1. The prevalence of physical activity ranged from 23.7% (worst prevalence), in area of high vulnerability cluster (VH-1) to 45.5% in a low-risk cluster (LO-1) in period from 2009 to 2014. The prevalence of physical activity increased to 31.4% (high vulnerability cluster) to 52.81% (low-risk cluster) from 2014 to 2018.

Conclusions

The use of AI to estimate the prevalence of physical activity in small areas proved to be effective and highlighted important differences in the city. Thus, national surveys, with a small number of interviews per census sector, can be used to predict risks and health outcomes for small areas.

Key messages

• The study highlights the importance of using artificial intelligence to predict estimates of risk factors for chronic non-communicable diseases in small geographic areas.

• The study showed less physical activity (PA) in areas of greater vulnerability. This can support health promotion policies and programs that encourage PA.
Document Indigenous Food Ingredients in China through Youth Participation
Authors: Wang Z , Ma M , Li Y
Published: October 2024

Problem

Indigenous food systems can affect multiple aspects of Indigenous people’s health and contribute to more efficient, sustainable, resilient, and equitable food systems. However, although tens of Indigenous groups live in China, very few projects have targeted their traditional or Indigenous food systems and ingredients.

Description of the problem

The main purposes include documenting traditional and Indigenous foods and medicine, building multiple social media for public impact, encouraging Indigenous youth participation, and advocating a more sustainable food system in China

Results

With the collaboration of Good Food Fund China, the project recruited 257 volunteers from 27 ethnic groups. The project collected 418 traditional food ingredients, produced 18 TikTok short videos to introduce Indigenous ingredients with the maximum number of views in a single post of more than 100,000, organized 16 Indigenous food culture knowledge webinars, translated 14 international case studies in Indigenous food systems with the permission of authors, and published 16 articles about Indigenous food ingredients and culture in the writing camp. The online lives also received more than a million total views. The results were presented at COP26 and COP28. More results will continue to be presented to the public through articles, books, academic papers, documentaries, short videos, online webinars, and other forms.

Lessons

The project demonstrates the potential to use online platforms to advocate and document sustainable food systems and biodiversity through youth participation. More similar projects can be designed in different parts of the world to support sustainable food systems transformation and ignite down-to-earth changes. However, funding and publication channels are still difficulties in the project.

Key messages

• The first national level youth participation project to document Indigenous food biodiversity in China.

• Take advantage of social media and the internet for public impact.
Bias analysis on socioeconomic status and lung cancer in a pooled international case-control study
Authors: Hovanec J , Kendzia B , Olsson A , Siemiatycki J , Jöckel K-H , Straif K , Schüz J , Kromhout H , Brüning T , Behrens T
Published: October 2024

Background

Low socioeconomic status (SES) groups showed increased lung cancer risks even after adjustment for smoking habits and other exposures to lung carcinogens. Although several biases were often indicated and discussed, only few studies quantified the impact of potential biases.

Methods

We conducted a bias analysis on the association of lung cancer and SES using data from the SYNERGY project, including 12 case-control studies with 18 study centres from Europe and Canada (16,550 cases, 20,147 controls). SES in quartiles was derived from the International Socio-Economic Index of occupational status (ISEI). Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression adjusting for age, study centre, and smoking. In addition, we estimated natural direct SES effects and natural indirect smoking effects by inverse odds ratio weighting. In a multiple quantitative bias analysis, we considered impacts of misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by a protective genetic factor, and created 95% simulation intervals (SI) by bootstrap. All analyses were stratified by sex.

Results

Adjustment for smoking as well as natural effects estimation showed that nearly half of lung cancer risks of lower SES groups in men and up to one third in women were attributable to smoking. Consideration of all types of bias reduced lung-cancer risks in the fully adjusted logistic regression models, with the strongest impact by selection bias: For the 4th versus 1st (highest) ISEI quartile OR decreased from 1.83 (1.69-1.98 CI) to 1.50 (1.30-1.73 SI) in men, and OR 1.48 (1.27-1.72 CI) to 1.20 (0.96-1.53 SI) in women.

Conclusions

Smoking is the main target for prevention of lung cancer, along with occupational and environmental exposures, in particular in lower SES groups. This finding remains, though our analysis revealed reduced lung-cancer risks of lower SES groups after multiple bias adjustment.

Key messages

• Impact of potential biases was quantified in the association of SES and lung cancer.

• Lung cancer risks were partially attributable to smoking and multiple biases.
Co-creating the intervention ‘MAMAACT’ for improved care for pregnant migrant women in Denmark
Authors: Villadsen S F
Published: October 2024

Background

The MAMAACT intervention was developed as a response to documentation of ethnic and social inequities in stillbirth in Denmark, despite free and universal access to antenatal care. The MAMAACT intervention aimed to reduce stillbirth in migrant families by improving communication about pregnancy complication during antenatal care.

Methods

The intervention consisted of a training program for midwives and health education materials. It was implemented at a structural level (training of midwives) and, through strengthened needs-based communication during antenatal care, the aim was to improve the health literacy of the women. 19 of the 20 Danish maternity wards participated in the study in 2018-19 and a comprehensive evaluation was conducted. The intervention was co-created with midwifery managers, midwives, and migrant women.

Results

The management and selected clinical midwives participated in the design of the midwifery training and the health education material as well as the intervention’s implementation and recruitment strategies for the evaluation. As representatives of the target group, a partnership with the non-profit organization Bydelsmødre was initiated. Bydelsmødre trains migrant mothers living in socially deprived areas to help vulnerable migrant women. Evening sessions were conducted with a specific group of women in their community, where the intervention components, the recruitment to the evaluation, and the interpretation of evaluation findings were discussed. A significant contribution was a video explaining the migrant experiences of becoming a mother in Denmark used in the midwifery training. MAMAACT researchers were invited to present the evaluation at the annual assembly for Bydelsmødre organization in 2019.

Conclusions

The partnership with Bydelsmødre provided a strong voice for migrant women, enhancing engagement with the intervention, recruitment for the trial, and its real-world relevance.
Planetary Health: a public health answer to climate change and other Anthropocene challenges
Authors: Cadeddu C
Published: October 2024

Although in the last century, humanity achieved extraordinary outcomes in terms of health, social and economic improvements, the Earth ecosystems around us suffer of high levels of degradation. This issue poses our recent public health and development gains at risk. The Anthropocene, a new geological era we are living in since mid 20th century, is indeed characterized by humanity’s dramatic impact on Earth’s biophysical conditions. Planetary Health is a relatively new field, oriented to solutions, based on transdisciplinarity and social movement, focused on analyzing and addressing the impacts of human disruptions to Earth’s natural systems on human health and all life on Earth. In this presentation, a brief overview of the main issues related to the Anthropocene in the public health perspective will be provided and new tools for the analysis of planetary health challenges will be proposed, citing relevant case studies for discussion.
Climate change perception and mental health: the public health perspective
Authors: Gianfredi V
Published: October 2024

Climate change is increasingly recognized as a critical environmental stressor with significant psychological impacts. Despite consolidated evidence describing the impact of various aspects of climate change on numerous physical and mental health outcomes, a novel and burgeoning area of research is now assessing the association between climate change perception/awareness and health. In fact, the increasing awareness of climate change and its impacts on natural and human systems is not only a matter of environmental concern but also of significant psychological importance. Awareness of climate change involves understanding its causes, foreseeing its long-term global and local impacts, and recognizing the limited window available for effective mitigation and adaptation. This level of awareness, while necessary for proactive behavior, has been linked to various psychological responses, including chronic stress, anxiety, and feelings of helplessness and despair, collectively referred to as ‘eco-anxiety.’ The association between climate change awareness and mental health is complex and mediated by various individual and social factors. As the reality of climate change becomes more integrated into the public consciousness, it is imperative to address the accompanying psychological impacts. In this presentation, the main issues related to climate change perception/awareness and mental health will be discussed through the lens of public health.
Association of park renovation with park use in New York City
Authors: Kodali H P , Wyka K E , Costa S A , Evenson K R , Thorpe L R , Huang TTK
Published: October 2024

Background

Equity-driven citywide park redesign and renovation, such as the Community Parks Initiative (CPI), has the potential to increase park use and opportunities for physical activity in underserved communities. The objective of this study was to evaluate changes in patterns of park use following park redesign and renovation in low-income New York City (NYC) neighborhoods.

Methods

The Physical Activity and Redesigned Community Spaces study was a prospective quality improvement pre-post intervention study design with 33 intervention and 21 matched control neighborhood parks. Data were collected at baseline (prerenovation) and 2 follow-up points (3 months and 1-year post renovation) between 2016 to 2022 summers. Main outcomes encompassed park use and physical activity levels assessed using the well-validated System for Observing Play and Recreation in Communities. Park use was quantified by total number of park users, categorized by age group (≤20 years vs ≥ 21 years), sex, and physical activity level (sitting or standing vs walking or vigorous activity). Changes in outcomes between groups were compared via the generalized estimation equation.

Results

A total of 28,322 park users were observed across 1,458 scans. At baseline, 59.7% were 20 years or younger, 46.3% were female, and 43.8% were sitting or standing. Intervention parks showed more net park users compared with control parks from baseline to the final follow-up (difference-in-difference relative rate ratio, 1.69 [95% CI, 1.22-2.35] users/scan). The association was driven by a significant increase in adult users at intervention parks and an overall decrease in all users at control parks.

Conclusions

In this quality improvement study, park redesign and renovation were positively associated with park use in low-income neighborhoods. However, park renovations may need to be accompanied by other programmatic strategies to increase physical activity.
Impact of park renovation on children’s quality of life in New York City
Authors: Hong H , Kodali H P , Dunlap A , Wyka K E , Thorpe L E , Evenson K R , Huang TTK
Published: October 2024

Background

Despite increasing interest in the role of parks on children’s health, research on the impact of park interventions is limited. This study uses a quasi-experimental pre-post design with matched controls to evaluate the effects of park redesign and renovation on children’s quality of life (QoL) in underserved New York City (NYC) neighborhoods with predominantly Hispanic and Black populations.

Methods

Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported QoL of children aged 3-11 years living within a 0.3-mile radius of 13 renovated parks (N = 201) compared to 11 (N = 197) control parks before and after the park intervention. QoL was measured using the modified KINDL questionnaire, a health-related QoL scale that assessed children’s physical and emotional well-being, self-esteem, and well-being in home, peer, and school settings. A difference in difference (DID) linear mixed model was used to compare QoL between intervention and control groups.

Results

We found a significant improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID=6.35, 95% CI = 0.85-11.85, p = 0.024). The differential improvement was strongest among girls (DID=7.88, p = 0.023) and children with parents in the lowest socioeconomic background (education high school or less DID=8.38, p = 0.024; Not employed DID=7.53, p = 0.048; Single/Widowed/Divorced DID=8.67, p = 0.025). No significant differences were found in other subscales.

Conclusions

Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings support investments in neighborhood parks to advance health equity.
Lessons learned and new approaches to stockpiling for public health emergencies
Authors: Burke E , Norris M , Power V , Spillane S , Ryan M , O’Neill M
Published: October 2024

Background

The COVID-19 pandemic highlighted the need to improve preparedness for emerging health threats. This includes reserving assets for use in health emergencies, such as, shelters, energy supply items, and a stockpile of medical countermeasures (MCMs). Learnings from the recent pandemic are key to improving future strategies for preparedness in Ireland and across Europe.

Methods

Semi-structured interviews were conducted with key representatives in France, Latvia, Lithuania, the Netherlands, and Norway. These countries were chosen as they have a similar threat profile to Ireland. The interviews aimed to understand the national approach taken in each country to stockpiling of MCMs for public health emergencies. Interview summaries were developed and reviewed by key representatives for clarity. Thematic analysis was conducted.

Results

All of the key representatives interviewed were working within their associated Department of Health, or a government affiliated public health agency. Themes and key findings identified included scope and current stockpiling approaches; cost considerations and efficiency, and an understanding of how stockpiling approaches have evolved overtime. While some countries stockpiled items such as facemasks, gloves and ventilators during the COVID-19 pandemic, this is being reviewed, due to the high costs involved. Additionally, all countries reported that waste due to unused stock was a challenge, however, the use of stock rotation can reduce stock waste. Choice of supplier is also key for security of supply. Using indigenous suppliers can facilitate a scale up of supply in times of crises.

Conclusions

National MCMs stockpiles are a key resource that may be deployed as part of a response to health emergencies and disasters. Reducing waste was a key priority and challenge for all countries. Measures identified to reduce waste in future included active management of stockpiles, stock rotation and the use of indigenous suppliers.

Key messages

• As a result of the COVID-19 pandemic, many countries are reviewing their current approach to stockpiling.

• Key issues for countries included preventing waste and ensuring security of MCM supply.
Digital health literacy and health behaviour of schoolchildren: A representative study in Germany
Authors: Stauch L , Renninger D , Fischer L , Hartmann A , Rangnow P , Dadaczynski K , Okan O
Published: October 2024

Background

Health information is increasingly available and plays a crucial role in making health decisions and developing healthy behaviours. Digital health literacy (DHL) enables one to distinguish between true and false health information online. Studies have found higher health literacy to be associated with healthier behaviour. However, there is no research on child DHL and health behaviour. This study aims to investigate the relationship between DHL and selected health behaviour of schoolchildren in Germany.

Methods

This cross-sectional study is based on a representative sample of (N = 1448) secondary schoolchildren (aged 9-18 years) in Germany across all 16 federal states and school forms. DHL was assessed using the child and adolescent version of the Digital Health Literacy Instrument developed and pretested in this study. Selected health behaviours (eating, teeth brushing, smoking, and alcohol consumption) were measured using self-report scales. Chi-square tests were conducted to measure differences between DHL and health behaviour.

Results

Associations were found between DHL and all eating behaviours (fruits; vegetables and salad; whole-grain products; other animal-based products; chocolate or other sweets; sugary drinks; fast food), except for eating meat and sausages. Schoolchildren with higher levels of DHL reported more often about regular consumption of fruits and vegetables (X2 (2)=17.06, p = <.001). salads (X2 (2)=56.54 p = <.001) and whole-grain-products (X2 (2)=98.81 p = <.001). While DHL was associated with teeth brushing (X2 (2)=44.46, p = <.001), no differences were observed for smoking (X2 (2)=1.93, p=.381) and drinking alcohol within the last 30 days (X2 (2)=2.62, p=.270).

Conclusions

These findings indicate that most health behaviours of schoolchildren may benefit from enhancing DHL in schools. Programs should build around these topics. However, more research is needed to investigate associations between DHL and health behaviours comprehensively.
Joint associations of psychological distress and working conditions with sickness absence in Finland
Authors: Svärd A , Kalima M L , Halonen J I , Mänty M , Roos E , Salmela J , Lallukka T
Published: October 2024

Background

Psychological distress has increased remarkably, especially among younger age groups, during the last years. Both psychological distress and exposure to strenuous working conditions are known risk factors for sickness absence (SA). We examined whether psychological distress and working conditions are jointly associated with SA periods of 1-7 days and 8+ days among young and midlife Finnish employees.

Methods

We linked survey data from the Helsinki Health Study cohort from 2017 (response rate 51.5%) with the employer’s SA register for the City of Helsinki, Finland (82% consented to the linkage; n = 3949, 80% women, age 19-39 years). Mean follow-up time was 2.1 years. We calculated rate ratios (RR) and 95% confidence intervals (CI) for SA periods of 1-7 days and 8+ days using negative binomial regression models among participants with and without psychological distress, and with and without exposure to strenuous working conditions. Psychological distress was measured with the emotional wellbeing subscale of RAND-36 (cut-off 60 points). Working conditions included physical and mental strenuousness of work and hours per day spent in heavy physical work.

Results

Participants with psychological distress and exposure to strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of ≥ 8 days (physically strenuous work: RR: 2.38, CI: 1.97-2.88; mentally strenuous work: RR: 2.08, CI: 1.72-2.53; ≥3 h per day spent in physical work: RR: 2.48, CI: 2.01-3.06), the interactions being additive. The associations were weaker for SA periods of 1-7 days. Adjusting for marital and employment status, education, alcohol use, smoking and body mass index only slightly attenuated these associations.

Conclusions

Psychological distress and exposure to strenuous working conditions were additively associated with SA. Both individual- and workplace-related risk factors for SA are important to be considered when planning preventive actions.

Key messages

• Young and early midlife Finnish employees with simultaneous psychological distress and exposure to strenuous working conditions had the highest rates of SA periods, the interactions being additive.

• Both psychological distress and exposure to strenuous physical and mental working conditions should be considered when planning preventive actions to reduce employees’ SA.
Self-rated health in preadolescents as a predictor for prescription redemption and hospital contacts
Authors: Renneberg C K , Rask C U , Rytter D , Hansen S N , Bech B H
Published: October 2024

Background

The decline in self-rated health among children and adolescents raises concerns for their overall well-being and future health outcomes. We examined whether self-rated health in preadolescence predicts both psychiatric and somatic prescription redemption and hospital contacts in later adolescence.

Methods

This cohort study is part of the Danish National Birth Cohort and focuses on children born between 1996 and 2003. A survey was distributed to 96,382 preadolescents aged 11, who were then followed from 2010 to 2018 (average follow-up of 6.9 years). Data on prescriptions and hospital contacts were obtained from Danish registries. Negative binomial regression was employed to calculate the incidence rate ratio (IRR), comparing preadolescent children who rated their health as poor (‘Not So Good’/’Poor’) to those who rated it as good (‘Excellent’/’Good’).

Results

Of the 47,365 (49.1%) 11-year-old preadolescents who participated in this study, 5.3% reported experiencing poor self-rated health. Overall, adjusted analyses revealed higher rates of prescription redemptions (IRR 1.63 [95% CI: 1.53; 1.73]) and hospital contacts (IRR 1.86 [95% CI: 1.74; 1.99]) in these children. Poor self-rated health in preadolescence was associated with more somatic (IRR 1.51 [95% CI: 1.40; 1.62]) and psychiatric (IRR 3.04 [95% CI: 2.59; 3.57]) prescriptions, as well as somatic (IRR 1.61 [95% CI: 1.51; 1.72]) and psychiatric (IRR 2.80 [95% CI: 2.42; 3.25]) hospital contacts in adolescence, with similar associations across sexes.

Conclusions

Poor self-rated health in preadolescence is associated with higher rates of prescription redemption and hospital visits in adolescence, suggesting that perceptions of health in early life influence long-term well-being, especially regarding psychiatric health. This straightforward self-rated health measure offers healthcare professionals valuable insights for identifying children who may require support and early intervention.

Key messages

• Poor self-rated health in preadolescence predicts higher prescription redemption and hospital visits in adolescence, especially regarding psychiatric health.

• Simple self-assessment of health in childhood may have the potential to help identify those needing support and early intervention for long-term well-being.
Social and environmental determinants of sleep health disparities
Authors: Johnson Dayna
Published: October 2024

Sleep is not equitable. Historically minoritized individuals have a high prevalence of sleep disorders and adverse sleep health. Research supports that social determinants of health are contributing to sleep health inequities. Further, sleep is socially patterned. Neighborhoods with high rates of crime, violence, disadvantage, pollution, inopportune light exposure, and noise, where historically minoritized individuals are most likely to live are associated with adverse sleep health and sleep disorders. Social determinants including discrimination, racism, socioeconomic status, lack of access to care are associated with adverse sleep health, particularly among minoritized individuals. While there is an abundance of evidence identifying risk factors for adverse sleep health, evidence also supports factors that promote healthy sleep. A small but growing literature supports that neighborhood social environment is associated with healthy sleep and may be avenue for addressing sleep disparities. Dr. Johnson will present epidemiologic data on the social and environmental determinants of adverse sleep health using a socioecological framework and discuss the mechanisms by which these factors are contributing to sleep disparities. The goal is to identify these factors, and how they can be utilized to address sleep health disparities.
Strategies to address common sleep disorders among middle-aged and older adults
Authors: Kendzerska Tetyana
Published: October 2024

Obstructive sleep apnea (OSA) is an underdiagnosed and prevalent condition in middle-aged and older adults, with a disproportionate burden of OSA in marginalized populations. Lack of appropriate and timely treatment puts many at risk of poor quality of life, comorbidity, motor vehicle crashes and increased health care utilization. Furthermore, social and environmental disparities were acknowledged as contributing to sleep health disparities, OSA health literacy and adherence to OSA treatment. This presentation will overview the social and environmental determinants of OSA prevalence and management. The presenter will also cover strategies to improve access and waiting time for OSA diagnosis and treatment in middle-aged and older adults, such as screening for OSA in general and marginalized populations, alternative at-home OSA detection solutions, involvement of alternative care providers in OSA care, alternative OSA targeted therapies, including accessible self-administered interventions, health equity interventions targeting OSA, and promotion of sleep-centered lifestyle approaches, including weight loss, diet and exercise.
Socioeconomic drivers of low value screening
Authors: Smit Frerik
Published: October 2024

Low-value care brings minimal or no benefit to the patient and is a growing concern for healthcare systems. In this presentation, we will discuss the issue of low-value cancer screening, its frequency, and how it is socially patterned. The general population, policymakers, and healthcare providers expect a lot from cancer screening, while the actual absolute benefits are generally relatively low. In addition, screening practice often does not follow recommendations regarding the frequency of testing or the ages at which to start and to stop, and many screenings providing no benefit are commonly performed. Addressing low-value screening is key for evidence-based population health management and prevention.