bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression Assessment in the German National Cohort (NAKO)
Authors: Berger K , Rietschel M , Streit F
Published: October 2022

Background

The mental health status of populations (public mental health) and its effect on societies has gained considerable attention in recent years, especially during the current pandemic. The measurement of depressive symptoms is at core of the assessment of mental health. The detailedness of this assessment defines the range of public mental health problems that can be answered.

Methods

Between 2014 and 2019 the German National Cohort (NAKO) recruited 205,000 participants aged 20-70 years into the baseline examination in 18 study centers. Depression and depressive symptoms were assessed by different instruments including a lifetime diagnosis of depression and current treatment, the Major Depressive Disorder (MDD) section of the Mini-International-Neuropsychiatric-Interview (M.I.N.I. 5.0) and the depression scale of the Patient Health Questionnaire (PHQ-9). These instruments include different time periods and interpretations. Associations between these depression outcomes and age, gender and education are analysed in linear and logistic regression models.

Results

A lifetime physician's diagnosis of depression was reported by 14.7% of participants with considerable regional variation and almost 50% of this group received treatment within the last 12 months. Based on PHQ-9 7.9% of the participants were classified as depressive according to the dimensional assessment (score≥10) and 3% of them as having a major depression subtype. In contrast 32.8% screened positive based on the MINI and 15.4% of those receiving the full MINI had a diagnosis MDD. Associations with important socioeconomic determinants for these different depression outcomes will be reported.

Conclusions

The large NAKO sample size and the detailed assessment of depression symptoms and status enables the analysis of a broad range of public mental health questions. The analysis of depression frequencies and the distribution of depressive symptoms allow the establishment of population references.
Health inequalities in very old age: Continuity, accumulation or convergence?
Authors: Wenner J , Fey J , Zank S , Wagner M
Published: October 2022

Background

Health inequalities are well documented empirically. However, it is unclear whether health inequalities persist in very old age (continuity), whether they accumulate steadily (accumulation), or whether they even attenuate in old age (convergence) - not least because of social inequalities in life expectancy, which make it less likely for individuals with lower social status to reach old age at all. The aim of this study is to empirically test these three hypotheses.

Methods

The analyses are based on representative cross-sectional data from 1,863 very old people and panel data from 912 participants in the 1st and 2nd wave (W1, W2) living in North Rhine-Westphalia the largest federal state in Germany (NRW80+ study). Health outcomes of the analyses are subjective health, multimorbidity and need for long-term care. Indicators of socioeconomic status (SES) are education, occupational status, and net equivalent income. Regression models (linear, logistic, ordinal) are used to analyze cross-sectional and longitudinal data. Panel selectivity is also considered by means of a failure model.

Results

Cross-sectional findings show health inequalities for all SES variables: persons with low education and low income have poorer subjective health and higher need for care. Low status is associated with higher need for care. Preliminary results from longitudinal analyses show a slight increase in health inequality: low income and low status are associated with higher multimorbidity and low education with higher dependency on long-term care at W2.

Conclusions

Despite the socially conditioned unequal chances of reaching old age, health inequality is still present in very old age and even increases slightly over time. The results argue against the convergence hypothesis and in favor of the continuity or even the accumulation hypothesis. A better understanding of the mechanisms leading to the persistent inequality is needed to development targeted interventions also in old age.

Key messages

• Health inequalities persist and even increase in very old age (80+).

• It is imperative that the oldest old – an increasingly large population group – be considered when designing strategies to reduce health inequalities.
1.J. Round table: Research Methods for Public Health Oriented Health Services Research – what works where and for what?
Authors:   Organised by: EUPHA-HSR, EUPHA-HIA, EUPHA-HTA, EUPHA-EPI, EUPHA-ECO, EUPHA-PHPP, German Public Health Association Section Research, German Network Health Service Research WG IHSR, Charité Institute for General Practice WG HPSRI,   Chair persons: Lorena Dini (EUPHA-HSR), Johan Hansen (EUPHA-HSR)
Published: October 2022

This workshop will present the different methodological approaches relevant to the field of public health. This includes approaches of health systems and health policy research, epidemiology, health technology assessment, health impact assessment, health systems performance and economic evaluations. Presentations will be hold by presidents and vice-presidents of the EUPHA Sections in the form of a panel, presenting the overview of each methodology and providing case examples. All organizers might invite special contributions from their members and students to share innovations of case examples from their counties. During the first half of the workshop the EUPHA Sections will provide input on traditional and innovative methods the following topics:

1. Health Policy and Systems Research (HPSR) applied to Primary Care.

2. The use of traditional and innovative epidemiological study designs for public health relevant inferences.

3. Overview of methods used for the quantification of health impacts, both following a risk assessment approach or an epidemiological approach.

4. Methodologies and techniques applied in Health Technology Assessment (HTA) and how their contribute to decision-making and evidence-informed policymaking.

5. Health Systems Performance Assessment (HSPA) and Economic evaluations.

6. Research methods from the public health policy and politics perspective.

In the second half of the workshop we will discuss and share examples on innovation in research methods and seek to find an answer to the question: what is being done in the countries? Input from DGPH-FO, DNVF-IHRS, Charité WG HPSRI and from all participants will be welcome. Target audience: young and old professionals interested in updating their methods skills and sharing their own experiences on innovation in methods for a stronger public health research.

Key messages

• There are no better or worse research methods; they are just a tool, that when applied properly support evidence and action for a stronger public health.

• As knowledge on research methods evolve, sharing knowledge amongst different fields is key to contribute to a stronger health system, better health policy decisions and a better health for all.

Speakers/Panellists

Lorena Dini

Charité Univesitätsmedizin Berlin, Berlin, Germany

Piedad Martin-Olmedo

Escuela Andaluza de Salud Pública, Granada, Spain

Stefania Boccia

Italian Society of Hygiene, Preventive Medicine and Public Health, Rome, Italy

Chiara de Waure

University of Perugia, Perugia, Italy

João Vasco Santos

Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
Creating smoke free environments by local policy
Authors: Rouwenhorst S , Koornstra A
Published: October 2022

In The Netherlands, around 20.000 people die each year from the effects of smoking and passive smoking. Every week, hundreds of children become addicted to smoking. To improve the overall public health in the Netherlands, it is important to substantially reduce the prevalence of smokers. Until recent years, municipalities played next to no role in helping to reduce smoking in the Netherlands. The start of a large campaign that aims a smokefree generation by 2040 has changed that. Part of that campaign is to create smoke-free environments. In a two-year program, 90% of the Dutch municipalities started policy and actions to ban smoking from public places, as part of the National Prevention Agreement. The participating municipalities were supported by all 25 Regional Health Services (GGDs) by providing knowledge and manpower on a regional level, together with national, regional and local organisations. The project has a number of successful elements: the GGD received a (very small) budget to actively participate in the region; knowledge was shared between the regions and from national to local level and legal issues were dealt with by the Nat Assoc of Municipalities (VNG). In 2021, 317 out of 352 Dutch municipalities were active in this project. There is a significant increase of smoke-free environments, mostly schoolyards, playgrounds, sports facilities, smoke-free bus stops and municipal institutions. Other results are integrated plans for smoking cessation care and accessible stop smoking service, e.g. in GGD Fryslan the number of registrations for smoking cessation care increased dramatically and 80% actually quit smoking. All parties involved agree that the strength of this project is its positive approach and the broad social support it generates for the Smokefree Generation. It is about persuasion, not compulsion. Working from a national focus towards a smoke-free environment, while taking into account local differences and needs, makes this project a success.

Key messages

• This project resulted in more local and regional partnerships and an increase of smoke-free environments, bringing the ultimate goal of a Smokefree Generation closer.

• 90% of Dutch municipalities have created smoke-free environments with the guidance of the regional GGD, financed by Ministry of Health: multilevel governance works.
Global market trends of flavour capsule and menthol cigarettes in 78 countries, 2010-2020
Authors: Kyriakos CN , Qi D , Chang K , Laverty AA , Filippidis FT
Published: October 2022

Background

Flavoured tobacco products, including innovative flavour capsule cigarettes (FCCs) and menthol cigarettes, can increase appeal and encourage smoking initiation and use. Global epidemiological data on these products are scarce.

Methods

This study examined market trends of FCCs and menthol (non-capsule) cigarettes across 78 countries from 2010 to 2020 and assessed ecological-level factors associated with market shares of these products. Market share and retail volume data came from Euromonitor Passport and country-specific sociodemographic data come from the WHO and World Bank. Adjusted linear fixed effects panel regression analyses were used to evaluate the relationship between predictors variables and market outcomes.

Results

Global total retail volume of FCCs increased over time (0.2% in 2010 to 4.5% in 2020) and market share was associated with year and unemployment rate and inversely associated with % urban population and smoking prevalence (p < 0.001). In contrast, menthol retail volume decreased over time (5.0% to 3.8%) and market share was associated with % urban population (p = 0.001) and inversely associated with year (p = 0.004) and unemployment rate (p = 0.017). The greatest market increase of FCCs was observed in the Americas region and among upper-middle income countries. In Europe, there was a decrease of 0.64 percentage points from 2019 to 2020.

Conclusions

Overall, FCCs experienced substantial global growth in the recent decade, with the exception of Europe whose slight decrease may be attributable to the European Union ban on flavours in cigarettes. Findings indicate that there is a need for increased efforts to address flavours and innovative features used in tobacco products, which are known to appeal to youth.

Key messages

• This study contributes to global monitoring of tobacco products.

• Findings can be used by advocates and policy makers to support countries in adopting measures to ban flavoured tobacco products.
Effectiveness of Behavior Change interventions for smoking cessation among expectant and new fathers
Authors: Khanal Bhattarai S , Miani C , Finne E , Morawe JM , Boeckmann M
Published: October 2022

Background

The perinatal period is an optimal time to intervene for achieving smoking cessation in expectant parents and offers multiple health benefits for women and the newborn. While Behavior Change Technique (BCT) interventions are a promising approach to support pregnant smokers to quit smoking, effectiveness of these interventions among expectant and new fathers is not equally well documented. Better understanding of the potential utility of these BCT interventions for this group is important for the development of effective gender-sensitive programmes.

Methods

This systematic review examines the existing evidence on effectiveness of BCTs on smoking cessation outcomes when offered to expectant and new fathers (child < 1 year) both through individual and/or couple-based interventions. Eight databases were searched for peer-reviewed articles. Studies were subjected to systematic retrieval and quality-assessment by two independent reviewers.

Results

We identified 9 randomised control trial studies (including 4,681 men) that fulfilled the inclusion criteria. In terms of quit outcome data, 8 studies reported biochemically verified quit rates for men. While 5 BCT interventions targeted expectant/new fathers, 3 were directed to couples and 1 primarily focused on women with a component directed at men. Though most of the interventions were found to be effective, they showed small significant positive effects on cessation outcomes. Findings are suggestive of gender specific interventions being more likely to have positive outcomes. High heterogeneity across the studies made it difficult to determine the most effective BCT approach.

Conclusions

This review suggests that use of BCT interventions for smoking cessation among expectant and new fathers is effective in achieving positive quit rates; however, these studies are limited. Further research is needed to determine the most effective BCT approach associated with smoking cessation among this group.

Key messages

• BCT interventions for smoking cessation among expectant and new fathers are a promising approach to increase quit rates.

• Future research needs to develop evidence based BCT interventions for smoking cessation specifically targeting expectant and new fathers to inform policy and practice.
How did the covid-19 pandemic affect lower respiratory tract infections in young children in England?
Authors: Foley KA , Maile EJ , Bottle A , Neale FK , Viner RM , Kenny SE , Majeed A , Hargreaves DS , Saxena S
Published: October 2022

Background

Social distancing policies to reduce transmission of covid-19 also reduced children's exposures to endemic respiratory viruses. We aimed to examine the impact of the covid-19 pandemic on lower respiratory tract infections in under 5s presenting to primary care in England.

Methods

Longitudinal trends analysis using electronic health records from a nationally representative primary care database. Our target population was children aged <5 years registered with a primary care practice from January 2015 to March 2021.

Our main outcome was total weekly contacts with primary care for a lower respiratory tract infection (LRTI). We defined three pandemic phases from March 2020 - March 2021: i) first national lockdown (late March to early June 2020), ii) childcare settings reopened and second national lockdown with schools open (mid-June to mid-December 2020) and iii) third national lockdown with schools closed (late December 2020 to end of March 2021). We compared outcomes during each of the three phases with corresponding calendar weeks during pre-pandemic years 2015 to 2019.

Results

Our study population included 843 020 children <5 years who had 1 076 181 contacts with primary care for LRTIs. During the first phase (first lockdown) there were falls of 79.3% (95% CI: 73.6 to 84.5) from an average of 28 547 primary care contacts for LRTI in 2015 - 2019 to 5915 in 2020; there was a 78.9% (95% CI: 73.7 to 83.9) fall in phase two (childcare settings reopened and second lockdown) from 107 873 to 22 792 contacts; and a 77.7% (95% CI: 73.5 to 81.4) fall in phase three (third lockdown) from 57 200 to 12 764 contacts.

Conclusions

Children under 5 in England had fewer contacts with primary care for LRTIs during the covid-19 pandemic. This change likely reflects lower prevalence of respiratory illness due to fewer social contacts. This may impact on future health service use as these children have had less exposure, and therefore may have less immunity, to respiratory diseases.

Key messages

• Children under 5 had fewer contacts with primary care for lower respiratory tract infections during the covid-19 pandemic in England likely due to the restrictions in place to reduce social contacts.

• The falls in lower respiratory tract infections during the covid-19 pandemic in under 5s may mean they have less immunity to respiratory viruses which may impact upon their future health service use.
Country-level social mobility and inequalities in adolescent health behaviours in 32 countries
Authors: Schmengler H , Peeters M , Stevens GWJM , Kunst AE , Delaruelle K , Dierckens M , Charrier L , Weinberg D , Oldehinkel AJ , Vollebergh WAM
Published: October 2022

Background

Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the association between family affluence and adolescent health behaviours is stronger in some countries than in others.

Methods

Using data from adolescents aged 11-15 years from 32 different countries, participating in the 2017/2018 wave of the Health Behaviour in School-aged Children (HBSC) study (N = 185,086), we employed multilevel regression models with cross-level interactions to examine whether country-level social mobility moderates the association between family affluence and adolescent health behaviours (i.e. moderate-to-vigorous physical activity, vigorous physical activity, healthy foods consumed, unhealthy foods consumed, having breakfast regularly, weekly smoking).

Results

Higher family affluence was more strongly associated with higher levels of physical activity in countries characterized by high levels of social mobility (cross-level interaction linear regression coefficient 0.34; 95% CI 0.08 to 0.60; p = 0.009 for moderate-to-vigorous physical activity, and 0.31; 0.11 to 0.50; p = 0.002 for vigorous physical activity). No cross-level interactions were found for any of the other health behaviours.

Conclusions

Our findings suggest that differences in social mobility at the country-level may contribute to cross-national variations in socioeconomic inequalities in adolescent physical activity. Further research can shed light on the mechanisms linking country-level social mobility to inequalities in adolescent physical activity to identify targets for policy and interventions.

Key messages

• This is one of the first studies to investigate country-level social mobility in relation to health equity. Inequalities in adolescent physical activity were steeper in socially mobile countries.

• Stronger efforts to engage adolescents from low-affluent families in physical activity may be necessary in countries characterized by high levels of social mobility.
The longitudinal impact of social media use on adolescent mental health in the UK
Authors: Plackett R , Sheringham J , Dykxhoorn J
Published: October 2022

Background

Cross-sectional studies have suggested a relationship between social media use and depression and anxiety in young people. We examined the longitudinal relationship between social media use and young people's mental health and the role of self-esteem and social connectedness as potential mediators.

Methods

The sample comprised 3,228 young people from the UK Longitudinal Household Study (waves 1-10). Mental health at age 14 or 15 was measured by the SDQ Total Difficulties score. The number of hours spent on social media was measured at age 12 or 13. Self-esteem at age 13 or 14 was measured via eight questions and social connectedness was measured by two questions. Multilevel linear regression models explored whether social media use at age 12 or 13 predicted mental health at age 14 or 15. Path analysis with structural equation modelling investigated the mediation pathways.

Results

In unadjusted analysis, for those who spent 7 or more hours on social media vs none, their mental health problems trended upwards by 3.87 (95% CI, 0.71-7.03) but this relationship was attenuated after including covariates. In unadjusted path analysis, more social media use was associated with lower self-esteem (b=-0.10, p < 0.05), which in turn was associated with more mental health problems (b=-6.80, p < 0.001). The indirect effect (b = 0.70, p < 0.05) showed that 68% of the effect of social media use on mental health two years later was mediated by self-esteem. This relationship was attenuated after adjusting for covariates and in imputed data, and social connectedness was not associated.

Conclusions

This study shows the importance of longitudinal evidence, as we found there was little evidence to suggest a causal relationship between social media use and mental health issues two years later. Interventions that address social media use alone may not improve young people's mental health but those that consider factors like self-esteem may be more effective.

Key messages

• Longitudinal data suggests there is limited evidence that high social media use causes poorer mental health in adolescents despite indications from cross-sectional analyses.

• Policy makers should consider that targeting social media use alone is unlikely to prevent poor adolescent mental health and factors like self-esteem may be more important prevention targets.
Young men’s gambling and violence perpetration in Mwanza, Tanzania
Authors: Stöckl H , Brambilla R , Mshana G , Malibwa D , Sichalwe S , Kapiga S
Published: October 2022

Background

The prevalence of intimate partner violence (IPV) in Tanzania is one of the highest in the sub-Saharan African region. Studies have shown that traditionally “manly” behaviours, such as risk-taking, are at the root of IPV perpetration. Only few studies investigated the co-occurrence of gambling and IPV, and none from LMICs.

Methods

Cross-sectional survey data of 1002 men aged 18-24 from Mwanza, Tanzania were analysed. Physical, sexual, emotional and economic IPV perpetration were measured using acts-based questions. Gambling was assessed through a question on whether the man bet or spent money on gambling or gambling machines. Consequences of gambling behaviours were assessed through four further questions. We conducted multivariate logistic regressions to control for potential confounders.

Results

21% of the men in the sample confirmed they had bet or spent money on gambling in the previous 12 months; the prevalence raises to 24% for men who had been in a relationship in the previous 12 months (N = 755). Of these, 23% had ever perpetrated physical IPV, 29% sexual IPV, 56% emotional IPV and 37% economic IPV in their lifetimes. Of those who gambled, 24% had ever perpetrated physical IPV, 46% ever committed sexual IPV, 66% emotional IPV and 45% economic IPV. Gambling was statistically significantly associated sexual IPV (aOR: 2.39; 95% CI: 1.66-3.45) and emotional IPV (aOR: 1.48; 95% CI: 1.03-2.14) even after controlling for age, alcohol use, depressive symptoms and suicidal ideation. Gambling was not associated with physical and economic IPV after adjusting for those confounders.

Implications

The analysis shows that young men's practice of gambling is an additional risk factor for IPV perpetration that needs to be addressed. More research is needed to understand how current prevention efforts can be expanded to include problem gambling treatment to curb the incidence of IPV and give couples conflict resolutions skills for issues that might arise from gambling.

Key messages

• Problem gambling has so far remained vastly under-researched in violence research.

• Gambling as well as drinking were associated with increased odds of physical and sexual IPV perpetration.
1.Q. Workshop: Summarising research evidence related to COVID-19 impact
Authors:   Organised by: PHIRI,   Chair persons: Maria João Forjaz (Spain), Paulo Nogueira (Portugal)
Published: October 2022

After the first SARS-CoV-2 infections surge in late 2019, and its spreading worldwide, COVID-19 rapidly became a pandemic by March 2020. Facing a new public health crisis, the scientific community deployed research efforts to study this new disease, generating a large amount of scientific evidence in a very fast way. This research was developed in several directions, for instance, describing how COVID-19 impacts the population's health and well-being. Specifically, the research aimed at describing and evaluating the risk factors either for being infected or evolving toward adverse outcomes, such as hospitalisation or death. Moreover, the effectiveness of implemented public health measures was assessed since countries’ governments rapidly implemented them to mitigate the pandemic.Therefore, several literature reviews have been performed within the European Project ‘Population Health Information Research Infrastructure (PHIRI)’ to summarise and share the published COVID-19 evidence through a health information portal, where researchers and other stakeholders can exchange best practices and expertise. This workshop aims at sharing the collaborative work and experience of a large group of European researchers within the PHIRI consortium, consisting in preliminary results and lessons learnt with the scientific community. The workshop format consists of five presentations by PHIRI members, each one presenting their literature review work, followed by a discussion among the presenters and with the audience. The first workshop presentation will describe the methodological aspects of research conducted to assess the COVID-19 impact on the population's health and well-being, including research methods and statistical methods. The subject for the second talk will show a representative sample of health indicators used to evaluate the direct impact of COVID-19 in the scientific literature. The third presentation will elaborate on a short and long-term impact of COVID-19 crisis on population with frailty, multimorbidity or with different socioeconomic status; evidence derived from systematic literature reviews of population-based studies. The fourth presentation will describe the effectiveness and impact of tracking COVID-19 patients using digital contact tracing tools. The last presentation describes the methodological aspects of a systematic literature review conducted to gain an overview of the foresight studies that have been done throughout the World about COVID-19.

Key messages

• During the pandemic, a literature reviews provide an important tool to summarise the large amount of scientific evidence that was generated.

• This workshop aims at sharing the collaborative work and experience of a large group of European researchers participating at PHIRI, the results and lessons learned with the scientific community.
Foresight and Preparedness Studies on COVID-19 in the World: A Systematic Literature Review
Authors: Peyroteo M , Vukovic J , Lapão L
Published: October 2022

A foresight study refers to a broad range of methodologies to describe possible futures. Also, foresight can be described as ‘a university human capacity that allows people to think ahead and consider, model, create and respond to future eventualities’ (Foresight International, 2006). Foresight studies in public health are research tools to support the understanding of possible future developments, which is essential for policy makers to anticipate and possibly influence trends. Therefore, we aimed at providing an overview of COVID-19's foresight activities across Europe and beyond. A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Methodology. The databases searched were Scopus and Web of Science Core Collection and the literature screening was conducted through March 2022. The exclusion and inclusion criteria were previously defined by the team and all the results had to be journal papers, published between 2019-2021 (except for “Foresight” query that was between 2015-2021) and written in English or Portuguese. The documents collected were only about Population Health and Non-Pharmaceutical Approaches. Among the topics under study (foresight, scenarios, modelling and preparation) it was possible to collect 9 550 articles. After removing duplicates and filtering out those that did not meet the inclusion criteria, 2 434 articles were selected for analysis. The literature review revealed that a large number of studies on the pandemic of COVID-19 have already been conducted using predictive methodologies, but that the focus of attention is on analysing how countries are prepared for the pandemic and what direction it will stat using mathematical modelling methods (e.g. in the short term). This study highlights the importance of predictive studies and that their use needs to be well-founded and cohesive if the conclusions drawn are to have impact and value in the future.
Measuring health expectancy in the European Union
Authors: Santos JV , Viana J , Devleesschauwer B , Haagsma JA , Costa Santos C , Ricciardi W , Freitas A
Published: October 2022

Background

Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

Methods

We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

Results

Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.

Conclusions

We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.

Acknowledgements: This presentation was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)

Key messages

• Different methods for evaluating health expectancy lead to significantly different results.

• There is a systematic tendency with countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.
Barriers and facilitators to healthcare access for homeless people in four European countries
Authors: Schiffler T , Carmichael C , Lehner L , Gil-Salmeron A , Kouvari M , Karnaki P , Grabovac I
Published: October 2022

Background

People experiencing homelessness (PEH) have higher prevalence of adverse health outcomes and premature mortality compared to the general population, and often experience significant barriers in accessing healthcare services. This study aimed to better understand the health needs of PEH, as well as to identify the barriers and facilitators to their timely and equitable access to health services from the perspective of PEH and relevant health professionals and social care workers.

Methods

During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Semi-structured interviews were conducted across four European settings (Austria, Greece, Spain and the UK). Interviews were audio-recorded, transcribed verbatim and analyzed according to the inductive thematic approach set out by Saldaña (2021).

Results

In total, 69 interviews were completed with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Three overarching themes relating to the research question were identified: (a) Health needs of people experiencing homelessness; (b) Barriers to access healthcare services and (c) Facilitators to access healthcare services. Overall, the general health of PEH was depicted as extremely poor and mainstream health services were portrayed as ill-equipped to respond to the needs of this population, with many organizational and system-level barriers noted. Tailored approaches to care, and in particular involving trusted professionals in the delivery of care, were identified as a key strategy for overcoming existing barriers.

Conclusions

While a number of context-specific findings were identified, results indicated there to be a high degree of overlap and consistency in the health needs of PEH, and in the barriers and facilitators that exist when accessing healthcare across four different healthcare systems.

Key messages

• Homelessness is a determinant of health that is linked to poor health outcomes. Tailored approaches that draw upon trusting relationships have the potential to overcome this problem.

• The array of identified barriers indicates that general healthcare services are not currently structured in a way that facilitates timely and equitable access and appropriate care for PEH.
Barriers to access cancer prevention services for the homeless population in four European countries
Authors: Schiffler T , Carmichael C , Gil-Salmeron A , Kouvari M , Karnaki P , Grabovac I
Published: October 2022

Background

People experiencing homelessness (PEH) are known to have increased burden of cancer and higher cancer-related mortality when compared to the general population. These outcomes are linked to a variety of etiological factors, as well as the existence of significant barriers in accessing cancer prevention services. The aim of this study was to better understand current practices and knowledge relating to cancer prevention among PEH, health professionals and social care workers.

Methods

During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Data were collected in Austria, Greece, Spain and the UK through semi-structured interviews. Interviews were transcribed verbatim and thematically analyzed in accordance with the approach set out by Saldaña (2021).

Results

In total, 69 interviews were conducted with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Two overarching themes relating to the research question were identified, namely (a) experiences and understanding of cancer prevention and treatment, and (b) considerations for program intervention. While cancer was a major source of concern, tailored cancer prevention programs for the homeless population were described as effectively non-existent, and very few homeless participants recalled being invited to a screening appointment. Health professionals also indicated that because of barriers to health care, opportunities for the early diagnosis of cancer among PEH were often being missed.

Conclusions

The results indicate that PEH have limited knowledge around the importance of cancer prevention programs, and that more focused input on the part of health and social care services is required in this area. Culturally sensitive and person-centered approaches should be adopted to facilitate access to cancer prevention for PEH.

Key messages

• Specialized cancer prevention and health care pathways that take account of the living conditions and support needs of PEH should be established to improve health and cancer-related outcomes.

• Cancer prevention programs should focus on improving health literacy by using accessible and tailored approaches, both for PEH and those that work directly with the homeless population.
Introducing walkable cities as a Public Health intervention
Authors: Matkovic V , Jevtic M , Kusturica MP , Bouland C , Jukovic M , Stojanovic D
Published: October 2022

COVID-19 pandemic yet again showed that health crises and epidemics are introducing urban planning as a public health response. Globally, we saw a renewed interest in urban environment and healthy living and the changes in urban environments which can make for a healthier living. Even before the pandemic, various urban concepts and models that take as basis a health-oriented, holistic approach are being implemented in many cities. To name a few: car-free centres or neighbourhoods, the so-called ‘Superblocks’, neighbourhoods with low-speed traffic, walkable and cyclable cities aiming at all amenities being easy reach so-called ‘15 Minutes city’. COVID-19 crisis only accelerated many of these initiatives and brought them to global level need and attention. Such interventions are being introduced to demotivate the use of polluting cars, to ease up and to promote healthy and active transportation such as walking and cycling. As a consequence, those interventions not only are hoped to lead to an increase in physical activity, but also better air quality, reduction of noise. Cities have accelerated urban transformations of the space for active transportation such as the introduction of more cycling lanes in their networks, transforming ‘car’ streets to mix use streets, etc. Particularly during the pandemic, the streets that were previously dominated by car use, parking lots, parking spaces, and car lanes have shifted their focus to the pedestrians, healthy and active mobility. Though, not so optimistic continuation of the speed of the changes in urban planning are seen at the end of the pandemic. It is still clear that spaces for people, spaces promoting mental health such as green spaces, green islands, green pedestrian streets and healthy mobility, are missing. Lockdown measures of reducing the car traffic and increasing the walkable spaces for citizens were primarily imposed to save public health but had one important co-benefit - improved air quality in many areas.
2.H. Workshop: Commercial determinants and global capture of public health- cases spanning the world
Authors:   Organised by: Governance, Ethics and Conflict of Interest in Public Health Network, UK Faculty of Public Health,   Chair persons: Jihad Makhoul (Lebanon)
Published: October 2022

Growing research around the globe shows that for-profit corporations incur increasingly adverse impacts on health and well-being of people, the planet and the global economy. Their health damaging products and practices fuel non-communicable disease epidemics, damage the earth's natural environment and interfere in health policy making. Such corporate interference in social and public health policy, research and practice is well documented for the pharmaceutical, tobacco, food and beverage, alcohol and arms industries. A commercial determinant lens allows a better understanding of heath inequalities by drawing attention to corporate actors and their tactics as drivers of ill-health rather than people's behaviors. This framework also makes it possible to present interventions to counter these influences. This workshop panel of 5 scholars and activists from around the world who are members of the Governance, Ethics and Conflict of Interest in Public Health Network serves to confirm the detrimental reach of industry practices and the global responses to this interference in public health. It aims to add to the emerging body of knowledge on commercial determinants of health using innovative research approaches and findings. The format is a series of 5 short sequential presentations, followed by an interactive discussion with the audience, moderated by the panel organizer. The presentations will showcase the research methods used including multi-stakeholder interviews, policy analyses, systems mapping and analyses of policy debates. The presentations will also document examples and cases of corporate capture of food industry in Europe, a global mapping of corporate systems, industry interference in health-protecting laws in Columbia, exploitation of humanitarian emergencies in Lebanon, and suggestions of ways forward to protect adults and children from industry vested interests with a Public Health Playbook.

Key messages

• Corporate interference in public health is a growing concern globally for its health harming influence on health systems and future generations.

• Continued concerted research revealing overt and covert health harming industry practices is needed to counter their impact on PH in a world fraught with global challenges and uncertainty.
Employer support for employees returning to work from sick leave – evidence for Europe
Authors: Leoni T
Published: October 2022

Background

Employers play an important role in facilitating the return-to-work (RTW) of employees after a prolonged sick leave. The involvement of employers in RTW efforts is however largely unexplored in an international comparative context. This paper provides evidence on the diffusion of procedures to support RTW after sick leave in European workplaces and discusses different policy approaches to involve employers in RTW.

Methods

Employer activities are examined using microdata from the three waves of the European Survey on New and Emerging Risks (ESENER), collected in 2009, 2014 and 2019 (N = 47,425). ESENER is a representative company survey, conducted on behalf of the European Agency for Safety and Health at Work (EU-OSHA). The outcome of interest is information on the existence of a procedure to support employees’ RTW after a long sickness absence. The analysis is carried out using logistic models, comparing countries and welfare state regimes.

Results

Overall, 71.8% percent of workplaces with more than 50 employees have procedures to support RTW. Employer support is most common in Nordic and Anglo-Saxon countries (OR = 3.2, 95% CI 2.58-4.05 and OR = 8.9, 95% CI 5.41-14.68 respectively, compared to Continental countries and accounting for firm size and sector of activity). In Southern and Eastern Europe, the diffusion of RTW support is lowest (OR = 0.3, 95% CI 0.26-0.37 and OR = 0.2, 95% CI 0.17-0.24). With the exception of Nordic and Anglo-Saxon countries, smaller establishments are significantly less likely to have procedures in place than larger ones. The observed patterns are stable over time.

Conclusions

Employer support for RTW varies greatly across countries and welfare state regimes, indicating that institutional settings and policies matter for employer involvement in RTW, particularly in smaller workplaces. Countries with high levels of RTW support display different combinations of legal obligations and/or incentives for employers to support RTW.

Key messages

• There are large differences in employer support for RTW after sick leave across Europe.

• High support levels are associated with policies combining obligations and/or incentives for employers.
Labour market strategies addressing precarious employment and its impacts: A systematic review
Authors: Gunn V , Vignola EF , Wegman DH , Hogstedt C , Bodin T , Orellana C , O'Campo P , Albin M , Håkansta C ,   PWR Consortium
Published: October 2022

Background

Precarious employment (PE), characterized by reduced worker rights, and employment and income insecurity, has complex public health implications including negative impacts on workers’ mental and physical health, occupational health and safety, wellbeing, and inequities in access to health and social protections. There is, however, a knowledge gap regarding effectiveness of interventions. We describe findings from a review of evaluated interventions with potential to address PE.

Methods

Our systematic review followed the 2020 PRISMA framework and covered PubMed, Scopus, Web of Science, and sources of grey literature. We included qualitative, quantitative, or mixed-methods studies evaluating initiatives to reduce workers’ PE published from 2000 to 2021 and focused on adult workers.

Results

The 23 eligible studies from across the world evaluated diverse strategies addressing PE including tax and trade reforms, industrial disputes legislation, business registration, and use of incentives to stimulate permanent contracts. Also included were union strategies to reach precarious workers, the provision of social benefits, and youth apprenticeships. Generally, while most initiatives had the potential to tackle certain PE aspects, they usually acted only on one or two PE dimensions. Additionally, the evaluation components were missing key details, thus, limiting the generalizability of findings, as did the heterogeneity of study designs, initiative purposes, economic and political context, and diverse populations targeted.

Conclusions

The increase in PE prevalence and its complex health implications requires sustainable upstream public health solutions. Multidisciplinary collaborations among public health and occupational health practitioners along with researchers, evaluation specialists, economists, and politicians could facilitate the implementation and evaluation of policies and standards regulating and monitoring PE and its health impacts.

Key messages

• Precarious employment has complex public health implications.

• Sustainable solutions to address precarious employment must be upstream and multidisciplinary.