European Journal of Public Health最新文献

Environmental health literacy (EHL) is a rather recent concept that applies health literacy skills to environmental issues. Research in this field is still at the beginning, and there is currently no existing tool in the literature designed to comprehensively assess individual general EHL among university students. The aim of our study is to fill this gap through the validation of the Environmental Health Literacy Index (EHLI) in such a target group. We adapted a previously administered survey, originally completed by 4778 university students from various Italian universities. Starting from the original questionnaire, our methodology involved a three-round item selection process, followed by a comprehensive evaluation of the instrument's psychometric properties. The EHLI consists of 13 Likert-type items, covering three primary domains of health literacy: functional (six items), interactive (three items), and critical (four items). The Cronbach's alpha coefficient is 0.808 for the global scale, while it stands at 0.888 for the functional, 0.795 for the critical, and 0.471 for the interactive components. The area under the receiver operating characteristic curve reached a value of 0.643. Spearman correlation analysis revealed a significant yet slight correlation between EHLI and both functional health literacy score and the extent of pro-environmental behaviors adoption. Our study serves as an important initial step in developing a tool able to evaluate the EHL of university-aged individuals. Further research efforts may improve the questionnaire's validity and completeness, as well as to explore its applicability to different age groups.

Aim: To examine the association between academic orientation and frequent cannabis use among Swedish adolescents in upper secondary school and include pupils from introductory programs (IPs), a large group of adolescents previously overlooked in research on adolescent cannabis use.

Methods: We used cross-sectional data from two anonymous school surveys carried out in upper secondary school in 2021. The samples consisted of pupils from all academic orientations, and the analysis included 3151 pupils in higher education preparatory programs (HEPs), 1010 pupils in vocational programs (VPs), and 819 pupils in IPs. The association between the exposure academic orientation and the outcome frequent (21+ times) cannabis was analyzed using multi-level mixed-effects Poisson regression.

Results: Estimates from the first model showed a significant (P < 0.05) 2.45 times higher risk of frequent cannabis use among pupils in IPs compared with in HEPs [incidence rate ratio (IRR) 2.45, 95% confidence interval (CI) 1.28-4.66] and 82% higher in VPs (IRR 1.82, 95% CI 1.09-3.04) compared with in HEPs. However, the associations between academic orientation and frequent (21+ times) cannabis use were attenuated and no longer significant when socioeconomic status, truancy, school dissatisfaction, and early onset of substance use were adjusted for.

Conclusions: There was a higher risk of frequent (21+ times) cannabis use among pupils in IPs, and this differential was explained by higher exposure to risk factors in this group. This result is important from a policy perspective as it provides knowledge of a previously neglected risk group for frequent cannabis use.

Background: Rising global temperatures due to climate change pose a health risk. Mortality and morbidity increase during heat events affects various organ systems. While warmer countries face higher risks, even colder regions show elevated mortality during hot periods. This study examines physiological responses to heat exposure using data from the general Danish population cohort Lolland-Falster Health Study (LOFUS) during the summers of 2016-2019.

Methods: In this cross-sectional study, we analysed health data from 3804 individuals aged ≥15 years. Data were analysed across organ systems: cardiovascular system, lung function, renal system, inflammation, coagulation, and liver function. Meteorological data from the Danish Meteorological Institute provided information on temperature and humidity. Heat exposure was defined as one day ≥28°C heat index the day prior to examination. Adjusted multiple linear regression was applied to analyse differences between the two groups.

Results: There were 46 of 368 days with temperatures ≥28°C heat index. In total, 396 participants were heat-exposed (exposure group), while 3408 constituted the unexposed group. Heat exposure was associated with lower systolic blood pressure (-3.82 mm Hg [-5.72; -1.93]), higher heart rate (1.71 beats/min [0.45; 2.98]), lower oxygen saturation (-0.28% [-0.45; -0.10]), higher sodium (0.56 mmol/l [0.33; 0.79]), and higher urine albumin (0.14 mg/l [0.02; 0.27]). No significant differences were observed in inflammation, coagulation, or liver function.

Conclusion: This study reveals early physiological responses to heat with one day of heat exposure ≥28°C, particularly in the cardiovascular, pulmonary, and renal systems. These findings underline the need for tailored strategies to mitigate health risks associated with rising temperatures.

The early socio-economic differences in smoking build on the interplay between individual-, family-, peer-, and school-related factors. The present study aimed to add knowledge to this by examining susceptibility to smoking (S-SM), electronic cigarette (e-cigarette) use (S-EC), and smokeless tobacco (snus) use (S-SN) by educational aspirations in a country with advanced tobacco control policies. National cross-sectional School Health Promotion study survey was conducted among 8.-9. grade students (av. 15-year-olds) in 2017 with no prior smoking (n = 47 589), e-cigarette use (n = 49 382), or snus use (n = 53 335). Gender-stratified, age-adjusted multilevel logistic regression analyses with S-SM, S-EC, and S-SN were considered as outcomes and student- and school-level (aggregated) factors were considered as independent variables. The highest prevalence was observed for S-EC (girls 29%, boys 35%), followed by S-SM (16%, 15%) and S-SN (10%, 16%). Compared to those planning for general upper secondary education, S-SM was the highest for those without educational aspirations (OR = 1.20, 95% CI = 1.04-1.40), S-EC for those planning for vocational education [1.15 (1.05-1.25)], and S-SN for those planning for extra year/discontinuation [1.65 (1.04-2.60)] among girls. Among boys, both S-SM [1.37 (1.23-1.52)] and S-EC [1.19 (1.09-1.29)] were the highest among those planning for vocational education, with no clear associations with S-SN. Current other tobacco/e-cigarette use [OR range 1.27-8.87], positive attitude towards product use in one's age group [3.55-6.63], and liking school [0.58-0.68] consistently associated with susceptibility. Students not planning for academically oriented education had higher susceptibility to different nicotine products. High S-EC warrants monitoring to strengthen policy evaluation and prevention.

Background: Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. Reliability and validity of adherence to NPIs in accordance with normalization process theory (NPT) in coherent and convenient social subgroups using reflective measurement model assessment has not been evaluated.

Methods: In February 2021, a sample of medical students and people with substance use disorders in treatment as coherent (based on continuous probability distribution) vs. convenient groups (based on convenience, not equal probability) composed of travellers and COVID-19 suspected persons from Split-Dalmatia County (SDC) (n = 656) in the Mediterranean completed self-administered surveys. Partial least squares structural equation modelling (PLS-SEM) was used to measure reflective model assessment of adherence to NPIs according to NPT.

Results: PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined adherence to NPIs with excellent goodness-of-fit [χ2 = 1.292, df = 1; P = 0.297, CFI = 1, TLI = 0.997, RMSEA = 0.011 (90% CI 0-0.105), RMSEA P = 0.604, SRMR = 0.008, Hoelter CN (α = 0.05) = 2322.757]. Significant negative factors covariance estimate (-0.716) revealed an inverse relationship between first (adherence to NPIs and internal locus of control (LoC) (0.640)) and second factor; young adulthood age (≤25) and highest level of education (1362). As the first factor increased the second tended to decrease. LoC is expected potential mechanism by which sex (MLsex = -0.017, SE = 0.007, P < 0.016) and belonging to coherent subgroups (MLgroup = -0.008, SE = 0.003, P = 0.015) can produce indirect effect of adherence to NPIs.

Conclusions: Coherent subgroups had a more pronounced tendency toward integration of NPIs in everyday life. Group factors that facilitate the normalization were higher educated younger adults with a tendency toward external LoC.

Background: Postpartum care focuses on prevention of health problems by performing medical check-ups and through enhancing maternal empowerment, the parent-infant interaction and knowledge about mother's own health and that of her newborn. We aimed to investigate whether there was significant clustering within neighbourhoods regarding the uptake of postpartum care and to what extent neighbourhood-level differences are explained by individual socio-demographic factors, pregnancy-related factors and neighbourhood-level determinants (i.e. deprivation and urbanization).

Methods: A nationwide population-based observational study was carried out using linked routinely collected healthcare data from appropriate-for-gestational-age weight live-born term singleton deliveries (2015-18) in the Netherlands. We performed two-level multivariable logistic regression analyses, using three different models. Model 1 contained no explanatory variables and was used to assess clustering of postpartum care uptake within neighbourhoods. In model 2, individual-level determinants were added one by one and in model 3, neighbourhood-level determinants were added.

Results: About 520 818 births were included. Multilevel modelling showed that 11% of the total variance in postpartum care uptake could be attributed to the neighbourhood of residence. Individual characteristics explained 38% of the neighbourhood variance, of which income and migration background were the most important contributors. An additional 6% of the variation could be explained by neighbourhood-level determinants.

Conclusion: We found substantial neighbourhood differences in postpartum care uptake. These differences are influenced by a complex interplay between individual-level and neighbourhood-level determinants, highlighting the importance of addressing both individual and neighbourhood-level determinants to improve the uptake of postpartum care and therewith overall community health.

Over the past decade, access to National Health Service (NHS) dentistry in England has been problematic. There are increasing media reports of patients being unable to find treatment at a local NHS dentist. However, the extent of this issue varies by location and by the characteristics of the neighbourhood. The study uses official data sources on NHS dental provision and population. Travel accessibility is measured using car journey times. An advanced form of Floating Catchment Area accessibility is used, which accounts for supply competition, varying catchments, and distance decay. Spatial availability and accessibility indices are calculated. Ways in which the method can be used to explore various types of 'what-if' scenarios are outlined. Both availability and accessibility vary by the level of neighbourhood deprivation and the urban/rural nature of the neighbourhood. A case study, based on a real-world situation, shows the impact on the local neighbourhood of the closure of a dental practice. For all neighbourhoods, NHS dental provision is generally less than would be needed to provide basic dental care. The interpretation of outputs needs to take account of edge-effects near to Scotland and Wales. Possible improvements include the inclusion of other modes of travel and the exclusion of the population that does not want to access NHS care.

Socioeconomic differences in health risk behaviours during pregnancy may be influenced by social relations. In this study, we aimed to investigate if social need fulfillment moderates the association between socioeconomic status (SES) and health risk behaviours (smoking and/or alcohol consumption) during pregnancy. We used baseline data from the Lifelines Cohort Study merged with data from the Lifelines Reproductive Origin of Adult Health and Disease (ROAHD) cohort. Education level was used to determine SES, categorized into low, middle, and high, with middle SES as the reference category. Social need fulfillment was taken as indicator for social relations and was measured with the validated Social Production Function Instrument for the Level of Well-being scale. The dependent variable was smoking and/or alcohol consumption during pregnancy. Univariable and multivariable logistic regression analysis was conducted to assess the association of SES and social need fulfillment with health risk behaviours and to test for effect modification. We included 1107 pregnant women. The results showed that women with a high SES had statistically significantly lower odds of health risk behaviours during pregnancy. The interaction effect between SES and social need fulfillment on health risk behaviours was not statistically significant, indicating that no moderation effect is present. The results indicate that social need fulfillment does not modify the effect of SES on health risk behaviours during pregnancy. However, in literature, social relations are identified as an important influence on health risk behaviours. More research is needed to identify which measure of social relations is the most relevant regarding the association with health risk behaviours.