bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging the gap: mapping co-creation methods for public health impact and innovation
Authors: Agnello D M , Balaskas G , Steiner A , Chastin S
Published: October 2024

Background

Co-creation offers a promising approach to public health innovation, particularly for tackling complex issues. However, the lack of a standardized methodology limits its reliability and reproducibility, especially across diverse contexts. This study explores co-creation methods used by researchers and practitioners, aiming to shed light on their implications for public health. Understanding this methodological landscape can enhance the effective implementation of co-creation processes to address complex challenges.

Methods

Utilizing the Systematic Methods Overview approach, we examined co-creation methods. Data were gathered from the Health CASCADE Co-Creation Database and grey literature using an artificial intelligence-assisted recursive search strategy and a two-step screening process. We conducted textual, comparative, and bibliometric analyses to evaluate methodological underpinnings and relationships between methods.

Results

Analysis of 2,627 academic articles and grey literature sources identified over 900 co-creation methods. While surveys, focus groups, and group discussions were prevalent, participatory methods were underutilized. Notably, 91.3% of methods co-occurred, with a predominant combination of qualitative approaches. Furthermore, a significant discrepancy between research and practice was evident, with only 10.2% convergence.

Conclusions

This study revealed a critical gap between co-creation in research and practice, emphasizing the need to bridge this methodological divide for advancing co-creation as a reliable approach in public health. The over-reliance on qualitative methods raises concerns about tokenistic engagement and undermines meaningful public participation in co-creation. Addressing this trend is vital to preserve the essence of true co-creation and maximize its potential for addressing complex public health challenges.

Key messages

• Mapping the diverse methods of co-creation in public health reveals both richness and disparities in approach, from surveys to participatory methods.

• Addressing the discrepancy between co-creation in research and practice is vital for establishing a reliable and effective approach to tackling public health challenges.
Validation of the NEED assessment framework: an EU level Delphi study
Authors: Claerman R , De Pauw R , Cleemput I , Kohn L , Levy M , Schönborn C , Maertens de Noordhout C
Published: October 2024

The NEED (Needs Examination, Evaluation and Dissemination) assessment framework was developed to identify and measure health-related patient and societal unmet needs across different health conditions, supporting the creation of needs-driven healthcare policy and innovation. It includes 25 criteria of needs and 46 related indicators allowing to estimate if the needs are met. The current study aims to validate this framework on the EU level using a modified Delphi approach. The selection of national and European institutes invited to participate in the Delphi process was based on their respective roles; specifically, public health, health technology assessment (HTA), medicine authorisation, pricing and reimbursement (P&R), and patient advocacy. Through a modified Delphi approach, the experts were able to express their opinion on the framework structure (dimensions and domains), health-related needs criteria and indicators. Two Delphi rounds were performed using online questionnaires. Consensus was reached when 85% of the respondents agree or totally agree with a proposal and less than 5% of the respondents totally disagree. A panel of 27 experts participated in the first round of the study. The majority of the experts worked in HTA agencies (39%) and P&R agencies (24%), followed by national medicine authorities (9%) and umbrella patient organisations (9%). Seventeen EU Member States were represented, with a higher representation of experts from Austria, Belgium, France, Germany, The Netherlands, Spain and Sweden. Consensus was reached for 22 out of the 25 criteria and 41 out of the 46 indicators after the first round. The modified Delphi technique was an adequate approach to aid the validation of the NEED framework at the EU level. This represents an important first step in achieving consensus on how to define and identify unmet health-related needs and move towards a more needs-driven healthcare policy and innovation landscape.

Key messages

• Consensus on the definition and identification of unmet health-related needs is crucial to transform public health innovation.

• Expert consultation by means of the Delphi technique assumed a pivotal role to reach consensus on the NEED framework.
The cost of not getting care: income disparities in the affordability of health services across high-income countries
Authors: Gunja M , Gumas E , Williams R , Doty M , Shah A , Fields K
Published: October 2024

This presentation will present findings from the Commonwealth Fund 2023 International Health Policy Survey of the General Population, focusing on financial barriers in accessing healthcare among adults across 10 countries. It highlights significant income-related disparities in healthcare affordability, particularly in the United States, where nearly a quarter of the population lacks affordable access to care. While disparities exist in other countries, Germany and the Netherlands demonstrate lower rates of affordability issues and income disparities, possibly due to their universal health coverage models and cost-sharing caps based on income levels. These countries also prioritize mental health and dental care within their public health plans. The analysis emphasizes the critical need for affordable and comprehensive healthcare coverage to ensure equitable health outcomes. It suggests that policies such as cost-sharing caps and income-based subsidies could mitigate financial barriers to care, drawing insights from successful models in Germany and the Netherlands. Ultimately, addressing affordability is vital for achieving health equity and improving overall population health.
Inequities faced by those with substance use disorder (SUD)
Authors: Finbråten A
Published: October 2024

This presentation delves into the inequities faced by individuals with substance use disorder (SUD), with a particular focus on people who use drugs (PWUD) and people who inject drugs (PWID). Individuals contending with SUD encounter multifaceted barriers that hinder access to appropriate care and support. This presentation will highlight the discourse surrounding biases that exacerbate health disparities among PWUD and PWID. Structural stigma and discriminatory practices not only impede access to healthcare services but also perpetuate social exclusion, amplifying the challenges faced in seeking help and support. PWUD and PWID often require tailored interventions that address not only their substance use but also co-occurring physical and mental health conditions. However, the fragmented nature of healthcare delivery and the lack of integration between substance use treatment and mainstream healthcare services pose significant obstacles to holistic care provision. Drawing on empirical evidence and lived experiences, this presentation explores strategies to dismantle the barriers faced by individuals with SUD in Norway. Ultimately, this presentation aims to foster dialogue that addresses the inequities entrenched in healthcare systems around the world. By advocating for a compassionate and inclusive approach to SUD care, we can strive towards a society where all individuals, regardless of their substance use history, can access the support and resources they need to lead healthy and fulfilling lives.
Better together: a program to increase the public health corps in the southeast United States
Authors: Kershner S , George T , Hucks J
Published: October 2024

Background

This undergraduate public health program implemented in the southeastern United States addresses the need for an expanded public health corps to fill health service gaps underscored by the Covid-19 pandemic, including a shortage of personnel with the skill to function on emergency frontlines; workforce development resources; and socially just healthcare programs to support under-resourced areas.

Objectives

To enhance student knowledge of public health and increase volunteers available for emergency and public health response within local, state, and global communities. After program participation, how confident did participants feel that they could know what to do in the case of an emergency? After program participation, how knowledgeable did participants feel that they would know what to do to protect others in the case of an emergency? After program participation, how aware were participants about the issue of public health response and preparedness?

Results

216 students were recruited at a university in the southeastern United States, and 75% completed 30 hours of modules, immersion activities and skill-based trainings. Almost all (91%) were pre-nursing/nursing or public health majors. The majority of participants (90%) indicated a level of agreement with the statement, “I am confident that I know what to do in the case of an emergency” and 93% indicated a level of agreement with the statement, “I would know what to do to protect others in the case of an emergency”. Almost all participants (96%) indicated a level of agreement with the statement, “My awareness of public health response and preparedness has increased due to participation in the project”. Qualitative results mirrored a similar strong level of support for the program.

Conclusions

Students who complete appropriate training play an essential role in pandemic management and the broad training the medical workforce receives can also be applied to diverse disaster scenarios.

Key messages

• The goal of the project was to enhance undergraduate student knowledge of public health.

• The secondary goal of the project was to increase the number of students available to volunteer for emergency and public health response in local, state, and global communities.
Association between gender inequality and climate adaptation across the global
Authors: Pinho-Gomes A C , Woodward M
Published: October 2024

Introduction

Climate change has a disproportionate impact on women in comparison to men and women have a key role to play in climate adaptation. However, evidence is lacking on how gender inequalities may be associated with climate vulnerability and ability to respond at country level.

Methods

This ecological study investigated the association between climate adaptation, measured by the Notre Dame Global Adaptation Initiative Country Index (ND-GAIN), and gender inequality, measured by the Global Gender Gap Index (GGGI) developed by the World Economic Forum and the Gender Inequality Index (GII) developed by the United Nations. Simple linear regression was used to estimate the associations between the indices and their subdomains for 146 countries.

Results

There was an approximately linear association between the GGGI and climate adaptation. Each 1% increase in gender equality was associated with a 0.6% increase in the ND-GAIN score (slope 0.59, 95% confidence interval [0.33 to 0.84]). This was driven by a negative association between gender equality and vulnerability (-0.41 [-0.62 to -0.20]), and a positive association between gender equality and readiness (0.77 [0.44 to 1.10]). Gender equality in the education domain of the GGGI had the strongest association with climate adaptation. There was a strong negative linear association between the GII and climate adaptation, which explained most (87%) of the between-country variation in climate adaptation. Each 1% increase in gender inequality was associated with a 0.5% decrease in the ND-GAIN score (-0.53 [-0.57 to -0.50]). The association between gender inequality and readiness was stronger than the association with vulnerability (0.40 [0.37 to 0.44] for vulnerability versus -0.67 [-0.72 to -0.61] for readiness).

Conclusions

Gender inequality measured broadly across different domains of life is associated with climate adaptation at country level, both in terms of vulnerability to impact and readiness to respond.

Key messages

• Gender inequality, considered broadly across multiple domains of life, is associated with increased vulnerability to climate change and poor readiness to respond.

• Addressing gender inequality needs to be a priority for governments and inter-governmental organisations if populations worldwide are to adapt to climate change.
Development of a heat mortality surveillance approach for England
Authors: Lo E , Thompson R
Published: October 2024

Background

England’s unprecedented temperatures in 2022 and 2023 highlighted the severe risks of rising global temperatures on public health. This study considers the impact of heatwave events on mortality rates, supporting the development of improved health surveillance and intervention strategies.

Methods

Firstly, heat-associated mortality for each heat episode was estimated by comparing observed daily mortality values with the expected baseline of daily deaths. Secondly, the historic temperature-mortality relationship was established at national and regional levels using a distributed lag non-linear model with temperature and mortality data from the previous 5 years. Finally, modelled estimates of heat-associated excess mortality were generated based on the historic temperature-mortality relationships, to assess any difference between observed and modelled estimates.

Results

In 2022 which saw record-breaking maximum temperatures in the UK, an estimated 2,985 (2,258-3,712) heat-associated deaths were recorded across five heat episodes, the highest annual count to date. Despite relatively cool temperatures, 2023 saw the third-highest heat-associated mortality since reporting began in 2016 of 2,295 (1,681-2,910). Comparisons between modelled and observed mortality were generally similar, but showed statistically significant discrepancies for certain heat episodes across the two summers.

Conclusions

Heatwaves have a rapid and clear impact on health, emphasising the need for effective early warning systems and interventions. The comparison of observed mortality with predictions from historic temperature-mortality relationships at regional level demonstrates the need for a nuanced approach to surveillance and health protection for adverse heat, with factors other than temperature also playing a critical role in health impacts. This will inform continuous improvements in England’s impact-based Heat Health Alerting system.

Key messages

• Heatwaves pose a significant risk to public health, as evidenced by the unprecedented excess deaths during the record-breaking temperatures in England in Summer 2022.

• Comparison of observed mortality with predictions from historic data can provide insight into contextual factors modulating the health impacts of heat, and inform future surveillance and response.
Preparing health students for climate change: the impact of an innovative ‘Plan Health Faire’ course
Authors: Guihenneuc J , Boissinot L , Cambien G , Gueritault M , Fritel E , Le Gonidec P , Migeot V , Ayraud-Thevenot S
Published: October 2024

Introduction

Recent studies highlighted the need for climate change (CC) training in universities, especially for health students. In France, a collaborative teaching program, “Plan Health Faire” (PHF), addresses this need. This study aimed to assess PHF’s impact on health students’ reactions, knowledge, and behaviour.

Methods

A cross-sectional study was carried out among all second-year health students enrolled in Medicine, Pharmacy, Odontology, and Maieutics at the University of Poitiers in September 2022. During a mandatory seminar, all students took part in the innovative and scientific PHF teaching program which aims to raise awareness of the challenges of CC as applied to healthcare. Two structured questionnaires based on the Kirkpatrick evaluation model were administered before and after the course. Using a comparative statistical analysis, the changes in students’ knowledge were assessed.

Results

In all, 294 students took part in the study, and 97.4% were satisfied or very satisfied with PHF. An average score of 8.6/10 was given to the collaborative dynamics of the training. In terms of changes in their level of knowledge and their perception of these changes, 98.3% of students felt that they had learned new knowledge about CC and healthcare. A comparative analysis of the answers to the knowledge questions showed that students’ level of knowledge is indeed significantly higher at the end of the course (p<0.0001). Finally, 94% of students expressed their probable or certain intention to integrate these issues into their future professional practice.

Conclusions

These results indicate that the PHF training program has a significant impact on health students, particularly in terms of satisfaction and knowledge. PHF could be an interesting way to teach health students about the challenges of CC in healthcare. PHF is currently tested in other French Universities and health care facilities.

Key messages

• Plan Health Faire is an innovative and collaborative educational program aimed at raising awareness among healthcare stakeholders about the challenges of climate change.

• Plan Health Faire is an effective program for raising awareness among health students about climate change and is also an interesting lever for integrating climate change into their future practice.
1.G. Scientific session: Forecasting dietary habits trends, human and planetary health
Authors:   Organised by: EUPHA-FN, -CHR, WHO/Europe Special Initiative for NCDs and Innovation,   Chair persons: Saverio Stranges (EUPHA-CHR), Mary Rose Sweeney (Ireland)
Published: October 2024

Extensive research has elucidated that dietary factors are pivotal in influencing both human health and the ecological stability of the planet. Suboptimal dietary patterns are implicated in over 10 million annual fatalities attributable to non-communicable diseases. Concurrently, the agricultural sector, a major component of food production, contributes significantly to environmental degradation. This sector is responsible for more than a quarter of global greenhouse gas emissions and utilizes approximately 50% of the planet’s habitable land. Moreover, it accounts for over 70% of global freshwater consumption and is a primary contributor to marine ecosystem disruption through nutrient runoff leading to ocean eutrophication. Despite these critical linkages, current global trends related to dietary practices show little alignment with the improvements needed to achieve the Sustainable Development Goals set for 2030. The existing policy framework and interventions lag considerably in addressing these concerns. Historical and ongoing discussions have repeatedly highlighted these issues, yet the allocation of resources necessary to counteract the pervasive influence of industry-driven marketing promoting less healthful dietary choices remains markedly inadequate. There is an urgent need to intensify dialogues and enhance the conceptual framework regarding the role of diet in sustaining global health and environmental integrity among public health professionals. Such measures are crucial for facilitating a shift towards more sustainable and health-promoting dietary habits globally. The EUPHA Food and Nutrition Section, the Chronic Diseases Section, in collaboration with the World Health Organization (WHO) Regional Office for Europe, aim to propose a joint workshop to share innovative research and activities held in the context of diet and environment. The workshop aims to provide new findings and stimulate the debate about the projections for the future of human and planetary health.

Key messages

• Human health and environmental preservation require an adaptation of dietary habits globally: are we going in the right direction?

• Current evidence suggests that there is an wide area of intervention to improve actual dietary habits, reduce the environmental impact, and improve human health.
Foresight diet quality: current trends and future problems
Authors: Bonaccio M , Grosso G
Published: October 2024

Current evidence suggests that several aspects of diet quality is globally suboptimal. While increasing animal-based products could exert certain benefits against undernutrition in developing countries, the preference of mass-produced low-quality meat-products over other animal-based ones (i.e., milk, dairy, and eggs) and their overall excessive consumption in spite of plant-based ones has been deemed responsible, at least in part, of the rise of non-communicable diseases. The industry-led response to the growing need of animal-food alternatives may not necessarily meet the health objectives of a natural vegetable source against highly processed products rich in chemical additives. Research in this area is growing producing mixed results, while adoption of plant-based dietary patterns seems less and less equivalent to be synonymous of a healthy nor sustainable choice. In this presentation, data on the current state of evidence on global food consumption, dietary patterns, as well as the relation between level of food processing and health will be provided.
System-wide health needs segmentation: innovating integrated care for complex needs households
Authors: Piroddi R , Baker W , Daras K , Buchan I , Rafferty J , Astbury A , Barr B
Published: October 2024

Background

Health needs segmentation is increasingly used in healthcare delivery and health policy planning to cater for diverse population groups and develop effective and equitable health policies. But existing models often lack a systemic approach, focusing instead on single conditions or settings. This leads to fragmentation, gaps and inefficiencies in service provision and inequities in health outcomes, particularly when addressing complexity, and specifically for children, as adversity clusters in families.

Aims

To develop a household health needs segmentation model to identify those households with children with high levels of complex cross-sectoral needs, to plan for integrated care services.

Methods

Data linkage of primary, secondary, mental, community and social care services, mortality records, residential information, and small-area multiple deprivation measures was used to design a rule-based model to identifying households with children with the most complex needs in the UK region of Cheshire and Merseyside (C&M), with large variation in demography, (human) geography, and deprivation.

Results

Of 2,645,329 individuals in C&M (97% of the registered population in 2021), 1,022,840 lived in 266,939 households with children aged 0-16: 21,527 households had complex needs. This 8% of families accounted for an estimated 34% of health and social care costs for families, £362 million in total, 42% of which spent on children in care of local authorities.

Implications

The model identified a specific group of families with complex service use patterns, high mental and physical comorbidity and socioeconomic vulnerabilities. These exhibit potential for improved outcomes through better integration of services and targeting of community building and family support resources.

Conclusions

Our model represents a significant innovation in health needs segmentation. By using whole system linked data, it provides a pragmatic way of profiling complexity for proactive care.

Key messages

• Complex health and social problems in children cluster in families with adults also having complex needs, so we need to transform fragmented services to support the whole family to improve outcomes.

• Household level segmentation using cross-sectoral, whole system data is an innovation to identify households with complex needs with respect to their locality to improve integration of support.
Active education for reducing the attainment gap in a public health course in the United Kingdom (UK)
Authors: Lima do Vale M , Murdoch J
Published: October 2024

Background

A diverse cohort of students join our UK postgraduate public health programme. We wanted to reduce attainment gaps between students. Active and inclusive educational activities may be important mechanisms for reducing attainment gaps as well as promoting student wellbeing. Our aim was to explore how active and inclusive curriculum design could support development of public health functions (e.g., designing interventions to address health inequalities) whilst reducing attainment gaps.

Objectives

Our 12-week module included a project to model determinants of adolescent’s health inequalities and design an evidence-based intervention to address determinants. Informed by Fink’s taxonomy and the assessment for learning framework, we designed educational activities (i.e., small group work and presentations, ethnographic visits, discussions with stakeholders) and assessments (i.e., group poster presentation and individual critical reflection) to structure the project. We assessed attainment gaps in student marks and surveyed student attitudes to the project (1 = strongly disagree; 5 = strongly agree).

Results

53 students (9 groups) completed the assessment with the following marks: poster (M = 61, SD = 7), critical reflection (M = 59, SD = 9), overall mark (M = 59, SD = 10). More students received ‘fails’ and ‘distinctions’ when only the critical reflection was considered (p < 0.001). Students (N = 39; 72% response rate) agreed that activities were intellectually stimulating (M = 5, SD = 0.8), supported their learning (M = 4, SD = 0.8) and made them feel included (M = 5, SD = 0.7). Active learning approach (i.e., benefits of interactions; creating effective groups); student’s caring and commitment; choice and inclusivity; complex and authentic tasks; informal, formal and timely feedback were highlighted.

Conclusions

Evidence that an active and inclusive approach functions to reduce attainment gaps is equivocal but appears to promote engagement, inclusion and learning.

Key messages

• Active learning strategies combined with authentic and flexible tasks and rich in feedback stimulate student’s interactions, inclusivity, and learning with potential for reducing attainment gaps.

• Active and authentic education requires educators to work on how to properly implement these strategies.
How have respiratory tract infections changed in the post-covid era for children under 5 years?
Authors: Foley K A , Hargreaves D S , Quint J K , Bottle A , Majeed A , Saxena S
Published: October 2024

Background

Social distancing measures introduced in response to the covid-19 pandemic reduced transmission of all respiratory pathogens. Exposure to respiratory pathogens in early life affects future lung health. We aimed to describe changes in the incidence of respiratory tract infections (RTIs) in children <5 years in England in the post-pandemic era.

Methods

Population-based retrospective cohort study using electronic health records. We included all children aged <5 years registered with a primary care practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs in the two post-pandemic years (April 2021 - March 2022 and April 2022 - March 2023) with corresponding months during pre-pandemic years (April 2016 - February 2020).

Results

There were 3 045 701 respiratory tract infections among 2 894 539 children <5 years registered with a GP practice during the study period. Pre-pandemic, monthly RTI rates varied from lows of 29.1 per 100 child-years in August to highs of 108.8 per 100 child-years in November. In 2021/22, monthly RTI rates were bimodal peaking in June and October, although the winter peak was lower than pre-pandemic years and mean monthly RTI rates were ∼15% lower overall. In 2022/23 mean monthly RTI rates remained ∼15% lower than pre-pandemic years, but there was a single peak in December 2022 of 117.6 RTIs per 100 child-years, exceeding the pre-pandemic winter peaks by 8.1%.

Conclusions

Overall, monthly RTIs in post-pandemic years were 15% lower than pre-pandemic years. However, there was a concerning peak in December 2022 that exceeded the winter peaks from previous years. Comparisons with national surveillance data suggest this peak reflects changes in RTI incidence, particularly among group A streptococcal infections, but this peak may also reflect changes in access to care or healthcare seeking behaviour. Continued monitoring of post-pandemic seasonal patterns will assist in planning for health service use.

Key messages

• Respiratory tract infections in children <5 years in post-pandemic years were 15% lower than pre-pandemic years, but winter peaks in incidence may be of greater magnitude in the post pandemic era.

• Ongoing monitoring of patterns of respiratory tract infections in young children is important for future health service planning and delivery.
1.K. Scientific session: Health literacy of children and adolescents across Europe
Authors:   Organised by: EUPHA-HL, -HSR,   Chair persons: Jany Rademakers (Netherlands), Orkan Okan (EUPHA-HL)
Published: October 2024

Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents.

Key messages

• Child and adolescent health literacy is an important, yet under-researched public health topic.

• Child health literacy is an important predictor of their health behavior and outcomes.
The influence of health literacy on health outcomes and behaviors in fourth-graders in Germany
Authors: Bollweg T M , Okan O
Published: October 2024

Background

For the adult population, evidence suggests that a high level of subjective health literacy is associated with a number of favorable health outcomes and behaviors. However, for younger populations, particularly children, little evidence is available. This study investigates the relationship between subjective health literacy, health outcomes, and health behaviors in children.

Methods

We conducted a representative survey of 4th-grade students (age 8-11) in North Rhine-Westphalia, Germany, between Oct. 2022 and Feb. 2023. Subjective health literacy was measured with the HLS-Child-Q15 questionnaire. For mental and physical well-being, the KINDL-R was used. For health behaviors, we asked about the frequency of (1) brushing teeth, (2) eating fruit and (3) vegetables, (4) exercising, (5) consuming sweetened drinks, and (6) wearing a helmet when riding the bike. Regression analysis was used to determine the impact of health literacy on outcomes, controlling for a number of sociodemographic indicators (birthplace, home language, sex, age), as well as the tendency to give socially desirable responses. Health behaviors were rated on a Likert scale and where dichotomized for ordinal regression.

Results

n = 1085 students are included with a mean age of 9.5 years (SD=.6). 50.3% are female. While controlling for a number of variables, health literacy was a significant predictor (p<.05) for every indicator except the frequency of (1) brushing teeth, (4) exercising, and (5) consumption of sweetened drinks. For mental well-being, health literacy was the strongest predictor.

Conclusions

Our findings highlight the potentially enabling role of subjective health literacy regarding favorable health outcomes and health behaviors. However, because this is a study among younger children, further research is needed on the interplay of individual subjective health literacy, social contexts (e.g., parental health literacy and health behaviors), and children’s health outcomes and behaviors.
Impact of the transition to retirement on alcohol consumption: a longitudinal analysis within SHARE
Authors: Vigezzi G P , Bertuccio P , Mosconi G , Fanucchi T , Gallus S , Odone A
Published: October 2024

In an ageing society, the impact of retirement on behavioural risk factors and health status needs to be carefully assessed. Evidence on the short-term and long-term effects of retirement on alcohol consumption are contrasting and inconsistent. A longitudinal study was conducted based on data from the Survey on Health, Ageing and Retirement (SHARE) collected between 2004 and 2020 in 27 European countries and Israel. A repeated measure generalised estimating equation (GEE) model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (CI) of alcohol consumption (frequency, quantity, and binge drinking) at different time periods before and after retirement. We selected a cohort of 8,998 individuals who were employed at baseline and retired during follow-up (median follow-up: 9 years; maximum: 16 years). Compared to the year of retirement, the RR for habitual daily or near-daily drinking was 0.88 (95%CI 0.76-1.02) 10 years before retirement and 0.92 (95%CI 0.83-1.02). This pattern reversed post-retirement with a RR of 1.12 (95%CI 1.01-1.23) 3-4 years after retirement and 1.28 (95%CI 1.11-1.48) 10 years or more after retirement. No significant changes in the consumption of high volumes (more than 8 units of alcohol) were observed: while the frequency of regular drinking might increase post-retirement, the instances of heavy episodic drinking do not necessarily rise. Additionally, a reduction in occasional heavy drinking episodes was noted both before (RR 0.86; 95%CI 0.77-0.95, 5-9 years prior) and after retirement (RR 0.78; 95%CI 0.66-0.93, more than 10 years after). These findings underscore the complexity of alcohol use behaviours in the context of retirement. The increase in regular drinking post-retirement might be attributed to changes in daily structure, social interactions, or coping mechanisms for life transitions. The decline in binge drinking suggests a shift towards more moderated consumption patterns as individuals age.

Speakers/Panelists

Licia Iacoviello

University of Insubria, Varese, Italy

João Vasco Santos

University of Porto, CINTESIS, ARS Norte, Porto, Portugal
Considerations for coping with loneliness from the perspective of young people
Authors: Verity L
Published: October 2024

Adolescence is a time characterized by high friendship instability. Adolescents have to navigate changes to their social worlds alongside developmental challenges such as identity formation. It makes sense then, that loneliness is a common experience during adolescence. For most, loneliness is transient and can be adaptive; it motivates individuals to strengthen their social relationships by seeking connection and evaluating existing relationships. For some, loneliness becomes chronic leading to heightened risk of additional mental health issues such as depression and anxiety, and physical health issues such as cardiovascular disease. Extant interventions to help youth cope with loneliness have been developed based on quantitative research and may be missing qualitative insights that can expand our understanding by identifying the decisions made by young people when determining how to cope. Exploring the lived experience of adolescents who are navigating loneliness can complement quantitative work by identifying preferred coping strategies, and barriers to coping adaptively. This presentation will focus on qualitative research with adolescents highlighting factors that influence their approach to coping. Drawing from insights gathered from 13 focus groups with young people aged 8-24 years in the UK, the presentation will discuss key themes developed to describe the process by which youth determine how to cope, the influence of their underlying reasons for feeling lonely, coping strategies that help to alleviate loneliness, and strategies which are counterproductive.
Machine Learning Approach to Injury Monitoring in Children and Adolescents
Authors: Feer S , Zysset A , Saaro M F , Bächli M , Niemann S , Meier D , Seiler M , Bogojeska J , Dratva J
Published: October 2024

Pediatric injuries are common and associated with individual suffering and costs for the healthcare systems and society. The incidence of injuries among children in Switzerland has so far been insufficiently monitored. Emergency department patient records can be a valuable database to assess medically relevant injuries and gain information for monitoring and evidence-based prevention. The talk will outline our stepwise development of a machine-learning program for a pediatric injury monitoring system and lessons learnt. In this feasibility study we draw on electronic case histories of children treated for injuries between 2018 and 2022 at the University Children’s Hospital Zürich emergency department (N= to 30’884). The ML- approach follows different steps: step 1. utility evaluation of electronic pediatric patient records regarding ML and injury monitoring and prevention requirements in a test-sample of 100 electronic pediatric case histories; step 2. choice/adaptation of coding tree; step 3. coder training and inter-coder reliability testing; step 4. manual annotation of a sub-sample (n 1000) of the electronic pediatric patient records, step 5. design and testing of the ML program in an iterative process, and step 6. performance testing in a random sample of pediatric patient records. First lessons learnt indicate that electronic case history data contain relevant data and fulfill requirements for monitoring and prevention purposes. The IDB coding system proved too complex and detailed for the pediatric data base, providing too few examples for the ML-learning process, and needed to be adapted. Initial data analyses indicate the majority of cases are classified as less severe (73%) and only few (<1%) as very severe but the later provide the most detailed data. ML is a promising approach and makes use of hospital data for a national monitoring of pediatric injuries in Switzerland.
Long-term disability following childhood injury: an imperative to monitor and address the continuum of trauma care
Authors: Ameratunga S , Harrison J E , Cameron P , Ponsford J , Reeder S , Lyons R A , Teague W , Nunn A , Gabbe B
Published: October 2024

Background

While injuries remain a leading cause of childhood death, increasing proportions of children survive life-threatening injuries. However, robust epidemiological data on their risks of long-term disability are scant, undermining comprehensive injury control efforts. This population-based prospective cohort study investigated the functional status and health-related quality of life of seriously injured Australian children over a 5-year period.

Methods

Patients aged <18 years hospitalised for major trauma (Injury Severity Score >12) in the State of Victoria over a 12-month period were followed-up at 6, 12, 24, 36, 48 and 60-months post-injury. Primary outcomes were assessed using the PedsQL, King’s Outcome Scale for Childhood Head Injury and the Glasgow Outcome Scale-Extended. Multivariable regression models investigated factors associated with outcomes.

Results

Of the 186 participants, 71% were retained to 60 months post-injury. At five years post-injury, only 39% had fully recovered while 39% experienced moderate to severe disability. Despite gains in functional status across the five years, psychosocial recovery lagged improvements in physical health. Factors associated with adverse outcomes included older age at injury, female sex, socio-economic disadvantage, remote/regional (versus urban) residence, pre-existing comorbidities, and injuries deemed compensable, intentional, or involving head trauma.

Implications

The high risks of long-term disability following serious childhood injury highlight the need for robust injury control efforts that monitor and address the inequitable burden of childhood injury, including the social determinants influencing the occurrence as well as sequelae following injury.
Gender identity differences in age of first mental health diagnosis: A population-based study of childhood and adolescence
Authors: Bränström R , Pachankis J E
Published: October 2024

Introduction

Gender minority (GM; i.e., trans, non-binary, and other gender diverse) individuals have an increased risk of mental health disorders, but few studies have explored disparities using population-based samples or the age of onset of this risk.

Objectives

The aim of the current study was to identify the age at which the gender identity disparity in physician-assessed psychiatric diagnosis and treatment for common mental health disorders can be first identified in a population-based sample linked to national health care registries.

Methods

All individuals aged 16 to 25 (n = 18,793) participating in the nationwide probability-based Swedish National Public Health Survey in 2018, 2020, or 2021 were included in the analyses. This sample could be linked to mental health care treatment history data in nationally comprehensive health care registries starting at age 8 years old.

Results

Individuals reporting a GM identity in adulthood were seven times more likely to having been diagnosed with depression and/or anxiety and about five times more likely to having been diagnosed with a neurodevelopmental disorder during childhood or adolescence compared to individuals with a cisgender identity. GM individuals’ increased likelihood of being diagnosed with depression and/or anxiety was significantly elevated from age 13, while their neurodevelopmental disorder diagnosis risk was significantly elevated from age 10, compared to cisgender individuals.

Conclusions

The results from this study are the first population-based evidence to show that GM individuals are more likely to be diagnosed and treated for mental health disorders early during childhood and adolescence compared to cisgender individuals. The early emergence of this increased risk requires further inquiry into causes of these early disparities. It also suggests a potential benefit of interventions that facilitate social belonging and inclusion and reduce stressors related to societal expectations of gender.
Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States
Authors: Gonzales G , Wilder J , Tran N
Published: October 2024

Objectives

The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States.

Methods

Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients.

Results

TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better.

Conclusions

We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.
Development of a first intervention for tobacco cessation for sexual and gender minority individuals in Romania
Authors: Lelutiu-Weinberger C , Matthews P , Zavodszky A , Hightow-Weidman L
Published: October 2024

Background

Data on tobacco use among SGM in Romania indicate high use rates, yet tailored smoking cessation efforts do not exist. We collected data from SGM individuals in Romania on tobacco use and cessation attitudes, facilitators and barriers to quitting, and intervention components acceptability to inform the first smoking cessation intervention for SGM in Romania, adapted from a U.S.-based intervention with mobile app support.

Methods

SGM individuals (≥ 18 years old, current smokers) recruited through community outreach in March 2024 completed a brief assessment and participated in a focus group regarding tobacco use, attitudes, norms, risks knowledge, facilitators and barriers to quitting, and intervention acceptability.

Results

Focus groups were held with 36 participants characterized as 45% cis male, 40% gender-diverse, 15% cis female; 40% gay, 33% bisexual, 10% queer, 8% pansexual; 6% lesbian, 3% heterosexual; M age=27, SD = 7.62. 70% smoked daily; median age of first cigarette was 17. Participants reported smoking up to 2 packs a day, with 50%-98% of people in their circles being smokers. Common reasons for smoking included to alleviate stress and “fit in.” Most did not receive support to quit from their social circles or within healthcare. While smoking was communal, quitting was individual and siloed, suggesting a preference for a group-based intervention, along with robust strategies to replace the function of smoking with adaptive habits. The app was evaluated positively, especially for its daily smoking tracking, reminders for alternative healthy activities, positive achievements, and forum for support.

Conclusions

Findings provide a solid platform for creating a first smoking cessation intervention for SGM individuals in Romania. Next steps include iterative testing of the mobile app to examine comprehension, usability, and satisfaction with content and functionality, in preparation for a randomized controlled trial testing the intervention’s efficacy.