Pub Date : 2026-02-06DOI: 10.1016/j.puhe.2026.106173
Irina B Grafova, Sharifa Z Williams
Objectives: To examine how household medical debt responds to changes in income and new health events.
Study design: Secondary analysis of a panel survey.
Methods: We analyzed data from 6,599 households in the 2019-2021 waves of the nationally representative US Panel Study of Income Dynamics (PSID) with no medical debt in 2019. We focus on the onset of unpaid medical bills, classifying debt ≥20 % of annual income as high burden and <20 % as low or medium. Using logistic regression, we estimate the impact of changes in household income and onset of chronic conditions on acquiring medical debt.
Results: In our analytic sample, 4.4 % of households experienced the onset of low or medium medical debt, and 1.2 % experienced the onset of high medical debt between the 2019 and 2020 waves of the PSID. Pandemic-related earnings loss increased high medical debt onset by 1.1 percentage points (95 % confidence intervals [95 % CI: 0.2 to 1.9]). The onset of low or medium medical debt rose by 3.4 percentage points (95 % CI: 0.4 to 6.4) among households in which the head or spouse received a new diabetes diagnosis, and by 3.5 percentage points (95 % CI: 1.4 to 5.6) among households with a new arthritis diagnosis. High medical debt onset increased by 1.8 percentage points (95 % CI: 0.2 to 3.3) in households with a new cancer diagnosis.
Conclusions: Unexpected earnings losses and new diagnoses of cancer, diabetes, and arthritis significantly increase the risk of medical debt onset.
{"title":"Household economic security and medical debt onset: Lessons from the COVID-19 pandemic.","authors":"Irina B Grafova, Sharifa Z Williams","doi":"10.1016/j.puhe.2026.106173","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106173","url":null,"abstract":"<p><strong>Objectives: </strong>To examine how household medical debt responds to changes in income and new health events.</p><p><strong>Study design: </strong>Secondary analysis of a panel survey.</p><p><strong>Methods: </strong>We analyzed data from 6,599 households in the 2019-2021 waves of the nationally representative US Panel Study of Income Dynamics (PSID) with no medical debt in 2019. We focus on the onset of unpaid medical bills, classifying debt ≥20 % of annual income as high burden and <20 % as low or medium. Using logistic regression, we estimate the impact of changes in household income and onset of chronic conditions on acquiring medical debt.</p><p><strong>Results: </strong>In our analytic sample, 4.4 % of households experienced the onset of low or medium medical debt, and 1.2 % experienced the onset of high medical debt between the 2019 and 2020 waves of the PSID. Pandemic-related earnings loss increased high medical debt onset by 1.1 percentage points (95 % confidence intervals [95 % CI: 0.2 to 1.9]). The onset of low or medium medical debt rose by 3.4 percentage points (95 % CI: 0.4 to 6.4) among households in which the head or spouse received a new diabetes diagnosis, and by 3.5 percentage points (95 % CI: 1.4 to 5.6) among households with a new arthritis diagnosis. High medical debt onset increased by 1.8 percentage points (95 % CI: 0.2 to 3.3) in households with a new cancer diagnosis.</p><p><strong>Conclusions: </strong>Unexpected earnings losses and new diagnoses of cancer, diabetes, and arthritis significantly increase the risk of medical debt onset.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"106173"},"PeriodicalIF":3.2,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-06DOI: 10.1016/j.puhe.2026.106181
Piotr Glimasiński, Iwona A Bielska, Małgorzata Lipińska, Paweł Jaskulski, Dawid Krefta, Krzysztof Bartosz Klimiuk, Oskar Bieńka, Łukasz Balwicki
Objectives: To describe sociodemographic characteristics, facility use and health conditions among adult men residing in homeless shelters in Gdańsk, Poland.
Study design: Retrospective, cross-sectional analysis of routinely collected non-governmental organization's operational records.
Methods: From 551 male shelter residents supported by the Saint Brother Albert's Aid Society in 2023, a random sample of 226 was selected. We summarized age, disability status, hospitalizations, diagnoses (ICD-10) and shelter use with descriptive statistics.
Results: Median age was 60 years; 42% had certified disability. In 2023, 31% were hospitalized at least once and 17 individuals had ≥3 admissions. Frequent diagnoses included essential hypertension (20%), epilepsy (11-12%) and heart failure (10%); alcohol dependence was documented in 40%. Infectious burdens were present, including tuberculosis (∼6%). Facility use concentrated in shelters with care services; night-shelter users had more admissions/removals and more fragmented stays.
Conclusions: Adult men experiencing homelessness in Gdańsk have substantial cardiovascular, neurological and infectious disease burdens with frequent hospital use. More studies based on medical registers and social services data should be conducted in the future.
{"title":"Medical issues of adult men residing in homeless shelters in Gdańsk, Poland.","authors":"Piotr Glimasiński, Iwona A Bielska, Małgorzata Lipińska, Paweł Jaskulski, Dawid Krefta, Krzysztof Bartosz Klimiuk, Oskar Bieńka, Łukasz Balwicki","doi":"10.1016/j.puhe.2026.106181","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106181","url":null,"abstract":"<p><strong>Objectives: </strong>To describe sociodemographic characteristics, facility use and health conditions among adult men residing in homeless shelters in Gdańsk, Poland.</p><p><strong>Study design: </strong>Retrospective, cross-sectional analysis of routinely collected non-governmental organization's operational records.</p><p><strong>Methods: </strong>From 551 male shelter residents supported by the Saint Brother Albert's Aid Society in 2023, a random sample of 226 was selected. We summarized age, disability status, hospitalizations, diagnoses (ICD-10) and shelter use with descriptive statistics.</p><p><strong>Results: </strong>Median age was 60 years; 42% had certified disability. In 2023, 31% were hospitalized at least once and 17 individuals had ≥3 admissions. Frequent diagnoses included essential hypertension (20%), epilepsy (11-12%) and heart failure (10%); alcohol dependence was documented in 40%. Infectious burdens were present, including tuberculosis (∼6%). Facility use concentrated in shelters with care services; night-shelter users had more admissions/removals and more fragmented stays.</p><p><strong>Conclusions: </strong>Adult men experiencing homelessness in Gdańsk have substantial cardiovascular, neurological and infectious disease burdens with frequent hospital use. More studies based on medical registers and social services data should be conducted in the future.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"106181"},"PeriodicalIF":3.2,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1016/j.puhe.2026.106185
Sally Hargreaves , Jennifer Ayton , Sarah Young , Emily Hansen
Objectives
Young mothers aged 15–24 years face complex maternity health needs, including higher risks of mental health issues, barriers to consistent and non-judgmental care, and increased social isolation and stigma. This study aims to examine how the health care needs of young mothers are represented in Australian maternity policies.
Study design
A qualitative content analysis.
Methods
This qualitative content analysis used a Foucauldian approach to analyse seven Australian national and regional Tasmanian maternity and health care policy documents. Data was extracted and placed into predefined categories.
Results
The policy documents provided minimal evidence to guide and inform service provision for young mothers who live in regional, rural, and remote areas. The disconnect between global, national, and local policy relating to identified health issues and maternal health care for young mothers was evident.
Conclusions
The paucity of specific documented maternal health strategies and service provision for young mothers within national, statewide and local policy is apparent. This has led to poor policy development and guidance for young mothers. Further policy developments targeting service provision and maternal health care for young mothers living in regional, rural and remote areas needs to be addressed.
{"title":"Representation of young mothers in Australian maternity and health care policy: A qualitative content analysis","authors":"Sally Hargreaves , Jennifer Ayton , Sarah Young , Emily Hansen","doi":"10.1016/j.puhe.2026.106185","DOIUrl":"10.1016/j.puhe.2026.106185","url":null,"abstract":"<div><h3>Objectives</h3><div>Young mothers aged 15–24 years face complex maternity health needs, including higher risks of mental health issues, barriers to consistent and non-judgmental care, and increased social isolation and stigma. This study aims to examine how the health care needs of young mothers are represented in Australian maternity policies<strong>.</strong></div></div><div><h3>Study design</h3><div>A qualitative content analysis.</div></div><div><h3>Methods</h3><div>This qualitative content analysis used a Foucauldian approach to analyse seven Australian national and regional Tasmanian maternity and health care policy documents. Data was extracted and placed into predefined categories.</div></div><div><h3>Results</h3><div>The policy documents provided minimal evidence to guide and inform service provision for young mothers who live in regional, rural, and remote areas. The disconnect between global, national, and local policy relating to identified health issues and maternal health care for young mothers was evident.</div></div><div><h3>Conclusions</h3><div>The paucity of specific documented maternal health strategies and service provision for young mothers within national, statewide and local policy is apparent. This has led to poor policy development and guidance for young mothers. Further policy developments targeting service provision and maternal health care for young mothers living in regional, rural and remote areas needs to be addressed.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106185"},"PeriodicalIF":3.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-03DOI: 10.1016/j.puhe.2026.106175
Hannah Rayment-Jones, Sam Burton, Tisha Dasgupta, Zenab Barry, Kaat De Backer, Natasha Baker, Claire A Wilson, Kerrie Stevenson, Zoë Vowles, Kirsty Kitchen, Abigail Easter, Andrew Jolly, Judith Rankin, Cristina Fernandez-Turienzo, Jane Sandall, Lucilla Poston, Laura A Magee, Robert Stewart, David Edwards, Mark Ashworth, Jane Sandall, Ingrid Wolfe, Cheryl Gillett, Michael Absoud, Lucy Pickard, Amanda Grey, Sarah Spring, Toyin Kazeem, Amelia Jewell, Matthew Broadbent, Finola Higgins, Leonardo de Jongh, Tisha Dasgupta, Carolyn Gill
Objectives: In the UK, an estimated two million migrants are irregular or subject to No Recourse to Public Funds (NRPF) visa conditions, restricting welfare access and often requiring payment for NHS maternity care. The impact on maternity and perinatal service use remains poorly quantified.
Study design: Retrospective cross-sectional study.
Methods: We used linked electronic health records from maternity, neonatal, and mental health services in South London (eLIXIR-BiSL cohort). The sample included 56,690 women with 67,308 pregnancies (Oct 2018-Oct 2023). Migration status was categorised as UK-born, migrants with recourse to public funds, NRPF, or unknown visa status. Adjusted risk ratios (aRRs) were estimated using generalised linear models, controlling for sociodemographic and clinical characteristics.
Results: Compared with UK-born women, migrants, particularly those with NRPF, had lower engagement with services. Women with NRPF were less likely to access early antenatal care (aRR 0.36 [0.33-0.38]), attend maternity triage (0.89 [0.82-0.96]), or birth in midwife-led settings (0.51 [0.36-0.71]). They were more likely to access care late (3.61 [3.33-3.92]), receive inadequate antenatal care (1.41 [1.30-1.53]), transfer providers (1.54 [1.36-1.74]), and experience prolonged postnatal stays (1.38 [1.21-1.57]). Women with NRPF had lower mental health care contact before (0.05 [0.03-0.08]) and during pregnancy (0.51 [0.37-0.69]), and reduced engagement with social care (0.36 [0.17-0.70]) and the criminal justice system (0.30 [0.19-0.44]).
Conclusions: Migrants with NRPF or unknown visa status face persistent barriers to maternity and mental health care. Inclusive reforms are needed to address inequity.
{"title":"Access and engagement with maternity, social care and mental health services for perinatal migrant women with no recourse to public funds and irregular status: A cross-sectional study using the eLIXIR born in South London, UK, maternity-child data linkage.","authors":"Hannah Rayment-Jones, Sam Burton, Tisha Dasgupta, Zenab Barry, Kaat De Backer, Natasha Baker, Claire A Wilson, Kerrie Stevenson, Zoë Vowles, Kirsty Kitchen, Abigail Easter, Andrew Jolly, Judith Rankin, Cristina Fernandez-Turienzo, Jane Sandall, Lucilla Poston, Laura A Magee, Robert Stewart, David Edwards, Mark Ashworth, Jane Sandall, Ingrid Wolfe, Cheryl Gillett, Michael Absoud, Lucy Pickard, Amanda Grey, Sarah Spring, Toyin Kazeem, Amelia Jewell, Matthew Broadbent, Finola Higgins, Leonardo de Jongh, Tisha Dasgupta, Carolyn Gill","doi":"10.1016/j.puhe.2026.106175","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106175","url":null,"abstract":"<p><strong>Objectives: </strong>In the UK, an estimated two million migrants are irregular or subject to No Recourse to Public Funds (NRPF) visa conditions, restricting welfare access and often requiring payment for NHS maternity care. The impact on maternity and perinatal service use remains poorly quantified.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>We used linked electronic health records from maternity, neonatal, and mental health services in South London (eLIXIR-BiSL cohort). The sample included 56,690 women with 67,308 pregnancies (Oct 2018-Oct 2023). Migration status was categorised as UK-born, migrants with recourse to public funds, NRPF, or unknown visa status. Adjusted risk ratios (aRRs) were estimated using generalised linear models, controlling for sociodemographic and clinical characteristics.</p><p><strong>Results: </strong>Compared with UK-born women, migrants, particularly those with NRPF, had lower engagement with services. Women with NRPF were less likely to access early antenatal care (aRR 0.36 [0.33-0.38]), attend maternity triage (0.89 [0.82-0.96]), or birth in midwife-led settings (0.51 [0.36-0.71]). They were more likely to access care late (3.61 [3.33-3.92]), receive inadequate antenatal care (1.41 [1.30-1.53]), transfer providers (1.54 [1.36-1.74]), and experience prolonged postnatal stays (1.38 [1.21-1.57]). Women with NRPF had lower mental health care contact before (0.05 [0.03-0.08]) and during pregnancy (0.51 [0.37-0.69]), and reduced engagement with social care (0.36 [0.17-0.70]) and the criminal justice system (0.30 [0.19-0.44]).</p><p><strong>Conclusions: </strong>Migrants with NRPF or unknown visa status face persistent barriers to maternity and mental health care. Inclusive reforms are needed to address inequity.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"106175"},"PeriodicalIF":3.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.puhe.2026.106160
Andrew Ck Lee, Michael Taylor
{"title":"Addressing the anti-vaccination threat to public health.","authors":"Andrew Ck Lee, Michael Taylor","doi":"10.1016/j.puhe.2026.106160","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106160","url":null,"abstract":"","PeriodicalId":49651,"journal":{"name":"Public Health","volume":" ","pages":"106160"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.puhe.2026.106177
Abdiwahab M. Ali , Nina Huang , Jason J. Liu
Objectives
To systematically evaluate the association of khat (Catha edulis) chewing with the risk of oral and esophageal squamous cell carcinoma (SCC) and oral white lesions in epidemiological studies.
Study design
Systematic review and random-effects meta-analysis.
Methods
We searched PubMed/MEDLINE, Web of Science, and Google Scholar for studies published between 2000 and 2025. We included eligible epidemiological studies assessing khat chewing in relation to oral or esophageal SCC and oral white lesions. Methodological quality was critically appraised, and pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated using random-effects models.
Results
Of 143 identified articles, 11 studies were included. For oral/esophageal SCC, the pooled analysis showed no significant association (odds ratio (OR) = 1.18, 95 % confidence interval (CI): 0.40–3.48, 5 studies) with high heterogeneity (I2 = 79.4 %). For oral white lesions, a significant positive association was found (OR = 17.89, 95 % CI: 4.99–64.21, 6 studies), also with high heterogeneity (I2 = 89.0 %). A sensitivity analysis for the SCC outcome resolved the heterogeneity. The risk of bias across studies was moderate to high, primarily due to selection bias and confounding.
Conclusions
Khat chewing is associated with oral white lesions, supporting targeted oral examinations in khat-endemic regions to identify mucosal changes for further clinical assessment and potential biopsy. However, the evidence for oral and esophageal SCC is inconclusive. High-quality prospective cohort studies are needed to confirm these findings and inform public health policies.
{"title":"Khat chewing and its association with oral/esophageal squamous cell carcinoma and oral white lesions: A systematic review and meta-analysis","authors":"Abdiwahab M. Ali , Nina Huang , Jason J. Liu","doi":"10.1016/j.puhe.2026.106177","DOIUrl":"10.1016/j.puhe.2026.106177","url":null,"abstract":"<div><h3>Objectives</h3><div>To systematically evaluate the association of khat (<em>Catha edulis</em>) chewing with the risk of oral and esophageal squamous cell carcinoma (SCC) and oral white lesions in epidemiological studies.</div></div><div><h3>Study design</h3><div>Systematic review and random-effects meta-analysis.</div></div><div><h3>Methods</h3><div>We searched PubMed/MEDLINE, Web of Science, and Google Scholar for studies published between 2000 and 2025. We included eligible epidemiological studies assessing khat chewing in relation to oral or esophageal SCC and oral white lesions. Methodological quality was critically appraised, and pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated using random-effects models.</div></div><div><h3>Results</h3><div>Of 143 identified articles, 11 studies were included. For oral/esophageal SCC, the pooled analysis showed no significant association (odds ratio (OR) = 1.18, 95 % confidence interval (CI): 0.40–3.48, 5 studies) with high heterogeneity (I<sup>2</sup> = 79.4 %). For oral white lesions, a significant positive association was found (OR = 17.89, 95 % CI: 4.99–64.21, 6 studies), also with high heterogeneity (I<sup>2</sup> = 89.0 %). A sensitivity analysis for the SCC outcome resolved the heterogeneity. The risk of bias across studies was moderate to high, primarily due to selection bias and confounding.</div></div><div><h3>Conclusions</h3><div>Khat chewing is associated with oral white lesions, supporting targeted oral examinations in khat-endemic regions to identify mucosal changes for further clinical assessment and potential biopsy. However, the evidence for oral and esophageal SCC is inconclusive. High-quality prospective cohort studies are needed to confirm these findings and inform public health policies.</div></div><div><h3>Registration</h3><div>PROSPERO 2025 CRD420251072476 (<span><span>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251072476</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106177"},"PeriodicalIF":3.2,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to examine the influence of warning-label content and smokers’ individual differences on perceived label effectiveness in the reduction of household smoking.
Study design
Cross-sectional online questionnaire study conducted between June 28 and July 2, 2025.
Methods
Adult Japanese smokers rated self- and family-oriented risk text warnings. Multiple regression analysis was utilized to test how warning content and individual characteristics could predict the perceived effectiveness in reducing overall and household smoking. Content analysis explored open-ended questions regarding reasons regarding smoking at home and attitudes toward warning labels.
Results
Responses from 170 participants were analyzed. Family- and self-oriented warnings were perceived to be similarly effective (B = −0.10, 95 % CI [-0.39, 0.19], p = .50). However, smokers with more cohabitants and those living in detached houses (vs. multi-unit housing) viewed warning labels as more effective in reducing overall smoking (B = 0.43, 95 % CI [0.07, 0.77], p = .02). Smokers who smoked more at home perceived the labels as less effective at controlling household smoking (B = −0.26, 95 % CI [-0.47, −0.04], p = .02). Content analysis showed that smoking at home was mainly attributed to stress relief, addiction, and designated smoking areas at home. Many smokers reported feeling nothing when seeing the labels. While some participants said that the labels made consider smoking cessation, some also stated that they believed the labels had no effect.
Conclusions
In Japan, the residential environments of smokers shape how effectively they perceive warning labels. This calls for the tailoring of antismoking policies according to individual differences.
目的探讨警示标签内容和吸烟者个体差异对警示标签减少家庭吸烟效果的影响。研究设计横断面在线问卷研究于2025年6月28日至7月2日进行。方法日本成年吸烟者对以自我和家庭为导向的危险文本警告进行评级。采用多元回归分析来检验警告内容和个体特征如何预测减少整体和家庭吸烟的感知有效性。内容分析探讨了关于在家吸烟的原因和对警告标签的态度的开放式问题。结果对170名参与者的反馈进行了分析。家庭和自我导向的警告被认为同样有效（B = - 0.10, 95% CI [-0.39, 0.19], p = 0.50）。然而，与更多的同居者和居住在独立住宅（与多单元住宅相比）的吸烟者认为警告标签在减少总体吸烟方面更有效（B = 0.43, 95% CI [0.07, 0.77], p = 0.02）。在家吸烟较多的吸烟者认为标签在控制家庭吸烟方面效果较差（B = - 0.26, 95% CI [-0.47, - 0.04], p = .02）。内容分析显示，在家吸烟的主要原因是缓解压力、成瘾和在家指定吸烟区。许多吸烟者报告说，看到标签时没有任何感觉。虽然一些参与者表示，这些标签考虑到戒烟，但也有一些人表示，他们认为这些标签没有效果。结论在日本，吸烟者的居住环境决定了他们对警告标签的感知程度。这就需要根据个体差异制定相应的禁烟政策。
{"title":"Perceived effectiveness of cigarette warning labels in reducing household smoking: A mixed-methods study with Japanese smokers","authors":"Xinyu Zhao , Tianshi Hao , Jinghao Ma , Changyi Wu , Eiichiro Watamura","doi":"10.1016/j.puhe.2026.106139","DOIUrl":"10.1016/j.puhe.2026.106139","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the influence of warning-label content and smokers’ individual differences on perceived label effectiveness in the reduction of household smoking.</div></div><div><h3>Study design</h3><div>Cross-sectional online questionnaire study conducted between June 28 and July 2, 2025.</div></div><div><h3>Methods</h3><div>Adult Japanese smokers rated self- and family-oriented risk text warnings. Multiple regression analysis was utilized to test how warning content and individual characteristics could predict the perceived effectiveness in reducing overall and household smoking. Content analysis explored open-ended questions regarding reasons regarding smoking at home and attitudes toward warning labels.</div></div><div><h3>Results</h3><div>Responses from 170 participants were analyzed. Family- and self-oriented warnings were perceived to be similarly effective (B = −0.10, 95 % CI [-0.39, 0.19], p = .50). However, smokers with more cohabitants and those living in detached houses (vs. multi-unit housing) viewed warning labels as more effective in reducing overall smoking (B = 0.43, 95 % CI [0.07, 0.77], p = .02). Smokers who smoked more at home perceived the labels as less effective at controlling household smoking (B = −0.26, 95 % CI [-0.47, −0.04], p = .02). Content analysis showed that smoking at home was mainly attributed to stress relief, addiction, and designated smoking areas at home. Many smokers reported feeling nothing when seeing the labels. While some participants said that the labels made consider smoking cessation, some also stated that they believed the labels had no effect.</div></div><div><h3>Conclusions</h3><div>In Japan, the residential environments of smokers shape how effectively they perceive warning labels. This calls for the tailoring of antismoking policies according to individual differences.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106139"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.puhe.2026.106171
Kristin R.V. Harrington , Samuel M. Jenness , Meron Siira , Elizabeth Rothschild , Tracie Graham , Sharon Rabinovitz , Samuel Shartar , Monica Crubezy , David Clark , Alexander Isakov , Allison Chamberlain , J Peter Cegielski , Jason R. Andrews , Lance A. Waller , Sara C. Auld , Neel R. Gandhi
Objectives
We reconstructed COVID-19 contact networks to examine individual characteristics and network structures that influenced transmission during the 2020–2021 hybrid-learning year at a US university.
Study design
Cohort study.
Methods
We used individual-level exposure histories collected through case investigation and contact tracing interviews during the Fall 2020 semester to construct contact tracing networks. We visualized networks and estimated global network statistics and secondary attack rates (SAR). We conducted a bias analysis on the impact of missing cases on these network statistics.
Results
During the Fall 2020 semester, we identified 441 COVID-19 cases, 1121 close contacts, and 1206 links between individuals. Most cases were female (62 %), off-campus students (49 %), and symptomatic (82 %). Individuals had a mean of 2.9 direct contacts, and the maximum number of individuals separating any two persons in a network was 8. The overall SAR was 9.7 % (50/518). Contacts of symptomatic cases had a higher SAR compared to contacts of asymptomatic cases (11.8 % [42/356] vs. 4.9 % [8/162]; p = 0.015). Networks were minimally clustered with the greatest clustering observed in September. Bias analyses indicated that missingness in our observed network was unlikely to have been random or based upon symptomaticity.
Conclusions
In this assessment of COVID-19 contact network structure and transmission characteristics, we found minimal clustering, a low proportion of asymptomatic cases, and higher SAR among contacts of symptomatic cases. Symptomatic cases were unlikely to have been oversampled in our observed network. Our findings suggest that university campuses have unique transmission characteristics, even in the context of a hybrid learning environment in which social interactions may be attenuated.
{"title":"The application of social network analysis to examine COVID-19 contact tracing networks in a university setting","authors":"Kristin R.V. Harrington , Samuel M. Jenness , Meron Siira , Elizabeth Rothschild , Tracie Graham , Sharon Rabinovitz , Samuel Shartar , Monica Crubezy , David Clark , Alexander Isakov , Allison Chamberlain , J Peter Cegielski , Jason R. Andrews , Lance A. Waller , Sara C. Auld , Neel R. Gandhi","doi":"10.1016/j.puhe.2026.106171","DOIUrl":"10.1016/j.puhe.2026.106171","url":null,"abstract":"<div><h3>Objectives</h3><div>We reconstructed COVID-19 contact networks to examine individual characteristics and network structures that influenced transmission during the 2020–2021 hybrid-learning year at a US university.</div></div><div><h3>Study design</h3><div>Cohort study.</div></div><div><h3>Methods</h3><div>We used individual-level exposure histories collected through case investigation and contact tracing interviews during the Fall 2020 semester to construct contact tracing networks. We visualized networks and estimated global network statistics and secondary attack rates (SAR). We conducted a bias analysis on the impact of missing cases on these network statistics.</div></div><div><h3>Results</h3><div>During the Fall 2020 semester, we identified 441 COVID-19 cases, 1121 close contacts, and 1206 links between individuals. Most cases were female (62 %), off-campus students (49 %), and symptomatic (82 %). Individuals had a mean of 2.9 direct contacts, and the maximum number of individuals separating any two persons in a network was 8. The overall SAR was 9.7 % (50/518). Contacts of symptomatic cases had a higher SAR compared to contacts of asymptomatic cases (11.8 % [42/356] vs. 4.9 % [8/162]; p = 0.015). Networks were minimally clustered with the greatest clustering observed in September. Bias analyses indicated that missingness in our observed network was unlikely to have been random or based upon symptomaticity.</div></div><div><h3>Conclusions</h3><div>In this assessment of COVID-19 contact network structure and transmission characteristics, we found minimal clustering, a low proportion of asymptomatic cases, and higher SAR among contacts of symptomatic cases. Symptomatic cases were unlikely to have been oversampled in our observed network. Our findings suggest that university campuses have unique transmission characteristics, even in the context of a hybrid learning environment in which social interactions may be attenuated.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106171"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.puhe.2026.106172
Alberto Borraccino , Roberta Onorati , Alessandro Migliardi , Carlo Mamo
Objective
Non-suicidal self-injury (NSSI) is a growing mental health concern among adolescents. While individual-level risk factors are well documented, less is known about how area-level determinants influence pathways to emergency care for NSSI. This study aimed to examine the association between area-level contextual factors and Emergency Department (ED) visits for NSSI among adolescents in the Piedmont Region of Northern Italy.
Study design
Retrospective cross-sectional analysis.
Methods
A retrospective cross-sectional analysis of administrative health data covering all ED presentations for NSSI among individuals aged 5–19 years from 2011 to 2021 was conducted. Cases were georeferenced using three validated territorial indicators: the regional socioeconomic deprivation index, the Health Action Zones (HAZ) classification, and the national Inner Areas classification. Sex-stratified multivariable logistic regression models were used to assess the association between each contextual indicator and NSSI-related ED visits.
Results
Contrary to conventional expectations, adolescents living in less deprived areas showed significantly higher odds of NSSI-related ED visits, particularly among girls and those aged 15–19 years. In addition, a clear gradient was observed across territorial marginality, with higher odds among adolescents residing in belt and peripheral areas. These associations remained robust after adjustment for age and contextual interrelations. Traditional deprivation measures alone may therefore fail to capture emerging or context-specific vulnerabilities, while differential access to services and help-seeking pathways may contribute to observed patterns of ED utilisation.
Conclusions
Structural and contextual factors play an important role how adolescent self-injury is detected within emergency services. Place-sensitive prevention strategies and cross-sectoral planning are needed to address both visible and less readily detected vulnerabilities across diverse communities.
{"title":"Adolescent non-suicidal self-injury, contextual and area-level inequalities: Insights from ten years of emergency department visits in northern Italy","authors":"Alberto Borraccino , Roberta Onorati , Alessandro Migliardi , Carlo Mamo","doi":"10.1016/j.puhe.2026.106172","DOIUrl":"10.1016/j.puhe.2026.106172","url":null,"abstract":"<div><h3>Objective</h3><div>Non-suicidal self-injury (NSSI) is a growing mental health concern among adolescents. While individual-level risk factors are well documented, less is known about how area-level determinants influence pathways to emergency care for NSSI. This study aimed to examine the association between area-level contextual factors and Emergency Department (ED) visits for NSSI among adolescents in the Piedmont Region of Northern Italy.</div></div><div><h3>Study design</h3><div>Retrospective cross-sectional analysis.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional analysis of administrative health data covering all ED presentations for NSSI among individuals aged 5–19 years from 2011 to 2021 was conducted. Cases were georeferenced using three validated territorial indicators: the regional socioeconomic deprivation index, the Health Action Zones (HAZ) classification, and the national Inner Areas classification. Sex-stratified multivariable logistic regression models were used to assess the association between each contextual indicator and NSSI-related ED visits.</div></div><div><h3>Results</h3><div>Contrary to conventional expectations, adolescents living in less deprived areas showed significantly higher odds of NSSI-related ED visits, particularly among girls and those aged 15–19 years. In addition, a clear gradient was observed across territorial marginality, with higher odds among adolescents residing in belt and peripheral areas. These associations remained robust after adjustment for age and contextual interrelations. Traditional deprivation measures alone may therefore fail to capture emerging or context-specific vulnerabilities, while differential access to services and help-seeking pathways may contribute to observed patterns of ED utilisation.</div></div><div><h3>Conclusions</h3><div>Structural and contextual factors play an important role how adolescent self-injury is detected within emergency services. Place-sensitive prevention strategies and cross-sectoral planning are needed to address both visible and less readily detected vulnerabilities across diverse communities.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106172"},"PeriodicalIF":3.2,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-24DOI: 10.1016/j.puhe.2026.106152
James O'Connell , Keith Ian Quintyne
Artificial intelligence (AI) is poised to play a transformative role in pandemic preparedness, with the potential to enhance surveillance, risk assessment, and outbreak response. Indeed, AI is already embedded in several areas of public health practice, including infectious disease modelling, syndromic surveillance, and health system demand forecasting, where it has demonstrated advantages in speed, scale, and scenario analysis. However, the successful integration of AI into public health practice depends not only on technological advancement but also on maintaining the public trust upon which effective pandemic response relies. This article examines the ethical, governance, and trust dimensions of AI integration in pandemic preparedness, arguing that public health leadership is essential to ensure its safe and equitable use. Without such leadership, there is a risk that AI will be driven by commercial rather than public interests, undermining trust and legitimacy in public health actions. It calls for a robust governance framework, applied research to determine where AI can add value, and leadership in shaping legal and digital infrastructures that support safe AI use. By proactively guiding AI's integration, public health can ensure this emerging technology strengthens, rather than compromises, the collective and ethical foundations of pandemic preparedness.
{"title":"Trust at risk: Why public health must lead the use of AI in pandemic preparedness","authors":"James O'Connell , Keith Ian Quintyne","doi":"10.1016/j.puhe.2026.106152","DOIUrl":"10.1016/j.puhe.2026.106152","url":null,"abstract":"<div><div>Artificial intelligence (AI) is poised to play a transformative role in pandemic preparedness, with the potential to enhance surveillance, risk assessment, and outbreak response. Indeed, AI is already embedded in several areas of public health practice, including infectious disease modelling, syndromic surveillance, and health system demand forecasting, where it has demonstrated advantages in speed, scale, and scenario analysis. However, the successful integration of AI into public health practice depends not only on technological advancement but also on maintaining the public trust upon which effective pandemic response relies. This article examines the ethical, governance, and trust dimensions of AI integration in pandemic preparedness, arguing that public health leadership is essential to ensure its safe and equitable use. Without such leadership, there is a risk that AI will be driven by commercial rather than public interests, undermining trust and legitimacy in public health actions. It calls for a robust governance framework, applied research to determine where AI can add value, and leadership in shaping legal and digital infrastructures that support safe AI use. By proactively guiding AI's integration, public health can ensure this emerging technology strengthens, rather than compromises, the collective and ethical foundations of pandemic preparedness.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106152"},"PeriodicalIF":3.2,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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