European Journal of Public Health最新文献

COVID-19 vaccine hesitancy among ethnic minority groups presents a public health challenge. However, there is limited understanding as to why ethnic minorities often exhibit lower levels of vaccine uptake. This study investigates the role of national identification and institutional trust in explaining differences in COVID-19 vaccine uptake between majority and minority ethnic groups. Using a large, cross-national dataset of 20 European countries (N = 31 240), we conducted multilevel structural equation modelling to assess the impact of ethnic identification on COVID-19 vaccine uptake, mediated by national identification and trust in institutions. Our findings revealed significant group differences, with minority group members reporting lower levels of national identification, trust in institutions and COVID-19 vaccine uptake compared to majority group members. We also found that ethnic identification indirectly influences COVID-19 vaccine uptake through national identification and trust in institutions. Specifically, people from minority ethnic groups tend to report lower levels of national identification, which makes them less likely to trust institutions. This lower level of trust, in turn, reduces their likelihood of COVID-19 vaccine uptake. Our findings underscore the importance of fostering inclusive national identities and building institutional trust to reduce COVID-19 vaccine hesitancy among ethnic minorities. Public health strategies that address these social dynamics are essential for increasing vaccination rates and ensuring equitable health outcomes across diverse populations.

In the European Union (EU), one in five youth currently smoke, with over half establishing regular smoking by age 18. Yet, evidence on the historical trends of smoking initiation remains scarce despite its importance for tobacco control. Using four waves of the Special Eurobarometer survey (2012-20; n = 110 753, aged ≥15), we retrospectively estimated trends in initiation rates (IRs) of regular cigarette smoking in the EU from 1940 to 2019 among individuals aged 10-24 by sex, region, and country for each calendar decade. EU-wide smoking IRs have decreased compared to the peak period, with narrowing disparities by sex and region. For males, the IRs have declined from 5.7% (95% CI = 5.6-5.9) in the 1970s to 3.2% (95% CI = 3.0-3.3) in the 2010s, and for females from 3.9% (95% CI = 3.7-4.0) in the 1990s to 2.4% (95% CI = 2.3-2.5) in the 2010s. The decline was more pronounced among young adults aged 18-24 than minors aged 10-17, with minors' IRs surpassing those of young adults during the 2010s. Marked declines occurred among young adults in all regions, while among minors, a clear decrease was observed only for males in Northern Europe. Concerningly, the IRs among minors have trended upward in Eastern Europe for both sexes. Despite declining youth smoking initiation, an unacceptably high number of European youth still begin smoking regularly before the legal age of 18. Stricter and comprehensive tobacco control policies targeting youth, along with smoke-free generation initiatives, could substantially reduce future tobacco use and smoking-related mortality.

This cross-sectional observational study aims to estimate the number of days absent from work due to health-related problems among employed individuals with multimorbidity and to quantify the lost productivity value from these absences. Data were obtained from the Belgian Health Interview Survey 2018, comprising employed individuals aged 15-64 (N = 4096). We examined 12 chronic conditions and 57 dyads. The Human Capital Approach was used by multiplying the reported number of days absent by the average wage per person per day, utilizing stratified gross wages from the Belgian Statistical Office. Approximately one-third of the study population reported multimorbidity. For individuals with zero to four+ chronic conditions, mean days of absence were 5.5 (95% CI: 2.3-8.8), 6.8 (95% CI: 2.9-10.7), 14.8 (95% CI: 10-19.6), 24 (95% CI: 17.8-30.2), and 36.2 (95% CI: 30.4-42), respectively. Depression (€3089; 95% CI: 2129-4049), diabetes (€2315; 95% CI: 962-3668), arthropathies (€1972; 95% CI: 1101-2844), and cancer (€1848; 95% CI: 598-3099), as standalone conditions, were associated with the greatest productivity losses. The effects were amplified up to seven times with the co-occurrence of multiple chronic conditions. We estimated 34.2 million days absent or €7.5 billion in lost productivity due to health-related work absenteeism among working-age employed individuals with multimorbidity in 2018. At the population level, the coexistence of two musculoskeletal disorders was linked to the highest aggregated productivity loss. At the individual level, the coexistence of a mental health condition and a somatic condition was associated with the highest average productivity loss per capita. The indirect cost due to health-related absence from work for individuals with multimorbidity in Belgium is high, and in many cases, exceeds the direct cost of treatment.

Private imports of alcoholic beverages-often referred to as cross-border trade-have long raised concerns in Sweden and other Nordic countries due to their potential impact on national alcohol policies and public health. A key concern is that this trade increases total alcohol consumption and related harms. This study examines the relationship between private alcohol imports and domestic sales in Sweden, with a focus on how cross-border trade influences total alcohol consumption. Using regional and beverage-specific time series data from 2002 to 2023, we applied SARIMA modelling to self-reported import estimates from the Monitor project to assess substitution effects on domestic alcohol sales. Private imports significantly displace domestic alcohol purchases, particularly in southern Sweden across all beverages, though the substitution is partial. For Sweden as a whole, analyses indicate that a 1-litre increase in imports is associated with a 0.456-litre decrease in domestic sales. In central Sweden, only spirits imports show a significant effect (1-litre increase in spirits imports yields a 0.175-litre decrease in domestic sprits sales), while no significant associations are observed in the north. The findings suggest that cross-border trade contributes to higher overall alcohol consumption, especially in border regions. Regional variation underscores the need for differentiated alcohol policy responses. Private imports undermine the effectiveness of domestic alcohol control measures. However, since domestic sales do not influence import levels, policy efforts such as increased excise taxation may reduce total consumption without triggering substantial compensatory imports.

Multimorbidity refers to the co-occurrence of multiple health conditions in a single individual. The objective of this systematic review was to synthesize and evaluate research on the prevalence of multimorbidity (including both mental and physical health conditions) for people who have experienced homelessness. MEDLINE, EMBASE, PsycINFO, Web of Science, and OpenGrey were searched for relevant studies between 1997 and 2025. Studies were included if the sample consisted of adults in high-income countries, where the exposure was current or former homelessness, and the outcome was multimorbidity including both mental and physical conditions. Random-effects meta-analyses were used to calculate pooled prevalence estimates. The studies were narratively synthesized, and quality assessed. The search retrieved 6043 papers, 30 of which were eligible for inclusion in the review. Most studies recruited participants from specialist homelessness services (n = 21). More than half of the study samples were over 75% male (N = 16). When excluding studies which applied non-probability sampling strategies, the pooled prevalence was 45% (95% CI, 25-66) for multimorbidity. There was a 34% (95% CI, 22-48) pooled prevalence for trimorbidity (co-occurring mental, physical, and substance/alcohol use conditions). High heterogeneity was observed across studies (I2 > 99%). To conclude, multimorbidity is highly prevalent for people who experience homelessness. There is a lack of research on multimorbidity for women who are or have been homeless, and for those who are not accessing specialist homelessness services. These findings demonstrate the need for the integration, collaboration, and co-ordination between services to support the multimorbid health needs of people who experience homelessness.

During the COVID-19 pandemic, a noticeable decrease in medical care utilization occurred which may contribute to increased morbidity and mortality rates associated with treatable conditions. In Italy, severely impacted by the pandemic, a comprehensive data source on healthcare renunciation is essential for policy formulation and intervention strategies. This study used data from the PASSI d'Argento (PdA) surveillance system to investigate healthcare renunciation among people aged ≥65 years in Italy from August 2020 to December 2021 and to estimate the health and sociodemographic profiles associated with barrier-renunciation (due to service disruption) and refusal-renunciation (because of fear of contagion). A total of 4364 out of 10 827 individuals needing healthcare reported foregoing at least one medical visit or diagnostic test, with the major reasons being fear of COVID-19 contagion (33%) and service disruptions (29%). Sociodemographic inequalities existed: regression analysis revealed significant associations between healthcare renunciation and being female [adjusted prevalence ratio (aPR) 1.17, 95% CI: 1.08-1.26], reporting economic difficulties (aPR 1.15, 95% CI: 1.02-1.28), having two or more chronic conditions (aPR 1.18, 95% CI: 1.04-1.34), and having at least one sensory problem (aPR 1.13, 95% CI: 1.06-1.22). Compared to 2020, healthcare renunciation decreased in 2021. The relevant healthcare renunciation among elderly in Italy during the pandemic highlights widening health gaps and barriers to care access. Long-term monitoring tools are crucial to mitigate the pandemic's impact on public health, especially for vulnerable populations.

To investigate the associations between tobacco smoking and mortality, focusing on all-cause, cardiovascular, and cancer mortality, with analyses stratified by sex. A total of 333 559 participants were included. Smoking status was categorized as current, past, or never. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes, adjusted for potential confounders. During a median follow-up of 11.8 years, 20 381 deaths occurred, including 4024 cardiovascular deaths. Current smokers had substantially increased risks of all-cause mortality (HR 2.37 [2.25-2.50] in males; HR 2.65 [2.47-2.84] in females), cardiovascular mortality (HR 2.58 [2.31-2.87] in males; HR 3.79 [3.17-4.54] in females), and cancer mortality (HR 2.47 [2.30-2.66] in males; HR 2.46 [2.25-2.69] in females) compared with never-smokers. Past smokers also exhibited elevated risks, and a clear dose-response relationship was observed with increasing smoking intensity and pack-years. Overall survival was higher in females, but the relative risks associated with smoking were largely comparable across sexes. Tobacco smoking is strongly associated with increased mortality risk, showing a clear dose-response relationship and long-term adverse effects even after cessation. The detrimental impact of smoking was broadly similar in males and females, with only minor differences. These findings reinforce the urgent need for universal prevention and cessation strategies to reduce the burden of smoking-related disease.

Though central nervous system (CNS) cancers have become a critical health concern in the United States, a comprehensive understanding of the nationwide and group-specific trends over time is still limited. This surveillance-based study used data obtained from the National Center for Health Statistics. Age-standardised mortality trends and the Average Annual Percent Change (AAPC) trends were estimated by demographic. We calculated the relative risks between various county-level socioeconomic factors and mortality for CNS cancers. CNS cancers death rates have decreased from 1999 to 2020 in the U.S., while they increased by 2% annually (AAPC, 0.2%, 95% CI [0.0% to 0.4%]) among people aged ≥65 years. The highest increase in CNS cancer was observed among Asian or Pacific Islanders (AAPC, 1.3%, 95% CI [0.8% to 2.3%]), followed by American Indian/Alaska Native individuals (AAPC, 1.2%, 95% CI [-0.3% to 3.0%]). Additionally, individuals residing in counties with greater poverty, more rural area, and lower education levels tended to have higher age-standardised mortality. There were varying degrees of increased mortality rates from CNS cancers by demographic. The strong association of CNS cancers mortality with county SES and rurality suggests that county-based public health strategies are needed to reduce this disparity in mortality.

Large language models (LLMs) like OpenAI's ChatGPT (generative pretrained transformers) offer great benefits to systematic review production and quality assessment. A careful assessment and comparison with standard practice is highly needed. Two custom GPTs models were developed to compare a LLM's performance in "Risk-of-bias (ROB)" assessment and "Levels of engagement reached (LOER)" classification vs human judgments. Inter-rater agreement was calculated. ROB GPT classified a slightly higher "low risk" overall judgments (27.8% vs 22.2%) and "some concern" (58.3% vs 52.8%) than the research team, for whom "high risk" judgments were double (25.0% vs 13.9%). The research team classified slightly higher "low risk" total judgments (59.7% vs 55.1%) and almost double "high risk" (11.1% vs 5.6%) compared to "ROB GPT" (55.1%), which rated higher "some concerns" (39.4% vs 29.2%) (P = .366). With regards to LOER analysis, 91.7% vs 25.0% were classified "Collaborate" level, 5.6% vs 61.1% as "Shared leadership", and 2.8% as "Involve" vs 13.9% by researchers, while no studies classified in the first two engagement level vs 8.3% and 13.9%, respectively, by researchers (P = .169). A mixed-effect ordinal logistic regression showed an odds ratio (OR) = 0.97 [95% confidence interval (CI) 0.647-1.446, P = .874] for ROB and an OR = 1.00 (95% CI = 0.397-2.543, P = .992) for LOER compared to researchers. Partial agreement on some judgments was observed. Further evaluation of these promising tools is needed to enable their effective yet reliable introduction in scientific practice.