Pub Date : 2025-12-19DOI: 10.1016/j.puhe.2025.106100
Derek S. Falk , Alfonso J. Rojas-Álvarez , Deborah M. Parra-Medina , Christian E. Vazquez
Objectives
Loneliness among older adults is a public health concern negatively impacting those with multimorbidity. As the population continues to age in the United States and the proportion of Hispanics grows, understanding the relationship between loneliness and multimorbidity for Hispanic older adults warrants further examination. Previous studies have explored loneliness and multimorbidity, but examine the impact on Hispanic older adults. To achieve this aim, we assessed loneliness and disparities in the dose-response relationship of multimorbidity in adults aged 65+.
Study design
Cross-sectional observational study using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS).
Methods
Weighted analyses represented U.S. adults aged 65+. Descriptive statistics and chi-square tests compared prevalence by ethnicity. Multivariable logistic regression models identified factors associated with loneliness in the overall sample and Hispanic subgroup. Predicted probabilities were plotted to highlight differences by race, ethnicity, and sex.
Results
Among U.S. adults aged 65+, 35.0 % reported feeling lonely. Hispanic older adults reported a higher prevalence of loneliness than non-Hispanic older adults (40.2 % vs 34.5 %) and were more likely to receive inadequate social support (10.7 % vs 6.3 %). Hispanic females showed the strongest dose-response effect, with loneliness increasing from 41 % (no conditions) to 57 % (3+ conditions).
Conclusions
Being Hispanic, regardless of sex, increased likelihood of loneliness and inadequate social support; however, Hispanic older females face the highest levels of loneliness when managing multimorbidity with inadequate social support compared to Hispanic males and individuals of other races/ethnicities. Further research is needed to address these disparities for Hispanics and women in particular.
{"title":"Loneliness among older adults with multiple chronic conditions: Exploring disparities for Hispanic adults in the 2023 Behavioral Risk Factor Surveillance System","authors":"Derek S. Falk , Alfonso J. Rojas-Álvarez , Deborah M. Parra-Medina , Christian E. Vazquez","doi":"10.1016/j.puhe.2025.106100","DOIUrl":"10.1016/j.puhe.2025.106100","url":null,"abstract":"<div><h3>Objectives</h3><div>Loneliness among older adults is a public health concern negatively impacting those with multimorbidity. As the population continues to age in the United States and the proportion of Hispanics grows, understanding the relationship between loneliness and multimorbidity for Hispanic older adults warrants further examination. Previous studies have explored loneliness and multimorbidity, but examine the impact on Hispanic older adults. To achieve this aim, we assessed loneliness and disparities in the dose-response relationship of multimorbidity in adults aged 65+.</div></div><div><h3>Study design</h3><div>Cross-sectional observational study using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS).</div></div><div><h3>Methods</h3><div>Weighted analyses represented U.S. adults aged 65+. Descriptive statistics and chi-square tests compared prevalence by ethnicity. Multivariable logistic regression models identified factors associated with loneliness in the overall sample and Hispanic subgroup. Predicted probabilities were plotted to highlight differences by race, ethnicity, and sex.</div></div><div><h3>Results</h3><div>Among U.S. adults aged 65+, 35.0 % reported feeling lonely. Hispanic older adults reported a higher prevalence of loneliness than non-Hispanic older adults (40.2 % vs 34.5 %) and were more likely to receive inadequate social support (10.7 % vs 6.3 %). Hispanic females showed the strongest dose-response effect, with loneliness increasing from 41 % (no conditions) to 57 % (3+ conditions).</div></div><div><h3>Conclusions</h3><div>Being Hispanic, regardless of sex, increased likelihood of loneliness and inadequate social support; however, Hispanic older females face the highest levels of loneliness when managing multimorbidity with inadequate social support compared to Hispanic males and individuals of other races/ethnicities. Further research is needed to address these disparities for Hispanics and women in particular.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106100"},"PeriodicalIF":3.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791393","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 : 2025-12-18DOI: 10.1016/j.puhe.2025.106109
Y. Eraso , D. Stefler , V. Whitelock , E. Clarke , D. Williams
Objectives
To identify the demographic and behavioural factors associated with cervical screening preferences if a choice of test, health professional-collected samples or self-sampling at home, is implemented in the UK; and the behavioural barriers to self-sampling at home.
Study design
A mixed-methods study of secondary data.
Methods
We used data from the Cancer Research UK CAM + survey (February 2023) and performed a quantitative regression analysis to examine the associations between demographics, behavioural factors, screening behaviours, and screening preferences of the UK population aged 25–64. Unadjusted and multivariable adjusted logistic regression models were used. Qualitative content analysis was used for free text comments on behavioural barriers to self-sampling and mapped onto the Theoretical Domains Framework.
Results
Analytical sample (n = 906). Test preference: Self-sampling (45.4 %); health professional-collected samples (41.1 %); and no test preference (13.6 %). Preference for self-sampling was significantly associated with older groups and psychosocial barriers (motivation and physical opportunity) regarding health professional-collected samples. Individuals with no test preference were the youngest and older groups, from low social grade and living with a partner. Behavioural barriers included test reliability and ability to do the test (motivation) and information needs (capability).
Conclusions
Home seems a suitable setting for self-sampling, and it could alleviate many barriers faced to health professional-collected samples. Yet introducing test options did not allow all individuals a compelling basis for preference. Specific behaviour change techniques for identified barriers are proposed for this group. Ultimately, if choice is offered, future screening guidelines should consider how to address individuals with no test preference.
目标：如果在联合王国实施一种检测选择，即由卫生专业人员收集样本或在家中自行抽样，确定与子宫颈筛查偏好相关的人口统计学和行为因素；以及在家进行自我抽样的行为障碍。研究设计：二级数据的混合方法研究。方法：我们使用来自英国癌症研究中心（Cancer Research UK） CAM +调查（2023年2月）的数据，并进行定量回归分析，以检验英国25-64岁人群的人口统计学、行为因素、筛查行为和筛查偏好之间的关系。采用未调整和多变量调整logistic回归模型。定性内容分析用于自抽样行为障碍的自由文本评论，并映射到理论领域框架。结果：分析样品（n = 906）。测试偏好：自抽样（45.4%）；卫生专业人员采集的样本（41.1%）；无考试偏好（13.6%）。对自我抽样的偏好与老年群体和对卫生专业人员收集的样本的心理社会障碍（动机和身体机会）显著相关。没有测试偏好的个体是最年轻和年龄较大的群体，来自社会地位较低和与伴侣生活在一起。行为障碍包括测试可靠性和测试能力（动机）和信息需求（能力）。结论：家庭是一种适宜的自采样环境，可以缓解卫生专业人员采集样本面临的诸多障碍。然而，引入测试选项并不能让所有人都有一个令人信服的偏好基础。针对这一群体提出了针对已识别障碍的具体行为改变技术。最终，如果有选择，未来的筛查指南应该考虑如何解决没有测试偏好的个体。
{"title":"Women's initial preferences for self-sampling tests at home for cervical cancer screening in the UK: A mixed-methods analysis of demographic and behavioural factors","authors":"Y. Eraso , D. Stefler , V. Whitelock , E. Clarke , D. Williams","doi":"10.1016/j.puhe.2025.106109","DOIUrl":"10.1016/j.puhe.2025.106109","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify the demographic and behavioural factors associated with cervical screening preferences if a choice of test, health professional-collected samples or self-sampling at home, is implemented in the UK; and the behavioural barriers to self-sampling at home.</div></div><div><h3>Study design</h3><div>A mixed-methods study of secondary data.</div></div><div><h3>Methods</h3><div>We used data from the Cancer Research UK CAM + survey (February 2023) and performed a quantitative regression analysis to examine the associations between demographics, behavioural factors, screening behaviours, and screening preferences of the UK population aged 25–64. Unadjusted and multivariable adjusted logistic regression models were used. Qualitative content analysis was used for free text comments on behavioural barriers to self-sampling and mapped onto the Theoretical Domains Framework.</div></div><div><h3>Results</h3><div>Analytical sample (n = 906). Test preference: Self-sampling (45.4 %); health professional-collected samples (41.1 %); and no test preference (13.6 %). Preference for self-sampling was significantly associated with older groups and psychosocial barriers (motivation and physical opportunity) regarding health professional-collected samples. Individuals with no test preference were the youngest and older groups, from low social grade and living with a partner. Behavioural barriers included test reliability and ability to do the test (motivation) and information needs (capability).</div></div><div><h3>Conclusions</h3><div>Home seems a suitable setting for self-sampling, and it could alleviate many barriers faced to health professional-collected samples. Yet introducing test options did not allow all individuals a compelling basis for preference. Specific behaviour change techniques for identified barriers are proposed for this group. Ultimately, if choice is offered, future screening guidelines should consider how to address individuals with no test preference.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106109"},"PeriodicalIF":3.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783505","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}
According to the 2021 Japanese National Fertility Survey, more than one-third of couples expressed concerns about infertility. However, no study in Japan has estimated the prevalence of infertility according to the World Health Organization definition (12 months of infertility). This study aimed to estimate the prevalence of infertility based on this definition.
Study design
A cross-sectional study design.
Methods
The survey was conducted in 2024 using a two-stage stratified systematic sampling design (response rate: 40.0 %). Among 1200 women aged 25–49 years (total participants), 853 were married or cohabiting with a male partner (cohabiting participants). There were 35 women aged 25–44 years, at risk of pregnancy, and actively trying to conceive (current duration participants). Lifetime and period prevalence were estimated using direct (self-reported) and current duration methods.
Results
Among cohabiting participants, the lifetime and period prevalence of infertility were 37.8 % (95 % confidence interval [CI]: 35.4 %–40.4 %) and 6.5 % (95 % CI: 5.1 %–8.4 %), respectively. Period prevalence among current duration participants was 23.1 % (95 % CI: 12.1 %–43.9 %). Help-seeking behaviour was reported by 51.1 % of those with lifetime infertility. Older age groups exhibited higher lifetime prevalence and lower period prevalence of infertility. Higher educational attainment was associated with lower lifetime and period prevalence of infertility and a higher help-seeking rate.
Conclusion
While period prevalence estimated using direct and current duration methods was consistent with international findings, lifetime prevalence estimated using direct method was higher, possibly due to older age distribution, delayed parenthood, shorter or ambiguous reproductive intention, and infrequent sexual activity.
{"title":"Prevalence of infertility among nationally representative women in Japan: A cross-sectional survey using a two-stage stratified systematic sampling design","authors":"Eri Maeda , Shoko Konishi , Satoshi Sunohara , Seung Chik Jwa , Isao Yokota , Jacky Boivin , Kyoko Nomura , Akiko Tamakoshi","doi":"10.1016/j.puhe.2025.106092","DOIUrl":"10.1016/j.puhe.2025.106092","url":null,"abstract":"<div><h3>Objectives</h3><div>According to the 2021 Japanese National Fertility Survey, more than one-third of couples expressed concerns about infertility. However, no study in Japan has estimated the prevalence of infertility according to the World Health Organization definition (12 months of infertility). This study aimed to estimate the prevalence of infertility based on this definition.</div></div><div><h3>Study design</h3><div>A cross-sectional study design.</div></div><div><h3>Methods</h3><div>The survey was conducted in 2024 using a two-stage stratified systematic sampling design (response rate: 40.0 %). Among 1200 women aged 25–49 years (total participants), 853 were married or cohabiting with a male partner (cohabiting participants). There were 35 women aged 25–44 years, at risk of pregnancy, and actively trying to conceive (current duration participants). Lifetime and period prevalence were estimated using direct (self-reported) and current duration methods.</div></div><div><h3>Results</h3><div>Among cohabiting participants, the lifetime and period prevalence of infertility were 37.8 % (95 % confidence interval [CI]: 35.4 %–40.4 %) and 6.5 % (95 % CI: 5.1 %–8.4 %), respectively. Period prevalence among current duration participants was 23.1 % (95 % CI: 12.1 %–43.9 %). Help-seeking behaviour was reported by 51.1 % of those with lifetime infertility. Older age groups exhibited higher lifetime prevalence and lower period prevalence of infertility. Higher educational attainment was associated with lower lifetime and period prevalence of infertility and a higher help-seeking rate.</div></div><div><h3>Conclusion</h3><div>While period prevalence estimated using direct and current duration methods was consistent with international findings, lifetime prevalence estimated using direct method was higher, possibly due to older age distribution, delayed parenthood, shorter or ambiguous reproductive intention, and infrequent sexual activity.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106092"},"PeriodicalIF":3.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791394","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}
Anxiety sensitivity (AS)—the tendency to fear anxiety-related sensations—has been consistently associated with risky drinking, yet the motivational mechanisms underlying this link remain unclear. This study examined whether specific drinking motives (DMs) mediate the association between AS and hazardous drinking, and explored the moderating effects of age and gender.
Study design
A cross-sectional, survey-based design was used.
Methods
Data were collected through an anonymous online questionnaire completed by 372 adults (69 % women; mean age = 25.3 years), including the Alcohol Use Disorders Identification Test (AUDIT), the Anxiety Sensitivity Index-3 (ASI-3), and four single-item DMs assessing social, avoidance, pleasure, and need-related motives. Analyses were restricted to participants with AUDIT >0. Correlation and regression analyses examined associations among AS, age, gender, and alcohol use. Structural equation modelling (SEM) tested AS as a latent construct (ASI-3 subscales as indicators) and the four DMs as parallel mediators of the AS–AUDIT relationship.
Results
Higher AS was associated with greater alcohol use, even after controlling for age and gender. SEM confirmed that AS formed a coherent latent factor and that motives operated in parallel. AS was positively linked to avoidance motives; however, this pathway did not mediate the AS–alcohol link. Only the social motive uniquely predicted higher AUDIT scores, while younger age—but not gender—was consistently associated with greater consumption.
Conclusions
Hazardous drinking was mainly explained by social motives and younger age. AS contributed indirectly through its influence on drinking motives rather than a direct effect.
{"title":"Understanding hazardous drinking: The role of anxiety sensitivity and mediating drinking motives","authors":"Maragda Puigcerver , Lucía Hipólito , Miguel-Ángel Serrano","doi":"10.1016/j.puhe.2025.106104","DOIUrl":"10.1016/j.puhe.2025.106104","url":null,"abstract":"<div><h3>Objectives</h3><div>Anxiety sensitivity (AS)—the tendency to fear anxiety-related sensations—has been consistently associated with risky drinking, yet the motivational mechanisms underlying this link remain unclear. This study examined whether specific drinking motives (DMs) mediate the association between AS and hazardous drinking, and explored the moderating effects of age and gender.</div></div><div><h3>Study design</h3><div>A cross-sectional, survey-based design was used.</div></div><div><h3>Methods</h3><div>Data were collected through an anonymous online questionnaire completed by 372 adults (69 % women; mean age = 25.3 years), including the Alcohol Use Disorders Identification Test (AUDIT), the Anxiety Sensitivity Index-3 (ASI-3), and four single-item DMs assessing social, avoidance, pleasure, and need-related motives. Analyses were restricted to participants with AUDIT >0. Correlation and regression analyses examined associations among AS, age, gender, and alcohol use. Structural equation modelling (SEM) tested AS as a latent construct (ASI-3 subscales as indicators) and the four DMs as parallel mediators of the AS–AUDIT relationship.</div></div><div><h3>Results</h3><div>Higher AS was associated with greater alcohol use, even after controlling for age and gender. SEM confirmed that AS formed a coherent latent factor and that motives operated in parallel. AS was positively linked to avoidance motives; however, this pathway did not mediate the AS–alcohol link. Only the social motive uniquely predicted higher AUDIT scores, while younger age—but not gender—was consistently associated with greater consumption.</div></div><div><h3>Conclusions</h3><div>Hazardous drinking was mainly explained by social motives and younger age. AS contributed indirectly through its influence on drinking motives rather than a direct effect.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106104"},"PeriodicalIF":3.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791395","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 : 2025-12-18DOI: 10.1016/j.puhe.2025.106110
Stephanie A. Prince , Yina Shan , Gregory P. Butler , Justin J. Lang , Gavin R. McCormack , Rachel C. Colley
Objectives
To compare perceived and objective measures of the neighbourhood built environment among a representative sample of youth and adults in Canada.
Study design
Cross-sectional study.
Methods
Two cycles (N = 7948) of the Canadian Health Measures Survey (2016–19) were linked to objectively-measured built environment data. Objective measures included walkability, cycling paths, recreation facilities, trails, and major roadways. Perceived built environment features were used to derive a composite measure of walkability. Perceived and objective measures were compared using age group- (12–17, 18–64, 65–79 years) and sex-stratified chi-square tests, Pearson correlations, and independent t-tests.
Results
Although objective measures did not differ by age, youth and working-aged adults generally perceived more neighbourhood amenities than older adults. Adults were more likely than youth to report poorly maintained sidewalks and traffic as barriers to walking and cycling. No sex differences were observed. Across all age groups, the perceived presence of dense housing, shops, transit stops, sidewalks, cycling infrastructure, and low-cost recreation facilities increased with objectively-measured neighbourhood walkability. Perceived and objectively-measured walkability were moderately correlated; features such as transit, sidewalks, recreation facilities, and cycle paths were more common in neighbourhoods where residents reported perceiving them.
Conclusions
Age differences in perceived environmental supports and barriers highlight the need to address age-related disparities to improve walkability. Future research should consider the relationship between perceived and objective built environment features and their impact on physical activity.
{"title":"Comparing perceived and objective measures of neighbourhood built environments among youth and adults in Canada","authors":"Stephanie A. Prince , Yina Shan , Gregory P. Butler , Justin J. Lang , Gavin R. McCormack , Rachel C. Colley","doi":"10.1016/j.puhe.2025.106110","DOIUrl":"10.1016/j.puhe.2025.106110","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare perceived and objective measures of the neighbourhood built environment among a representative sample of youth and adults in Canada.</div></div><div><h3>Study design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>Two cycles (N = 7948) of the Canadian Health Measures Survey (2016–19) were linked to objectively-measured built environment data. Objective measures included walkability, cycling paths, recreation facilities, trails, and major roadways. Perceived built environment features were used to derive a composite measure of walkability. Perceived and objective measures were compared using age group- (12–17, 18–64, 65–79 years) and sex-stratified chi-square tests, Pearson correlations, and independent t-tests.</div></div><div><h3>Results</h3><div>Although objective measures did not differ by age, youth and working-aged adults generally perceived more neighbourhood amenities than older adults. Adults were more likely than youth to report poorly maintained sidewalks and traffic as barriers to walking and cycling. No sex differences were observed. Across all age groups, the perceived presence of dense housing, shops, transit stops, sidewalks, cycling infrastructure, and low-cost recreation facilities increased with objectively-measured neighbourhood walkability. Perceived and objectively-measured walkability were moderately correlated; features such as transit, sidewalks, recreation facilities, and cycle paths were more common in neighbourhoods where residents reported perceiving them.</div></div><div><h3>Conclusions</h3><div>Age differences in perceived environmental supports and barriers highlight the need to address age-related disparities to improve walkability. Future research should consider the relationship between perceived and objective built environment features and their impact on physical activity.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106110"},"PeriodicalIF":3.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792032","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106095
Ben Wijnen , Margreet Ten Have , Linda Bolier , Frederick Thielen , Marlous Tuithof , Annemarie I. Luik , Filip Smit , Laura Shields-Zeeman
Objectives
Understanding economic benefits associated with improved mental well-being in the general population is important for informing population-level strategies. We aimed to estimate the economic impact associated with changes in mental well-being in the Dutch adult population.
Study design
This study was based on a longitudinal cohort (the Netherlands Mental Health Survey and Incidence Study-2)
Methods
5303 adults aged 18–64 years. Were included. Three measurements, each separated by a time interval of three years, were used to evaluate how a change in well-being predicts a change in costs. Well-being was measured using the Mental Health Continuum-Short Form. Societal costs encompassed three cost categories: 1) healthcare costs; 2) productivity losses; and 3) patient and family costs. Main analysis was based on a model where a change in costs Y(t2-t1) was regressed on a synchronically occurring change in well-being X(t2-t1). Additionally, this model was compared with a diachronic model where a subsequent change in costs was regressed on a preceding change in well-being, i.e. Y(t3-t2) on X(t2-t1).
Results
Each %-point increase in mental well-being reduced societal costs by –€50.74 (95 %CI: €78.72; –€22.76) per person, which was statistically significant (SE = 14.27, t = −3.56, p < 0.001). The majority of these savings (89 %) were attributable to increased productivity. In the diachronic model, no significant difference between wellbeing and subsequent costs was found.
Conclusion
This study demonstrated that improvements in mental well-being are potentially associated with simultaneously occurring cost reductions, primarily through increased productivity. Hence, there may be potential for mental well-being interventions to reduce societal costs and enhance productivity at a population level.
{"title":"Economic benefits of mental well-being over time: Results from the Netherlands mental health survey and incidence study-2","authors":"Ben Wijnen , Margreet Ten Have , Linda Bolier , Frederick Thielen , Marlous Tuithof , Annemarie I. Luik , Filip Smit , Laura Shields-Zeeman","doi":"10.1016/j.puhe.2025.106095","DOIUrl":"10.1016/j.puhe.2025.106095","url":null,"abstract":"<div><h3>Objectives</h3><div>Understanding economic benefits associated with improved mental well-being in the general population is important for informing population-level strategies. We aimed to estimate the economic impact associated with changes in mental well-being in the Dutch adult population.</div></div><div><h3>Study design</h3><div>This study was based on a longitudinal cohort (the Netherlands Mental Health Survey and Incidence Study-2)</div></div><div><h3>Methods</h3><div>5303 adults aged 18–64 years. Were included. Three measurements, each separated by a time interval of three years, were used to evaluate how a change in well-being predicts a change in costs. Well-being was measured using the Mental Health Continuum-Short Form. Societal costs encompassed three cost categories: 1) healthcare costs; 2) productivity losses; and 3) patient and family costs. Main analysis was based on a model where a change in costs Y<sub>(t2-t1)</sub> was regressed on a synchronically occurring change in well-being X<sub>(t2-t1).</sub> Additionally, this model was compared with a diachronic model where a subsequent change in costs was regressed on a preceding change in well-being, i.e. Y<sub>(t3-t2)</sub> on X<sub>(t2-t1).</sub></div></div><div><h3>Results</h3><div>Each %-point increase in mental well-being reduced societal costs by –€50.74 (95 %CI: €78.72; –€22.76) per person, which was statistically significant (SE = 14.27, t = −3.56, p < 0.001). The majority of these savings (89 %) were attributable to increased productivity. In the diachronic model, no significant difference between wellbeing and subsequent costs was found.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that improvements in mental well-being are potentially associated with simultaneously occurring cost reductions, primarily through increased productivity. Hence, there may be potential for mental well-being interventions to reduce societal costs and enhance productivity at a population level.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106095"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783482","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106101
Chuan Li , Rong Song , Xin Yu , Yanhong Fang , Jiayuan Yang , Zhiyuan Tang , Shaoqi Wang , Xunrong Cheng , Jian Song , Weizhuo Yi , Rubing Pan , Hong Su
Objectives
This study aimed to investigate the association between low-level air pollution and adverse pregnancy outcomes, assess the potential mediating role of healthy lifestyle, and identify key modifiable behaviors.
Study design
Case-control study.
Methods
This study included a total of 231,331 female participants from the UK Biobank. A healthy lifestyle score was established based on non-smoking, moderate drinking, healthy diet, regular physical activity, and ideal BMI. Multivariable logistic regression model was used to explore the associations between low-level air pollution, healthy lifestyle and adverse pregnancy outcomes. The eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) were employed to elucidate the relative importance of these modifiable behaviors.
Results
Each 1 μg/m3 increase in PM2.5, PM10, NO2, and NOx was associated with an increased risk of low offspring birthweight. The odds ratios (95 % CI) were 1.046 (1.025–1.068) for PM2.5, 1.015 (1.004–1.027) for PM10, 1.007 (1.004–1.009) for NO2, 1.003 (1.002–1.005) for NOx. No significant associations were found between low-level air pollution and other adverse pregnancy outcomes. Participants with unfavorable lifestyle and higher low-level air pollution had the highest risk of low offspring birthweight. In the modeling study, a healthy diet, and ideal BMI were identified as main modifiable behaviors.
Conclusions
Low-level air pollution was still associated with reduced offspring birth weight. Adopting a healthy lifestyle, especially healthy diet, and ideal BMI, could help mitigate the risks of air pollution. These findings provide evidence to support integrated interventions that combine environmental regulation with lifestyle modification programs to reduce adverse pregnancy outcomes effectively.
{"title":"Healthy lifestyle mitigates the impact of low-level air pollution on adverse pregnancy outcomes: Evidence from a population-based study","authors":"Chuan Li , Rong Song , Xin Yu , Yanhong Fang , Jiayuan Yang , Zhiyuan Tang , Shaoqi Wang , Xunrong Cheng , Jian Song , Weizhuo Yi , Rubing Pan , Hong Su","doi":"10.1016/j.puhe.2025.106101","DOIUrl":"10.1016/j.puhe.2025.106101","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate the association between low-level air pollution and adverse pregnancy outcomes, assess the potential mediating role of healthy lifestyle, and identify key modifiable behaviors.</div></div><div><h3>Study design</h3><div>Case-control study.</div></div><div><h3>Methods</h3><div>This study included a total of 231,331 female participants from the UK Biobank. A healthy lifestyle score was established based on non-smoking, moderate drinking, healthy diet, regular physical activity, and ideal BMI. Multivariable logistic regression model was used to explore the associations between low-level air pollution, healthy lifestyle and adverse pregnancy outcomes. The eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) were employed to elucidate the relative importance of these modifiable behaviors.</div></div><div><h3>Results</h3><div>Each 1 μg/m<sup>3</sup> increase in PM<sub>2.5</sub>, PM<sub>10</sub>, NO<sub>2</sub>, and NO<sub>x</sub> was associated with an increased risk of low offspring birthweight. The odds ratios (95 % <em>CI</em>) were 1.046 (1.025–1.068) for PM<sub>2.5</sub>, 1.015 (1.004–1.027) for PM<sub>10</sub>, 1.007 (1.004–1.009) for NO<sub>2</sub>, 1.003 (1.002–1.005) for NO<sub>x</sub>. No significant associations were found between low-level air pollution and other adverse pregnancy outcomes. Participants with unfavorable lifestyle and higher low-level air pollution had the highest risk of low offspring birthweight. In the modeling study, a healthy diet, and ideal BMI were identified as main modifiable behaviors.</div></div><div><h3>Conclusions</h3><div>Low-level air pollution was still associated with reduced offspring birth weight. Adopting a healthy lifestyle, especially healthy diet, and ideal BMI, could help mitigate the risks of air pollution. These findings provide evidence to support integrated interventions that combine environmental regulation with lifestyle modification programs to reduce adverse pregnancy outcomes effectively.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106101"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783459","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106099
Aditi Roy , Gavin Pereira , Jennifer Dunne , Sylvester Dodzi Nyadanu , Gizachew A. Tessema
Objectives
In a country such as India where caste systems deeply influence social dynamics, caste systems could modify the association between experiencing intimate partner violence (IPV) and maternal and child health and wellbeing. This study aimed to investigate the association between IPV and child mortality across various caste groups.
Study design
The study has a cross-sectional design drawn from the two latest available nationally representative National Family Health Surveys data (2015–2021) in India.
Methods
This study included 58,685 mother-child pairs. In the study, the main exposure variable was IPV, measured by women's experiences of emotional, physical, and sexual violence perpetrated by a partner, with caste considered as an effect modifier in the analysis. The outcomes of the study included under five mortality. By accounting for women's and child demographics, logistic regression analysis was used to estimate adjusted odds ratios (aOR) for the association between IPV and infant, neonatal, and under-five mortality stratified by caste.
Results
Women who had experienced IPV had 16 % greater odds of neonatal mortality (1.16, 95 % CI: 1.10–1.23), 17 % greater odds of infant mortality (1.17, 95 % CI: 1.03, 1.33), and 12 % greater odds of under-five mortality (1.12; 95 % CI: 0.98, 1.18). When stratified by caste, IPV exposure among women from upper castes had a 68 % greater in the odds of neonatal mortality (aOR: 1.68, 95 % CI: 1.22, 2.29), 24 % greater odds of infant mortality (1.24, 95 % CI: 1.02, 1.80), and 40 % greater odds of under-five mortality (aOR: 1.40, 95 % CI: 1.09, 1.81). Notably, among lower-caste groups, we observed greater odds of under-five mortality among women who experienced IPV in STs group compared to SCs and OBCs.
Conclusion
IPV is associated positively with neonatal, infant, and under-five mortalities with greater effect in upper than lower caste women. Our findings suggest that addressing IPV in caste-specific situations may be crucial for reducing under-five mortality in India.
{"title":"Maternal intimate partner violence and under five mortality in India: The effect modifying role of caste","authors":"Aditi Roy , Gavin Pereira , Jennifer Dunne , Sylvester Dodzi Nyadanu , Gizachew A. Tessema","doi":"10.1016/j.puhe.2025.106099","DOIUrl":"10.1016/j.puhe.2025.106099","url":null,"abstract":"<div><h3>Objectives</h3><div>In a country such as India where caste systems deeply influence social dynamics, caste systems could modify the association between experiencing intimate partner violence (IPV) and maternal and child health and wellbeing. This study aimed to investigate the association between IPV and child mortality across various caste groups.</div></div><div><h3>Study design</h3><div>The study has a cross-sectional design drawn from the two latest available nationally representative National Family Health Surveys data (2015–2021) in India.</div></div><div><h3>Methods</h3><div>This study included 58,685 mother-child pairs. In the study, the main exposure variable was IPV, measured by women's experiences of emotional, physical, and sexual violence perpetrated by a partner, with caste considered as an effect modifier in the analysis. The outcomes of the study included under five mortality. By accounting for women's and child demographics, logistic regression analysis was used to estimate adjusted odds ratios (aOR) for the association between IPV and infant, neonatal, and under-five mortality stratified by caste.</div></div><div><h3>Results</h3><div>Women who had experienced IPV had 16 % greater odds of neonatal mortality (1.16, 95 % CI: 1.10–1.23), 17 % greater odds of infant mortality (1.17, 95 % CI: 1.03, 1.33), and 12 % greater odds of under-five mortality (1.12; 95 % CI: 0.98, 1.18). When stratified by caste, IPV exposure among women from upper castes had a 68 % greater in the odds of neonatal mortality (aOR: 1.68, 95 % CI: 1.22, 2.29), 24 % greater odds of infant mortality (1.24, 95 % CI: 1.02, 1.80), and 40 % greater odds of under-five mortality (aOR: 1.40, 95 % CI: 1.09, 1.81). Notably, among lower-caste groups, we observed greater odds of under-five mortality among women who experienced IPV in STs group compared to SCs and OBCs.</div></div><div><h3>Conclusion</h3><div>IPV is associated positively with neonatal, infant, and under-five mortalities with greater effect in upper than lower caste women. Our findings suggest that addressing IPV in caste-specific situations may be crucial for reducing under-five mortality in India.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106099"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783529","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 : 2025-12-17DOI: 10.1016/j.puhe.2025.106094
Jasper W.A. van Egeraat , Julie A.E. van Oortmerssen , Jeanine E. Roeters van Lennep , Maryam Kavousi , Robert T.A. Willemsen , Tobias N. Bonten , Annelieke H.J. Petrus , the IMPRESS consortium
Objectives
Acute coronary syndrome (ACS) incidence and mortality rates have risen among women <60 years. This study sought to examine sex differences in healthcare pathways for first-time ACS in young patients, focusing on pre-ACS care, diagnosis and in-hospital management, and post-discharge outcomes.
Study design
Observational cohort study.
Methods
This study uses linked data from primary care, hospital records and national mortality datasets to assess ACS care pathways among Dutch patients aged 30–60 years between 2013 and 2022. Continuous variables were compared with Wilcoxon rank-sum tests and categorical variables with Chi-square tests. Multiple testing is addressed by controlling the false discovery rate.
Results
Women more often had at least one comorbidity (57.6 % vs 51.3 %, p = 0.024) and more primary care consultations in the month preceding ACS (1.37 vs 1.00, p < 0.001). Men were more frequently diagnosed with ST-elevation myocardial infarction (STEMI), while women were more often diagnosed with non–ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), p < 0.001. In-hospital interventions were similar between sexes for STEMI but were different and less frequently performed in women with NSTEMI (p = 0.001) or UA (p = 0.005) compared with men. Post-discharge, women were less likely to receive antithrombotic (87.7 % vs 91.5 %, p = 0.024) and lipid-lowering therapies (82.6 % vs 88.5 %, p = 0.002). Mortality rates before hospitalization, at 30 days, and at 1 year were comparable between sexes.
Conclusions
Sex differences exist in healthcare pathways for individuals aged 30–60 years with first-time ACS regarding prevalence of comorbidities, ACS subtype, in-hospital interventions, and post-discharge medication use. However, 30-day and 1-year survival rates after discharge were comparable between women and men.
{"title":"Sex differences in care for acute coronary syndrome in patients under 60 years: Primary care presentation, referral patterns, hospitalizations and clinical outcomes","authors":"Jasper W.A. van Egeraat , Julie A.E. van Oortmerssen , Jeanine E. Roeters van Lennep , Maryam Kavousi , Robert T.A. Willemsen , Tobias N. Bonten , Annelieke H.J. Petrus , the IMPRESS consortium","doi":"10.1016/j.puhe.2025.106094","DOIUrl":"10.1016/j.puhe.2025.106094","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute coronary syndrome (ACS) incidence and mortality rates have risen among women <60 years. This study sought to examine sex differences in healthcare pathways for first-time ACS in young patients, focusing on pre-ACS care, diagnosis and in-hospital management, and post-discharge outcomes.</div></div><div><h3>Study design</h3><div>Observational cohort study.</div></div><div><h3>Methods</h3><div>This study uses linked data from primary care, hospital records and national mortality datasets to assess ACS care pathways among Dutch patients aged 30–60 years between 2013 and 2022. Continuous variables were compared with Wilcoxon rank-sum tests and categorical variables with Chi-square tests. Multiple testing is addressed by controlling the false discovery rate.</div></div><div><h3>Results</h3><div>Women more often had at least one comorbidity (57.6 % vs 51.3 %, p = 0.024) and more primary care consultations in the month preceding ACS (1.37 vs 1.00, p < 0.001). Men were more frequently diagnosed with ST-elevation myocardial infarction (STEMI), while women were more often diagnosed with non–ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), p < 0.001. In-hospital interventions were similar between sexes for STEMI but were different and less frequently performed in women with NSTEMI (p = 0.001) or UA (p = 0.005) compared with men. Post-discharge, women were less likely to receive antithrombotic (87.7 % vs 91.5 %, p = 0.024) and lipid-lowering therapies (82.6 % vs 88.5 %, p = 0.002). Mortality rates before hospitalization, at 30 days, and at 1 year were comparable between sexes.</div></div><div><h3>Conclusions</h3><div>Sex differences exist in healthcare pathways for individuals aged 30–60 years with first-time ACS regarding prevalence of comorbidities, ACS subtype, in-hospital interventions, and post-discharge medication use. However, 30-day and 1-year survival rates after discharge were comparable between women and men.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106094"},"PeriodicalIF":3.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783544","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 : 2025-12-16DOI: 10.1016/j.puhe.2025.106098
Andreas Lindegaard Jakobsen
Objectives
This study aimed to examine the association between living alone and adult loneliness, and the buffering role of neighbourhood social interaction and attachment on this association.
Study design
Cross-sectional study.
Methods
Survey data encompassing 15,044 adults aged 35 and older from the North Denmark Region Health Survey 2017 were linked to Danish population register data. Loneliness was assessed using the Three-Item Loneliness Scale (T-ILS). Neighbourhood social interaction, attachment and living arrangements were measured through survey-based indicators. Register data provided information on sociodemographic covariates including sex, age, own/parental country of birth, education, income, and employment status. Multilevel linear probability models, with individuals nested within small area neighbourhoods, were used to test the hypotheses.
Results
After adjusting for covariates, living alone was significantly associated with an 8.72 percentage point higher probability of loneliness. Individuals reporting frequent neighbourhood social interactions or high levels of neighbourhood attachment had an 8.18 and 5.06 percentage point lower probability of loneliness, respectively. Moderation analyses indicated that both neighbourhood social interaction and attachment significantly buffered the negative impact of living alone, as living alone was less strongly associated with loneliness among individuals who reported high levels of neighbourhood social interaction and attachment.
Conclusions
These findings suggest that neighbourhood social interaction and attachment may buffer the negative impact of living alone on loneliness. Strengthening neighbourhood attachment and fostering local social interactions could be valuable public health strategies to mitigate loneliness among individuals living alone.
{"title":"Living alone and adult loneliness: The buffering role of neighbourhood social interaction and attachment","authors":"Andreas Lindegaard Jakobsen","doi":"10.1016/j.puhe.2025.106098","DOIUrl":"10.1016/j.puhe.2025.106098","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the association between living alone and adult loneliness, and the buffering role of neighbourhood social interaction and attachment on this association.</div></div><div><h3>Study design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>Survey data encompassing 15,044 adults aged 35 and older from the North Denmark Region Health Survey 2017 were linked to Danish population register data. Loneliness was assessed using the Three-Item Loneliness Scale (T-ILS). Neighbourhood social interaction, attachment and living arrangements were measured through survey-based indicators. Register data provided information on sociodemographic covariates including sex, age, own/parental country of birth, education, income, and employment status. Multilevel linear probability models, with individuals nested within small area neighbourhoods, were used to test the hypotheses.</div></div><div><h3>Results</h3><div>After adjusting for covariates, living alone was significantly associated with an 8.72 percentage point higher probability of loneliness. Individuals reporting frequent neighbourhood social interactions or high levels of neighbourhood attachment had an 8.18 and 5.06 percentage point lower probability of loneliness, respectively. Moderation analyses indicated that both neighbourhood social interaction and attachment significantly buffered the negative impact of living alone, as living alone was less strongly associated with loneliness among individuals who reported high levels of neighbourhood social interaction and attachment.</div></div><div><h3>Conclusions</h3><div>These findings suggest that neighbourhood social interaction and attachment may buffer the negative impact of living alone on loneliness. Strengthening neighbourhood attachment and fostering local social interactions could be valuable public health strategies to mitigate loneliness among individuals living alone.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106098"},"PeriodicalIF":3.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776181","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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