bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of digital health literacy on anxiety and preventive behaviors during the pandemic
Authors: Duplaga M , Wojcieszko M 
Published: October 2023

Abstract

Background
From the pandemic's beginning, many authors suggested that digital health literacy (DHL) may be an important factor in protecting against araising misinformation and enhancing compliance with preventive behaviors. In this study, we analyzed the effect of DHL on future anxiety and generalized anxiety, as well as on adherence to preventive measures and COVID-19 vaccination uptake after adjusting for sociodemographic factors.

Methods
Data used in the analysis originated from the web-based survey carried out in a representative sample of 2189 Polish Internet users in the later phase of the COVID-19 pandemic. The effect of DHL on FA, GA, and APM after adjusting for SD factors was analyzed with multivariable linear regression and on C19VU with multivariable logistic regression. DHL was measured with an eHealth Literacy Scale (eHEALS) consisting of 8 items. The effects of predictors in MLiR models were expressed as B coefficients and 95% confidence intervals (B; 95%CI) and in MLoR model as odds ratio and 95%CI (OR; 95%CI).

Results
Mean age (standard deviation, SD) of respondents was 44.1 (15.25) years, mean DHL measured with eHEALS was 28.91 (5.17). The analysis demonstrated that higher DHL was significantly associated with a higher level of FA (B; 95%CI: 0.07; 0.02-0.12) but with lower GA (B; 95%CI: -0.01; -0.016 - 0.03). Interestingly, higher DHL favored greater compliance with general PM (wearing the mask, washing hands, and keeping a social distance) (B; 95%CI: 0.04; 0.02 - 0.05). However, no effect was observed concerning C19VU (OR, 95%CI: 0.99; 0.97 - 1.01).

Conclusions
The effect of DHL on the outcomes related to the pandemic is not consistent. Higher DHL seems to predict the perception of long-term consequences of the pandemic reflected by higher levels of FA. However, the level of GA shows the status of current anxiety is lower with persons with higher DHL.

Key messages
• The effects of digital health literacy are not fully consistent with predictions from the beginning of the COVID-19 pandemic.
• Digital health literacy is significantly associated with adherence to general pandemic preventive measures but not with readiness to get vaccinated against COVID-19.
Health Catch-UP!: process evaluation of a migrant multi-disease screening and vaccination tool
Authors: Carter J , Knights F , Goldsmith L P , Deal A , Crawshaw A F , Hayward S E , Zenner D , El Kheir N , Requena-Mendez A , Hargreaves S 
Published: October 2023

Abstract

Background
European migrants face a disproportionate burden of infection (tuberculosis, HIV, hepatitis B/C and parasites), are at-risk of underdiagnosis of non-communicable diseases and are an under-immunised group. Reducing these health inequities is a key public health priority, with the ECDC calling for innovative strategies to deliver multi-disease screening to at-risk migrants. Current strategies in the UK to screen migrants report low uptake despite clear health and cost benefits. Health Catch-UP! is a collaboratively produced innovative digital tool applying UK guidance to identify screening and vaccination requirements of migrants based on country-of-origin. (https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-with-requested-editsmp4

Methods
We did a mixed methods process evaluation of the Health Catch UP! tool in two GP practices, using the Medical Research Council framework for complex interventions. We recorded data on demographics, patients screened, disease detection and catch-up vaccination rates. We conducted qualitative interviews with staff and migrants to explore barriers and facilitators.

Results
Outcomes data were extracted for 99 migrants, predominantly from Asia (31.3%), and Sub-Saharan Africa (26.1%). 61.6% of participants were recommended screening, uptake of screening was high with 86.9% were screened for at least one health problem. New diagnoses included: one case of hepatitis C, 6 hypercholesteremia, 4 pre-diabetes and one diabetes. Catch-up vaccination uptake was poor (2.0%). Qualitative data strongly supported the acceptability and feasibility of the tool but recommended clear laboratory and management pathways, financial incentives, and a staff and patient information and training implementation package.

Conclusions
Innovative primary care digital tools like Health Catch-UP! have potential to significantly improve disease detection and effective implementation of screening guidance but require robust testing and resourcing.

Key messages
• Migrants face disproportionate burden of infectious diseases, screening and vaccination innovations are required to reduce health inequity.
• Digital clinical support tools in primary care have potential to improve disease detection and implementation of migrant screening guidance.
Educational inequality in cause-specific mortality among immigrants and their descendants in Sweden
Authors: Miething A 
Published: October 2023

Abstract

Introduction
Although immigrants in Western countries often face disadvantages and vulnerabilities such as lower socioeconomic status, they tend to exhibit weaker educational gradients in mortality compared to the native majority populations. However, it is unclear how these gradients vary across specific causes of death and whether they persist among second-generation immigrants. Therefore, this study aims to investigate educational inequalities in cause-specific mortality among first- and second-generation immigrants compared to the native ancestral population in Sweden.

Data & Methods
Individual-level analysis was conducted on Swedish register data from 2004 to 2016, including men and women aged 25 to 64. Poisson regression was used to examine the association between the highest educational degree attained and mortality due to circulatory diseases, neoplasms, external causes, self-harm, drug and alcohol use.

Results
The findings indicated that first-generation immigrants exhibited significantly lower educational inequality in all causes of death compared to native ancestral Swedes. In contrast, second-generation immigrants showed similar degrees of educational inequality in all-cause mortality and mortality due to neoplasms when compared to ancestral Swedes. However, they displayed more pronounced educational inequalities in mortality from external causes, self-harm, and drug use.

Conclusions
The results highlight that while first-generation immigrants experience lower educational inequality in the considered causes of death, second-generation immigrants show pronounced educational inequalities in avoidable causes of death. This study emphasizes the importance of considering heterogeneity in educational disparities in immigrant mortality and calls for policy interventions to address educational inequalities in second-generation immigrants.

Key messages
• When compared to the native majority population, first-generation immigrants in Sweden demonstrate lower educational inequality in mortality, regardless of the underlying cause.
• Conversely, second-generation immigrants display larger educational inequalities, particularly for mortality caused by preventable factors.
An HIV prevention intervention helps immigrants open up about transactional sex. The Makasi study
Authors: Coulibaly K , Gosselin A , Desgrées du Loû A ,   for The Makasi study group
Published: October 2023

Abstract

Background
Transactional sex is known to be an exposure factor for HIV acquisition among immigrants in France. We analysed the factors associated with the increase in the proportion of transactional sex among African immigrant men and women living in precarious situations in the greater Paris area.

Methods
Data were collected in the Makasi research project. Participants were recruited in public places based on their precarious situations, they were randomised into two groups (intervention and control) followed during six months between 2019 and 2021. We described the levels of transactional sex at each follow-up time (0, 3, 6 months) and used random-effects logistic regression models to analyse factors associated with the evolution of transactional sex participants.

Results
The majority of participants were men (76.5% (470/614)) and almost half of them arrived in France in two years prior to inclusion (49.8%). Transactional sex increased in both study groups: at inclusion, 1% of men in the control group and 0% in the intervention group reported having had transactional sex. At the six-month follow-up, 15% and 8% of men in the control and intervention groups respectively reported transactional sex. Among women, 7% in the control group and 8% in the intervention group reported transactional sex at baseline. They were 27% and 24% respectively to report transactional sex at the six-month follow-up in each group. We find that exposure to the intervention liberate the speech about transactional sex, especially among men.

Conclusions
Our results suggest that the proportion of transactional sex seems to be important among immigrants in precarious situations, especially among men, and that the empowerment intervention facilitated participants’ openness about their sexual activities. These results suggest that the social hardships and structural barriers faced by immigrants in precarious situations limit the effect of HIV prevention interventions in this population.

Key messages
• Social hardships experienced by immigrants must be addressed to reduce their exposure to HIV.
• An empowerment-based outreach intervention facilitated participants’ openness about transactional sex.
Nutritional quality of food intakes according to the Nutri-Score and blood biomarker concentrations
Authors: Deschasaux-Tanguy M , Huybrechts I , Julia C , Hercberg S , Riboli E , Touvier M ,   EPIC collaborators
Published: October 2023

Abstract

Background
Diet has a direct impact on our health and as such is an important leverage in public health prevention strategies. Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label based on a nutrient profile called FSAm-NPS that was proposed as a tool to help people choose healthier foods. It has been adopted by several European countries, but remains optional under current EU labeling regulation (under revision). This study aimed to provide insights into the relevance of the FSAm-NPS to characterize healthier foods by studying associations with a range of biomarkers reflecting pathways underlying nutrition-health associations.

Methods
This analysis included healthy participants from the EPIC cohort study (inclusion in 1992-2000, 8 European countries) for which blood biomarkers were measured from baseline samples in several case-control studies. Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruit and vegetables. Multi-adjusted linear models were computed.

Results
Consuming foods with higher FSAm-NPS scores (lower nutritional quality) was positively associated with the concentration of C-peptide (n = 788, β = 0.02, P = 0.04) and C-reactive protein (n = 899, β = 0.04, P = 0.04) and with a multi-marker profile characterized by apolipoprotein B, total and LDL cholesterol concentrations derived from principal component analysis (n = 498, lsmeans = -0.35 in quintile 1 and -0.03 in quintile 5, P = 0.02).

Conclusions
In this European context, higher concentrations of blood biomarkers reflecting hyperinsulinism, inflammation and dyslipidemia were observed in participants consuming foods and beverages with higher FSAm-NPS scores (lower nutritional quality/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help people eat healthier food products.

Key messages
• The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with concentrations of blood biomarkers reflecting hyperinsulinism, inflammation and dyslipidemia.
• This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help people choose healthier foods and beverages.
Systems dynamics for healthy and sustainable local food environments
Authors: Poelman M P , Wopereis T , Wierda J , Rongen F , Dijkstra S C 
Published: October 2023

Abstract

Background
Current food environments steer unhealthy food choices, increasing the risk for diet-related non-communicable diseases. Changing food environments is complex and underlying system dynamics of local food environments are relatively unclear. This study aimed to identify factors and leverage points that shape local food environments and to develop systemic actions with local stakeholders to improve food environments.

Methods
Two workshops (in 2022) were held in a Dutch municipality using a community-based system dynamics approach in which a variety of stakeholders (n = 13) participated (e.g., policy maker, retailers, health coach, citizens). Group model building exercises were used to identify factors shaping the local food environment and to develop a causal loop diagram. Subsequently, leverage points and actions to improve food environments were identified by the stakeholders.

Results
Based on the first workshop, a total of 46 factors influencing the local food environment were identified and categorized into four subsystems including commercial-, political-, global- and societal factors. The leverage points included the anti-lobby from food industry, food industry's willingness to change, Government/consumer priority on healthy food, food policy, e-commerce and platform economy, demand for healthy food, time to prepare/consume meals. In correspondence, 20 actions to improve the local food environment were identified during the second workshop. Moreover, the exercises initiated dialogues and collaborations between the participating stakeholders to adapt their local food environment.

Conclusions
This research yielded one of the first causal loop diagrams showing the multiple and varied factors influencing the local food environment. It underlines the importance of using a systems approach to adapt and improve food environments. More work is needed to implement the developed actions and to translate the system dynamics approach for use by non-academics.

Key messages
• Food environments are complex adaptive systems, which require a systems dynamic approach to generate change.
• Food environments need to be adapted at multiple levels requiring multiple pathways and stakeholders to succeed, and thus move away from single component interventions.
Effects of social protection programs on suicide mortality: a study in 81 LMICs between 2000-2019
Authors: Landín Basterra E , Silva N J , Alves FJO , de Sampaio Morais G A , Brachowicz N , Rasella D 
Published: October 2023

Abstract

By 2019, LMICs bore more than 77% of the global suicide burden worldwide. In addition, the consequences of the COVID-19 pandemic exacerbated the existing inequalities and social protection gap between high- and low- and middle-income countries (LMICs). The United Nations’ Sustainable Development Goals 2021 Agenda targeted, both, the promotion of social protection for all (target 1.3) and the reduction of suicide mortality by one-third (target 3.4) by 2030. These targets will not be met if current trends maintain. There is a lack of studies investigating the link between social protection and suicide in LMICs. This study aimed to help fill this knowledge gap by assessing the effects of social protection (SP) programs on the suicide mortality rates in 81 low- and middle-income countries (LMICs), over the period 2000-2019. Multivariable regression analyses using Poisson models were performed adjusting for relevant socioeconomic and healthcare factors. Robust standard errors and fixed-effects specifications were included to estimate the relationship between SP coverage and suicide rates. Our results showed that a 1% increase in the population covered by SP programs could reduce by 0.19% (IRR:0.83;95%CI:0.74-0.94) the suicide rates of the 81 LMICs over the 20 years studied. By disaggregating, the strongest suicide reductions were found among the youngest population of 10-24 years (a 0.21% suicide reduction when increasing SP coverage by 1%: IRR:0.81;95%CI:0.69-0.95). To our knowledge, this study shows for the first time in a large sample of LMICs, that social protection programs could reduce the suicide mortality in LMICs, especially among the youngest populations. Understanding the potential benefits that SP programs could have on reducing health inequalities in LMICs could guide policymakers to target more efficient interventions to prevent suicide and associated factors, quantify its public health cost, and create strategies to tackle stigma-related behaviors.

Key messages
• Promoting the expansion of social protection interventions could be an effective strategy to reduce the suicide burden over the next years in LMICs, especially among the youngest populations.
• Advocating for the de-stigmatization and promotion of standardized methods to classify suicide should be a public health priority.
Achieving a healthy, sustainable and climate-friendly diet: what do municipalities and counties need?
Authors: Lyshol H , Totland T H , Helleve A , Budin Ljøsne I S , Torheim L E 
Published: October 2023

Abstract

Background
In 2022 the Norwegian Institute for Public Health was asked to ascertain how local authorities help their citizens maintain a healthy, sustainable and climate-friendly diet. The research should identify the barriers and promoting factors involved, and pinpoint national policies and tools that would support the local authorities, using quantitative and qualitative methods.

Methods
356 municipalities and 10 counties were asked to fill in an online questionnaire. 6 municipalities and 6 counties took part in qualitative interviews. Interview transcripts and text from the 180 received questionnaires were subjected to content analysis and combined with questionnaire data in a mixed methods analysis.

Results
The municipalities did not consider sustainability and climate in their nutrition work, apart from projects on food waste. The counties were involved on their own behalf and also tried to support the municipalities. Main barriers for the municipalities were lack of personnel (67%), economic resources (65%), and competence (48%). Several municipalities indicated that lack of policy foundations and support from local authorities along with lack of knowledge about local challenges hindered this work. The opportunities indicated by the municipalities were making nutrition a part of local policies and budgets (55%) and making the prioritization of nutrition visible within the municipality (66%). Local cooperation and having access to personnel with nutritional competence and responsibility for nutrition were also considered important. The counties saw their roles as facilitators and distributors of project funds to the municipalities, but many of them required more resources to fulfil their duties.

Conclusions
The municipalities’ work to promote a healthy and sustainable diet is inadequately anchored in Norwegian municipalities’ policies and governance. The municipalities need interventions and tools to increase the public health sector's competence in the field.

Key messages
• Municipalities should include nutrition and sustainability in local planning, policy, and governance.
• Counties should be provided with tools that help them to support local level work.
Determinants of COVID-19 vaccine intention in a University population: a serial mediation approach
Authors: Paridans M , Dardenne N , Donneau A F , Gillet L , Bureau F , Guillaume M , Pétré B 
Published: October 2023

Abstract

Background
While many studies have used the Health Belief Model (HBM) to understand vaccination intention, few have explored the relationships between the HBM constructs. The aim of this study is to develop a serial mediation model dealing with latent variables to assess direct and indirect effects of the six HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy and cue to action) on COVID-19 vaccine intention.

Methods
From April to June 2021, a questionnaire on vaccine intention against COVID-19 was administered to staff and students at the University of Liège (Belgium). To evaluate direct and indirect effects of the HBM constructs on vaccine intention (score 0-100), serial mediation models for each latent variable permutation were assessed with Partial Least Squares Path Modeling (PLS-PM). Bayesian information criterion (BIC) was used to compare models. Internal consistency reliability and discriminant validity were evaluated. Sociodemographic variables, health literacy, psychological profile, body mass index, chronic disease and previous COVID-19 infection were included in the models as covariates.

Results
The sample consisted of 1256 participants. After running all permutation chains, the final causal chain, with the lowest BIC value, was barriers (-0.09 (-0.15 - -0.03))* - severity (-0.13 (-0.20 - -0.07))* - low self-efficacy (0.20 (0.15 - 0.25))* - low susceptibility (-0.55 (-0.60 - -0.51))* - vaccine intention (outcome). This highlighted a significant indirect and direct effect (-0.20 (-0.25 - -0.15))* between barriers and vaccine intention. Constructs benefits and cue to action were removed due to no significant path and weak reliability. Non-significant confounding factors were also removed. *estimate

Conclusions
The results showed that perceived barriers are a key determinant of COVID-19 vaccine resistance. Public health actors should communicate messages to remove barriers that reduce vaccine intention primarily.

Key messages
• Serial mediations allow a better understanding of how a vaccination intention works.
• Public health communications should primarily focus on messages to remove barriers to get vaccinated.