bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does School Education Improve Children’s Health Literacy? Evidence from a Performance-Based Survey
Authors: Heiss R , Schamberger L , Leuprecht E , Schütze D , Überall M , Zoller C , Sahling F , Gell S , Griebler R 
Published: October 2024

Abstract

Background
Children begin using digital sources of health information at a young age and are quickly exposed to a variety of unmoderated health content. Health literacy helps children navigate, understand, evaluate, and act on this content. But is the educational system preparing young people for these tasks? This study develops a validated, performance-based measure of health literacy and applies it to a sample of 9- to 13-year-old children (grades 4 to 7).

Methods
A performance-based tool to measure children’s health literacy was developed through expert consultation and qualitative and quantitative pretesting. The tool uses vignettes and quizzes and captures three dimensions of health literacy: nutrition, physical activity, and psychosocial health. The validated tool was then used in a cross-sectional survey of Austrian children aged 9 to 13 years (n = 780): Diet, Physical Activity, and Psychosocial Health.

Results
Results show that the performance-based health literacy scores do not correlate with self-reported scores. Girls (vs. boys) and native speakers perform better on the performance-based literacy test, while boys and children reporting more robust financial backgrounds overestimate their literacy on self-reported questions. Most importantly, the data do not show meaningful increases in performance-based health literacy across grade levels. For nutrition literacy, the study even shows a slight negative trend across grade levels.

Conclusions
This study questions the heavy reliance on self-reported health literacy, which is often confounded with self-efficacy and social environment. Performance-based instruments are needed to measure health literacy as an educational outcome. This study presents one of the first validated instruments. Most importantly, the study shows that the current educational system may not produce meaningful increases in performance-based health literacy, calling for deeper educational reforms.

Key messages
• Performance-based health literacy is a distinct concept from the subjective health literacy measures that dominate current health literacy research.
• Performance-based health literacy did not increase with grade level, indicating a poor performance of the education system in strengthening health literacy.
Why is regulation of the online world urgently needed to protect children’s wellbeing?
Authors: Signal L , Smith M , Gurtner M , Gage R 
Published: October 2024

Abstract

Background
The online world affords children many benefits, such as connectivity and access to educational and cultural content. Simultaneously, it increases their likelihood of encountering harmful or distressing web-based content and behaviour, such as marketing for harmful products, violent or discriminatory material, and cyberbullying. Yet, there is a dearth of objective research globally on children’s real-time experiences, with current research relying on self-reports or observations made in experimental conditions. This paper reports on the nature and extent of children’s online world.

Methods
Kids Online Aotearoa is a cross-sectional observational study of children’s real-time experiences of the online world. A strategic sample of 180 12-year-olds from schools in the Wellington region of Aotearoa, New Zealand, used Zoom video conferencing software to record their online world for four days. Recordings were analysed manually and using AI.

Results
Children spend most of their time online on their phones, often using TikTok. Children spend 25 % of their online phone time gaming or watching games (game time). They encounter many gambling and gambling-like activities while doing so. Of game time, 16% of the time children are exposed to marketing. Preliminary analysis reveals that children are exposed to marketing for alcohol, junk food, tobacco, vapes and gambling. This is counter to national legislation prohibiting or restricting such marketing to children.

Conclusions
This novel methodology reveals the actual online experiences of children as they go about their daily lives. This includes engaging in harmful behaviours such as gambling and encountering harmful product marketing. While from New Zealand, this study is likely to be relevant for other countries given the global reach of the online world. The research indicates the urgent need for national and global government regulation of the online world to protect the rights of children and ensure their wellbeing.

Key messages
• Kids Online Aotearoa reveals the nature and extent of children’s online world, including their exposure to harmful product marketing.
• National and global regulation of the online world is urgently needed to protect child rights and wellbeing.
Effects of legal age change on adolescents’ perception of access to alcohol in Portugal
Authors: Lima D , Leão T 
Published: October 2024

Abstract

Background
Adolescents and young adults are a group particularly vulnerable to the effects of alcohol consumption. In Portugal, legislative changes in 2013 and 2015 prohibited the sale of alcoholic beverages to under-18s. This study aimed, first, to evaluate the impact of these policy shifts on the perceived access to alcohol among Portuguese adolescents, and second, to assess the different impacts across gender and socioeconomic strata.

Methods
Data from the ESPAD survey, spanning 1995-2019, was used. A quasi-experimental difference-in-differences study design was employed, using Finland, Norway, and Sweden as controls. The perceived access to beer, wine, and spirits among 16-year-old adolescents was used as outcomes, adjusted for gender and parental education. Results were also stratified by gender and by parental education status.

Results
After the increase in the minimum age for alcohol sales, there was a higher perceived easiness of access to beer (coef=0.018, p = 0.001) and a decline in spirits (coef=-0.088, p = 0.022), with no changes in wine. Male adolescents exhibited a decrease in the perception of access to spirits (coef=-0.100, p = 0.007) and wine (coef=-0.049, p = 0.049), while changes in the perception of access to beer were non-significant. Similar patterns were observed in female adolescents, yet non-significant for wine or spirits. These positive impacts on beer and negative impacts on spirits were observed in the different socioeconomic groups; wine was the exception, with only the highest-education group showing a decrease in the perception of access (coef=-0.056, p = 0.011).

Conclusions
In this study, the effect of raising the minimum age for alcohol sales in Portugal varied according to the alcoholic beverage, gender, and, for wine, according to the socioeconomic group. These findings suggest limitations in the policy’s effectiveness and equity. Future research should delve into the underlying causes to optimize health-promoting policies.

Key messages
• Portugal’s alcohol policy changes led to differential impacts on the perception of access to alcohol, with an impact in higher alcohol content beverages.
• The impact of alcohol policy changes also differed across gender and socioeconomic status, with a stronger effect on male adolescents and higher socioeconomic strata.
Psychological Distress Changes During COVID-19: A Belgian Cohort Study On Psychosocial Factors
Authors: Duveau C , Nicaise P , Smith P , Seeber K , Lorant V 
Published: October 2024

Abstract
Longitudinal studies have identified an increase in psychological distress across the general population during the COVID-19 pandemic. Nevertheless, the trajectories of mental health outcomes exhibit variations, suggesting potential associations with psychosocial individual factors. This paper identifies the factors of this individual trajectory of psychological distress during the COVID-19 pandemic. Five waves of a prospective cohort survey were conducted with a convenience sample of the general population in Belgium between March 2020 and November 2021 (n = 4,550). Psychological distress was measured using the GHQ-12. Individual covariates included socioeconomic factors (age, gender, level of education), psychological factors (loneliness, social support, and social activities), and factors related to the virus and the lockdown measures (exposure to COVID-19 and survey wave). Multilevel models were used for analysis. Women and young people experienced more pronounced fluctuations in their risk of psychological distress across study waves, experiencing both increases and decreases. We found that individual variance in psychological distress breaks down into two components, respectively 43% for psychosocial factors (time-invariant) and 57% for the survey waves (time-variant) variation. A significant share of the time-invariant difference in psychological distress over COVID-19 is associated with loneliness, social support, and social activities. Loneliness emerged as the most important interpersonal factor associated with psychological distress. The change in psychological distress was mainly associated with psychosocial factors rather than with pandemic-related dynamics (e.g. survey waves). These findings suggest that mitigation policies aiming at controlling the pandemic should focus more on addressing specific individual vulnerabilities rather than solely responding to the fluctuations within pandemic waves to decrease their detrimental impact on mental health.
SARS-CoV-2 Infection And COVID-19 Outcomes Among Mental Disorders: A Register-based Study in Catalonia
Authors: Haro J M , Giné-Vázquez I 
Published: October 2024

Abstract
This study aimed to study the risk of SARS-CoV-2 infection and severe COVID-19 outcomes across different mental diagnoses and to assess the role of sex in these associations. We used electronic health records from Catalonia to identify adults receiving inpatient/outpatient mental health care between 2017-2019 with diagnosis of non-affective psychosis (NAP), bipolar disorder (BD), depressive disorder (DEP), stress-related disorders, neurotic/somatoform disorders (NSD), and substance misuse (SUB) (exposed). Outcomes included SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19-related death. Adjusted logistic regression analyses were conducted. 785,378 adults were included (70.3% &lt; 65 years old; 57.1% women). Compared to unexposed, those with NAP [OR (95%CI): 0.84 (0.80-0.88)], BD [0.80 (0.75-0.86)], DEP [0.97 (0.94-1.00)] and SUB [0.81 (0.78-0.84)] had a lower risk of SARS-CoV-2 infection, while people with NSD presented an increased risk [1.03 (1.01-1.06)]. Among those infected, people with DEP, NSD, and SUB had a lower risk of COVID-19 hospitalization, but higher risk of COVID-19-related death [1.23 (1.07-1.41); 1.26 (1.07-1.48); 1.48 (1.24-1.71), respectively]. A higher COVID-19-related death was also found in people with NAP and BD [1.68 (1.34-2.12); 2.02 (1.50-2.73)]. Sex-stratified analysis showed that women with NSD were especially vulnerable to infection [1.07 (1.03-1.11)], and women with DEP and NSD to COVID-19-related death [1.24 (1.05-1.47); 1.26 (1.02-1.54)]. These results suggest different vulnerabilities to infection and COVID-19 hospitalization and death across mental disorders. These findings have implications for pandemic preparedness, highlighting the need for specific public health strategies to mitigate the excess of mortality of people with certain mental disorders.
Tradition to Concern: Health Risks and Nicotine Dependence of Midwakh Use in Young Males in the UAE
Authors: Saddik B , AlHajjaj M , AlHouqani M , Halwani R , Mahboub B , Zeidan R , AlHammadi M , Shukla A , Seif A , Saheb Sharif-Askari F 
Published: October 2024

Abstract

Background
Midwakh smoking, a traditional practice, poses a growing public health concern in the Middle East region. Despite global efforts to curb tobacco use, smoking rates, particularly among young men, remain high. This study explores nicotine dependency, assesses acute health effects, and measures carbon monoxide levels among midwakh smokers.

Methods
A quasi-experimental before-and-after study involved 103 young male midwakh smokers in the UAE. Data collection included surveys featuring the Hooked-on Nicotine checklist (HONC), clinical measurements, and pre/post-smoking saliva samples. Statistical analyses, including descriptive, paired samples, correlation, and regression, assessed associations between midwakh smoking, dependency, and health outcomes.

Results
Preliminary findings found that 33% of midwakh smokers were under 21 years, 68% had below undergrad education, and household incomes over 15,000 AED monthly. Smoking initiation was as early as 10 years. Smoking habits revealed 37% exclusive midwakh, 54% midwakh with e-cigarettes, 21% with shisha, and 34% with cigarettes. Post-smoking clinical measurements showed significant increases in blood pressure, heart, pulse and respiratory rates, and carbon monoxide levels (p ≤ 0.05). Significant differences in pre- (134.6 ng/ml) and post-smoking (154.4 ng/ml) saliva cotinine levels (p ≤ 0.05) were observed. Regression analysis identified predictors of nicotine dependency: initiation age (β= -.315; -0.579,0.0512), household income (β = 1.221; 0.297,2.146), multiple tobacco use (β = 0.576; 0.129,1.024), quit attempts (β = 1.555; 0.519,2.590) and smoking risk perception (β = 3.420; 1.950,4.890)

Conclusions
Midwakh smoking adversely affects clinical measurements, with early start correlating with higher nicotine dependency, worsened by using multiple tobacco products. Urgent action is needed, including tailored prevention campaigns and support systems to aid youth cessation and raise awareness of midwakh smoking’s harmful effects.

Key messages
• Midwakh smoking is deeply ingrained in UAE tradition but poses significant adverse health outcomes and nicotine dependency.
• There is a need to establish specialized cessation programs offering support and resources to midwakh users, addressing both the health consequences and addictive nature of midwakh.
Early life social predictors of longitudinal relations between childhood BMI and overeating
Authors: Bartoskova Polcrova A , Ksinan Jiskrova G , Bobak M , Pikhart H , Ksinan A J 
Published: October 2024

Abstract

Introduction
The progression of obesity is a continuous process involving a complex system of genetic, environmental, and behavioural factors. Socioeconomic disadvantage as well as psychological distress may lead to overeating, subsequently associated with increased energy intake and weight gain. Recent evidence indicated that the association between childhood obesity and overeating might be bidirectional. Therefore, this study aimed to longitudinally investigate the directionality of the association between childhood BMI and overeating and to identify antecedent early childhood predictors.

Methods
The study sample included 5,777 children from the European Longitudinal Study of Parents and Children (ELSPAC), collected between 18 months and 11 years of child age. The outcomes were child BMI and overeating. Predictors included maternal BMI, maternal education, single-parent households, financial difficulties, and adverse childhood experiences (ACEs). The random intercept cross-lagged panel model (RI-CLPM) was applied.

Results
The results showed temporal stability in the development of overeating and BMI, with a bidirectional relationship that strengthened over time. The child’s BMI was predicted by maternal BMI (β = 0.37, p &lt; 0.001). The child’s overeating was predicted by maternal BMI (β = 0.13, p &lt; 0.001), but a stronger effect was found for ACEs (β = 0.24, p &lt; 0.001). ACEs mediated the impact of maternal education, financial difficulties, and single parenthood on overeating with indirect effects of β = -0.01 (p = 0.005), β = 0.04, (p &lt; 0.001), and β = 0.07 (p &lt; 0.001), respectively.

Conclusions
We observed stable bidirectional longitudinal effects, with a stronger association from BMI to overeating. The results suggested two main pathways: one linked to maternal BMI and early childhood BMI increase followed by overeating, and the other associated with ACEs mediating the effect of early childhood socioeconomic factors on overeating, leading to gradual BMI gain. #NGEU

Key messages
• The study revealed a stable bidirectional association between childhood BMI and overeating, with a stronger association from BMI to overeating.
• There are two potential pathways in childhood obesity development, one involving maternal BMI, and the second associated with social disadvantage and ACEs.
Mental health symptoms and treatment for common mental disorders among sexual minority immigrants in Sweden – a national population-based study
Authors: Tinghög P , Bränström R , Malm A 
Published: October 2024

Abstract

Background
Although sexual minorities are at greater risk of poor mental health, less is known about mental health among dual minority statuses individuals based on sexual orientation and migration status. The current study investigated disparities in mental health symptoms and psychiatric treatment for common mental disorders among Swedish-born and immigrant heterosexuals and sexual minorities. It further explored the role played by interpersonal and social stress in explaining these disparities.

Methods
Participants (n = 104,652) were drawn from the Swedish Public Health Survey in 2018. Six groups were compared based on sexual orientation (heterosexual, sexual minority) and migration status (Swedish-born, European-born, non-European). The survey was complemented with information on psychiatric treatment from nationwide registries. Odds ratios were calculated using logistic regression.

Results
Compared to Swedish-born heterosexuals, Swedish-born and non-European sexual minorities had the greatest risk of mental health symptoms (odds ratios [OR]=2.20, 95% confidence intervals [CI]: 1.89-2.57, and OR = 2.10, 95% CI 1.34-3.29, respectively). Swedish-born sexual minorities had greater risk of psychiatric treatment (OR = 2.58, 95% CI 2.20-3.01), while non-European heterosexuals had lower risk (OR = 0.61, 95% CI 0.52-0.72). No differences in psychiatric treatment was found for non-European sexual minorities (OR = 0.82, 95% CI 0.46-1.48). Interpersonal and social stress factors mediated the associations between migration status and mental health symptoms and psychiatric treatment differently depending on sexual orientation.

Conclusions
No excess risk of mental health symptoms was found among sexual minority immigrants compared to their Swedish-born counterparts.

Key message
• Non-European sexual minority immigrants’ risk of mental health symptoms was equally high to the risk among Swedish-born sexual minorities, but they received less psychiatric treatment.
6.P. Scientific session: Economic evaluation of health impacts for better decision choices
Authors:   Organised by: EUPHA-HIA, -FS, -ECO, -PHPP, University of Bath (UK), RIVM (Netherlands),   Chair persons: Piedad Martin-Olmedo (EUPHA-HIA), Henk Hilderink (EUPHA-FS)
Published: October 2024

Abstract

The strategy of Health in All Policies (HiAP) pursues to analyse the wider determinants of health affected by the decision-making process of traditionally non-health sectors, seeking to enhance population health benefits while avoiding health inequalities. This usually involves the use of health impact assessment (HIA) or health lens analysis to any policy, program, plan or project (PPPP), preferably prior to its implementation. On the other hand, decision-makers from a wide range of public and private sectors also demand a better insight of the meaning of the health impacts quantified under HIA. Assuming the (ubiquitous) situation of limited resources and budgets, decisions need to be based on cost effectiveness criteria and, whenever possible, direct and indirect health costs should be part of the impact assessment. Economic appraisal attempts to define whether a proposal makes a net contribution to social welfare, quantifying and valuing changes to individuals’ utility from the societal perspective, taking into account the impact of health on the individual, their family, employers, healthcare providers and the state. This approach can incorporate different components of the welfare costs of illness, including direct medical and paid care expenses, indirect lost opportunity costs such as productivity and the value of informal care time, as well as a value that monetises the disutility or pain and suffering associated with disease. The range of methods and estimated benefits can make it challenging to identify a best practice approach.
The present session aims to address certain methodological aspects related to the economic evaluation of health impacts, which still generate some controversy and debate, with particular emphasis on the following topics: • Approaches for synthesizing evidence on health impact pathways and economic evaluation of health impacts for a better decision choice; • Health metrics: influence on the conclusions of economic analysis within HIA; • Sources of metrics used for economic analysis; • Uncertainties inherent to economic valuation of health outcomes: how to deal with it.

Key messages
• The economic analysis of health impacts can help prioritizing aspects with the greatest impact on population health, facilitating a more effective use of human and economic resources.
• The economic analysis within HIA can improve decision-making but requires careful consideration of health metrics, sourcing of data, and management of uncertainties.
Cost-benefit analysis: just a step in the HIA process
Authors: Santos J 
Published: October 2024

Abstract
The economic analysis within Health Impact Assessments (HIA) is a critical component in informing public policy decisions by assessing the financial implications of health outcomes associated with the different intervention options. Health metrics play a role defining the cost-effectiveness and societal value associated with the interventions. These metrics, quantifying the health impacts, include quality-adjusted life years (QALYs), years of life lost (YLLs) or disability-adjusted life years (DALYs). On another level, such metrics need to be translated into cost-effectiveness and societal value in which other methods play a role, such as the value of statistical life (VSL) or the value of a life year (VOLY). While VSL quantifies the value individuals place on reducing mortality risk, VOLY evaluates the value attributed to extending life expectancy. On another hand, uncertainties related to economic valuation pose challenges to the accuracy and reliability of cost estimates within HIA. These come from several factors, including data quality, methodological differences across studies, and subjective judgments involved in valuing health states. In fact, estimating the economic value of a prevented death involves multifaceted considerations and important assumptions. Additionally, assigning monetary values to non-fatal health outcomes, such as disability or reduced quality of life, involves subjective assessments and value judgments. By selecting appropriate metrics, considering diverse data sources, and addressing methodological steps and uncertainties, HIA practitioners can improve the utility of economic assessments, facilitating evidence-based decision-making in public health policy and resource allocation. This work 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).